HomeMy WebLinkAbout39902-Z �,O��FF4pG a Town of Southold
8/11/2015
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%� ,, P.O.Box 1179
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\ -0O Southold,New York 11971
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CERTIFICATE OF OCCUPANCY
No: 37707 Date: 8/11/2015
THIS CERTIFIES that the building DECK
Location of Property: 700 Youngs Ave, Mattituck
SCTM#: 473889 Sec/Block/Lot: 141.-149
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
6/19/2015 pursuant to which Building Permit No. 39902 dated 6/25/2015
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:
"AS BUILT"DECK ADDITION TO AN EXITING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Baruth,Kathleen
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Au e Signa re
,• � TOWN OF SOUTHOLD
OFOUr
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o O BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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#: 39902 Date: 6/25/2015
Permission is hereby granted to:
Baruth, Kathleen
PO BOX 7
Amargasa Valley, NV 89020
To: "As built"deck addition to existing single family dwelling as appied for. Additional
certification will be required.
At premises located at:
700 Youngs Ave, Mattituck
SCTM # 473889
Sec/Block/Lot# 141.-1-19
Pursuant to application dated 6/19/2015 and approved by the Building Inspector.
To expire on 12/24/2016.
Fees:
AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $659.20
CO -ADDITION TO DWELLING $50.00
Total: $709.20
B •'•- nspector
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 1%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. /7 /
New Construction: Old or Pre-existing Building: t� (check one)
Location of Property: -70C) Yum -S ,g//n Jt? Oa tl floc�
House No. Street Hamlet
Owner or Owners of Property: 0,,'h iced f wlh
Suffolk County Tax Map No 1000, Section /1-¢id 00 Block 0/, 0 0 Lot /q1 ao C)
Subdivision Filed Map. Lot:
Permit No. 3 07-- Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
611-4-2
Fee Submitted: $ 5-U
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Applicant S'gnature
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
, , FOUNDATION 1ST [ ] ROUG UMBING
[ ] FOUNDATION 2ND [ ] IJJS1ILATION
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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DATE aw INSPECTOR
FIELD INSPECTREPORT EPO1 DATE , i•• CON.Iyr,NTS
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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 yet a- (titer of 4 sets of Building Plans
TEL: (631) 765-1802 C-er+.I Pi CA,-i 06'1 -frorn Planning pp Board approval
FAX: (631) 765-9502 e��i �� Or ��� .--Survey
SoutholdTown.NorthFork.net PERMIT NO. 3fgO.2 Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined (0 23 ,20 ELS Single&Separate
Storm-Water Assessment Form
L.5�' Contact: �/
Approved ,20 IJ Mail to: 700 y� ok) . five.
Disapproved a/c �`'1 ,{-Lu; .r � P 1 p f J 0
Phone: 6.1_ 605 -c L o q 5
Expiration f 2124 ,20 l (()
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9 i Buil. _ pector
�Th� "PLICATION FOR BUILDING PERMIT
; AN 1
DateJ(,(AJ I ( , 20“.;
DG UEl I - INSTRUCTIONS
'r.
a. Ti-ri-s-apphca ion v-UST 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.,
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(Signature of applicant or name,if a corporation)
100 ?A/4y �E� /�''S h " ` • fi9S- -
ailin address of a licaht
Mailing pp )�
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
OW f€ r-
Name of owner of premises ILA !ems 11
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be do e:
70 ®, rov S' A7P/dc /o rr'
House Number 'Street ' Hamlet
County Tax Map No. 1000 Section /Lilo 0 0 •• -Block 6/..,Q 6 Lot 0 f O 0
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy<proposed construction:
a. Existing use and occupancy rc I}i / b�6. arty (S%yk).
d
y
b. Intended use and occupancy ,S-e2 i )e 'L u l
3. Nature of work(check which applicable):New Building Adclitio A
( Alteration
Repair Removal Demolition Ot r
(Description)
4. Estimated Cost 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.
r
7. Dimensions of existing structures, if any: Front Rear cqc9 C 0 � Depth - 4 6 Pp II/ ‘f
Height 071-0" Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
Dimensions of entire new construction: Front Rear Depth
,. 1
:
Height Number of Stories ',: ''•''�� �' ' ��
/ ®r
9. Size of lot: Front /�c0 r Rear /76 a 0 Depth /O ( 0 k
10. Date of Purchase Name of Former Owner
''
11. Zone or use district in which premises are situated '70
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X
13. Will lot be re-graded? YES NO /`"Will excess fill be removed from premises? YES NOX.
14 Names of Owner of premises )01k6APVIACA Address NO ,l (6/Yetglidc. Phone No.(9.3)-4 0.3 czae C3-fr
Name of Architect Address Phone No
Name of Contractor Address Phone No.
