HomeMy WebLinkAbout39091-Z Town of Southold Annex 12/3/2014
P.O.Box 1179
54375 Main Road
lb 4W Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 37303 Date: 12/3/2014
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 53245 Route 25, Southold,
SCTM#: 473889 Sec/Block/Lot: 61.-1-8.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/5/2014 pursuant to which Building Permit No. 39091 dated 8/7/2014
was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
PORCH REPAIR TO AN EXISTING ONE-FAMILY DWELLING AS APPLIED FOR
The certificate is issued to 53245 Main Road Corp
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Auto ed S gnatur
oe :.- TOWN OF SOUTHOLD
ONO
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
'a SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 39091 Date: 8/7/2014
Permission is hereby granted to:
53245 Main Road Corp
22 Wright Rd
Rockville Centre, NY 11570
To: Proch repair. Has Administrative permit from LPC.
At premises located at:
53245 Route 25, Southold
SCTM # 473889
Sec/Block/Lot# 61.-1-8.1
Pursuant to application dated 8/5/2014 and approved by the Building Inspector.
To expire on 2/6/2016.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00
CO -ALTERATION TO DWELLING $50.00
tal: $250.00
Building Inspector
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I%lead.
5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date. �" l
New Construction: Old or Pre-existing Building: (check one) ff
Location of Property: 3v245zor,(d �P
House No. Street Hamlet
Owner or Owners of Property: 014ed Ortiv,UI
Suffolk County Tax Map No 1000, Section Block Lot Vt
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:_
Request for: Temporary Certificate Final Certificate: t, (check one)
Fee Submitted: $
Applicant Sign ure
3�o
rAFS OUlyolo
�l
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION IST [ IR H PLUMBING
[ ] FOUNDATION 2ND [ ] SOLATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
+,
DATE `j INSPECTOR
OF SOUT,y��
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROU PLUMBING
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ]
FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE A CHIMNEY [ ) FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ) CODE VIOLATION [ ] CAULKING
REMARKS:
do LILL,,
DATE �Z INSPECTOR
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PLUMBING
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MULATION PEP,N.Y.
STATE RNERGY
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. -��(�� Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 Single&Separate
Storm-Water Assessment Form
Contact: '-9%1 (( eby.tO r"I
Approved ,20 Mail to:
Disapproved a/c
Phone: t31 375- q d 3 r
Expiration ,20
1; Building Inspector
Aub APPLICATION FOR BUILDING PERMIT
Date O , 20
�----F INSTRUCTIONS
nlu
is application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an
addition six months. Thereafter,a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County,New York,and other applicable Laws,Ordinances or
Regulations, for the construction of buildings, additions,or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections. Q am
(Signature of applicant cklAme,if a corporation)
�Aae diva _ fL 1 d A 1 IS7/
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Colt L,-tt-c �
Name of owner of premises C I f,mpra �d Ct)r�,kta
(As on the iax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. 1356
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
51-3 3 4 5'- MA I'►I 20441
House Number Street Hamlet
County Tax Map No. 1000 Section �p� Block Lot o '
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of pro osed construction:
a. Existing use and occupancy C f oSed I n �✓vn 1L j�a r�2` f o' o r C�a�r h*&,
b. Intended use and occupancy —LLt, d /7C e� t;- Cl ese d �,� � � l��!C� �-!�� /h Oy' /eta
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal. Demolition Other Work
(Description)
4. Estimated Cost Fee
Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: FrontIS ID Rear — Depth
Height a-' Number of Stories 1
Dimensions of same structure with alterations or additions: Front 5990 if Re �
Depth � �D l` Height J,� Number of Stories 1
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth /
10. Date of Purchase :P0/! Name of Former Owner /Y/,*;1^ (Orl? V n—,
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO�
13. Will lot be re-graded? YES NOA-Will excess fill be removed from premises? YES NOA""
14.Names of Owner of premises CJ%Mrd COY-Ad/ Address Phone No.
Name of Architect Address Phone No
Name of Contractor(�'#[��CrwM def Address 13 ax rZo X Phone No. 63/ 375'-N63S'
scx�f'�i,o lc(
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO—X
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,Agent, Corporate Officer,etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
SW o before meth's
day of 20JOk-A 1. WA
,
Notary Public CONNIE D.BUNCH Sig ture of A licant
Notary Public,State of New York
No.01 BU6185050
Qualified in Suffolk County
Commission Expires April 14,2 Q Ko
Scott A. Russell
SUPERVISOR M[Ak'N A\(G►)EMLENT
a
SOUrHOLDTOWN HALL-P.O.Box 1179 'own of Southold
53095 Main Road-SOUTHOLD,NEW YORK 11971 '�
CHAPTER 236 - STORMWATER MANAGEMENT-WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
--- - --- ----------
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
(CHECK ALL THAT APPLY)
Yes No
❑(" A. Clearing, grubbing, grading or.tripping of land which affects more
• i
than 5,000 square feet of ground surface. ;
#] ] B. Excavation or filling involving more than 200 cubic yards-of material
within any parcel or any contiguous area.
t
E]o C. Site preparation on slopes which exceed 10 feet vertical rise to
100
feet of horizontal distance.
t D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
t El E. Site preparation within the -one-hundred-year floodplain as depicted
' on FIRM Map of any watercourse.
! Eli F. Installation of new -or resurfaced impervious surfaces of 1,000 square
( feet or more, unless prior approval of a Stormwater Management ,
I
Control Plan was received by the Town and the proposal includes j
in-kind replacement of impervious surfaces.
If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building Department with your Building Permit Application.
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. ": 1000 Date
Pe Y ( 8 District � ^
NAME
Section Block Lot
"" FOR BUILDING DEPARTMENT USE ONL`i"
Contact Information:
Reviewed By:
Date-
Property
ateProperty Address / Location of Construction Work: — — — — — — — — — — — — — — — — —
�/ Approved for processing Building Permit.
S3a��pu(h &a/ to Tk )144 — — Stormwater Management Control Plan Not Required.
Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
FORM SMCP- TOS MAY 2014
,ITOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET J L L1,5 VILLAGEDIST. SUB. LOT
Amywot!4 &
FORMER OWNER N E ACR.
t2s,�?
/6` e I o.-,r,c?Pd /#ce s
W TYPE OF BUILDING
RES. g/0 SEAS. VL FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
pU 17Z3 ° A � a 5r� n
Y1 117,F
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! ave L'5,vb 7c7oo 5 Z 3 F." 3 P /f«41 e/N(51,4. ob / Arc 6070 u �.� lb4
AGE BUILDING CONDITION g g �L2.88 r � a4q 0 1Q1e, qn fCm
NEW NORMAL BELOW ABOVE e-rcl"L {bran i rm r-Ot 001 -- 3107 2C4 cos
FARM Acre Value Per Value
Acre
Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland FRONTAGE ON WATER
Brushland FRONTAGE ON ROAD
House Plot DEPTH r
BULKHEAD
Total DOCK
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NOTIFY BUiLDING RMl E NT A
765-1802 8 Al"ji -10 4 PI'" FOR THE
FOLLOWING INSPECTION":
J J& 1. FOUNDATION - TWO REQUIRED
and T2cvc jt
FOR POURED CONCRETE
-s+1r)5 ?k 2. ROUGH - FRAMING & PLUMBING
r. Iz 3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
,vo)5 'i
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
910 YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
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OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
rF OCCUPANCY
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