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 QUIRED.
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
* IF YES, PROVIDE A COPY.
7 STATE OF NEW YORK)
SS:
COUNTY OF )
061,v1 cif, /( being duly sworn, deposes and says that(s)he is the applicant
(Name of individual�igning cof tLract)above named,
(S)He is the , .
(Contr.rtor,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.
Sworn to before me t is t�
I
5L`E f day of 1"" 20 co
`---- 1 rv----, €5L'fr\4 \ / 1 /i'
Notary Public No.0191.16185050 Sig'nat Applic f nt
Own ,,;in County !
Com�tiaslon Expires April 14,2S-2_1
Scott A. Russell N(0)RM\WATJER
SUPERVISOR = MA.NAGJEM]EN T
SOUTHOLD TOWN HALL-P.O.Box 1179 • ate! r • T
53095 Main Road-SOUTHOLD,NEW YORK 11971 �:i 0���•, 1 own of Southold
I 14
4 MAO
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
1OES THIS PROJECT INVOLVE ANY OF THE IEOALOWIING:
Yes No (CHECK ALL THAT APPLY)
❑p A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
❑
pi B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑ ] C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑El D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
❑[2] E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
❑I J F. Installation of new or resurfaced impervious surfaces of 1,000 square
feet or more, unless prior approval of a Stormwater Management
Control Plan was received by the Town and the proposal includes
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:
#:
District
NAME. a- - h1ek.) ft TA t fh , 141®0 61'06 oiq 000 //e is-
Section Block Lot
l//gtii&'-(ikPuirrL
/:2e0/e1,60
FOR BUIL DING DEPARTMENT USE ONLY '
Contact Information: OQ 3/-6 b 3 " c:20 /J
Reviewed By yv4 A
Date: (O
Property Address / Location of Construction Work:
V Approved for processing Budding Permit
70 0 'J/J c�S /t/:,/1 (VJ I Stormwater Management Control Plan Not Required.
ill,}l i��.'�✓ ' IJ' ® Stormwater Management Control Plan is Required.(Forward to Engineering Department for Review.)
FORM " SMCP- TOS MAY 2014
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UNAUTHORIZED AL TERA TION OR ADDITION TO THIS DRAW/NG AND RELATED DOCUMENTS ISA VIOLATION OF SEC. 720.9 OF THE N.Y5.EDUCATION LAW
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DATE: . . 15 ti.P.# AS REQUIRED AND CONDITIONS OF
FEE: .: BY: _ 'POt�PatOi3 ( ��i-/ii CCl "11,1
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NOTIFY BUILDING DEPARTMENT AT . -CC L: I rt d > m
765-1802 8 AM TO 4PM FOR THE C ' ;.v;, °.,..:;., ..• , ,., Q ;
FOLLOWING INSPECTIONS: } —
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4. FINAL - CONSTRUCTION MUST 707::::ictI.Y.S.
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ALL CONSTRUCTION SHALL MEET THE
- REQUIREMENTS OF THE CODES OF NEW LAWFULYORI{ STATE. NO7 RESPONSIBLE FORERTIFICDESIGN OR CONSTRUCTION ERRORS. ATE li
OF OCCUPANCY _
RETAIN STORM WATER RUNOFF ' W
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The contractor is responsible for ensuring that all completed work and construction meets or SCALE: 4" = I '-0" /6
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6.16.15
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UNAUTHORIZED ALTERATION OR ADDITION TO THIS DRAWND AND RELATED DOCUMENTS IS A VIOLA DON OF SEC. 7209 OF THE N-Y-S. EDUCADON LAW
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UNAUTHORIZED AL TERA T/ON OR ADDITION TO THIS DRAWING AND RELATED DOCUMENTS/S A VIOLATION OF SEC. 7209 OF THEN.Y.S.EDUCATION LAW
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