HomeMy WebLinkAbout40959-Z F�1�CoG� Town of Southold 9/27/2016
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P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38539 Date: 9/27/2016
THIS CERTIFIES that the building ACCESSORY
Location of Property: 255 Founders Path, Southold
SCTM#: 473889 Sec/Block/Lot: 64.-2-32
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/24/2016 pursuant to which Building Permit No. 40959 dated 9/2/2016
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:
outdoor shower stall as applied for.
The certificate is issued to Hirsch,Huck&Brodsky,James
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
o ed Signature
' TOWN OF SOUTHOLD
� BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
o . SOUTHOLD, NY
9 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#: 40959 Date: 9/2/2016
Permission is hereby granted to:
Hirsch, Huck & Brodsky, James
255 Founders Path
Southold, NY 11971
To: construct outdoor shower as applied for.
At premises located at:
255 Founders Path, Southold
SCTM # 473889
Sec/Block/Lot# 64.-2-32
Pursuant to application dated 8/25/2016 and approved by the Building Inspector.
To expire on 3/4/2018.
Fees:
ACCESSORY $100.00
CO -ACCESSORY BUILDING $50.00
Total: $150.00
Bui ing Insp 6r
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. ' `21.
New Construction: %/ Old or Pre-existing Building: (check one)
Location of Property: -2-!;!5 F�-oiUflCkS PAIN 1 L,6 MY (0-71
House No. Street Hamlet
Owner or Owners of Property: "o-e L tp—sc(tdf PL 8
rr
Suffolk County Tax Map No 1000, Section tp� Block Lot
Subdivision Filed Map. Lot:
o/
Permit No. 5 Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: y (check one)
Fee Submitted: $
VV
Applicant Signature
ol 5 BOE so
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cOUNTI,�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ rSAU (LATION
FRAMING / STRAPPING [ NLOrI/.J, ��
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
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DATE INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(IST) s®
----------------------------
FOUNDATION (2ND)
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PLUMBING y
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INSULATION PER N.Y.
STATE'ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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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. ,20J Single&Separate
Storm-Water Assessment Form
Contact:
Approved 120& Mail to:
Disapproved a/c
Phone: �i+3 15?6. 53 L�
Expiration ,20 f
B.
m Inspector
g P
AUG 2 4 XWPN FOR BUILDING PERMIT
BUILDDODE". Date , 20
TOWN OF SOUTHOLD INSTRUCTIONS
a. This 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. - '
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises 1U-Ck, &kP-Se4 Z cJ tJu #bA,agg K7/
(As on the tax roll or latest deed)
If applicant is a corporation, signature,of duly authorized officer
(Name aildatitle4of 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
�bb�e done:
Z55 �cv'0�$ �PAZ4 9-N„r - g 3 N7
House Number - Street - ' / Hamlet
County Tax Map No. 1000 Section �`'[" Block � Lot ��
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(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.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Frontf,' I Rear
Depth Height NunabeT f Stories
8. Dimensions of entire new construction: Front Rear bepth;
Height Number of Stories
9. Size of lot: Front Rear Depth
__ nit• 6."264x} r d 4:'.. ..
10. Date of Purchase Name of Former Owner
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 NO Will excess fill be removed from premises? YES NO
14. Names of Owner of premises Address Phone No.
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 J
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE Ij�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.
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, CONNIE D.BUNCH
Notary Public,State of New York
(S)He is the No.01BU618W50
(Contractor,Agent, Corporate Officer, etc.) ua in Suffolk County
Commission Expires April 14,2 �
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.
S- 1
w�, I
Sworn to�before me t is
�_dayo � 20_/_�
Vw-P L�&A�\,
Notary Public Signature of Applicant
Scott A. Russell
�`� �' ��J(A\-NA\(G�EI��JL�E1�`7C'
SUPERVISOR P v, t� i
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 y���' Town of Southold
CHAPTER 236 - STORMVVATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
(DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
(CHECK ALL THAT APPLY)
Yes No
❑[U"'A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface_
❑[:dB. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
Fj FA C_ Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
❑d E. Site preparation within the one-hundred-year floodplain as depicted
- _L----- = -=en==Eap-=of-any-=watorc-Qur-sE: - --- ------_— _-- -: _
[][ 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.
S_C.T_M. ": 1000 Date
APPLICANT: (Property owner.Design Professional.Agent,Contractor,Other) Dritrict
NAME- V 1�_ `�� Section Block Lot
FDI R BUILDIN, f� DEPART-N-11 NT USE ON ,
Contact Inforrnation, ►t CB �J�I�`.�N
T ��.�.rx.• Reviewed By:
Date:
Property Address / Location of Construction Work: — —
Approved for proce en Building Permit.
Fo — — —
Stormwater Management Control Plan Not Required
_ —
Jt"l`ir\iU Stormwater Managemeni Control Pla.i is Required.
L� (Forward to Engineering Department for Review)
FORM " SMCP -TOS MAY 2014
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PURSUANT TO CHAPTER 236
OCCUPANCY OR OF THE TOWN CODE.
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
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A 4-5-2014 OUTLINE SURVEY
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1 pLF REV. DATE C�ESCRthTtON
SURVEYED BY: SUFFOLK COUNTY TAX MAP LOT #52 & THE SOUTHERLY 1 /2 OF LOT X51
FRANCIS � X. KARL L.S. DISTRICT—1 000 ON THE MAP OF
27 ART--IUR AVENUE SECTION 064.00 "FOUNDERS ESTATES"
BLUE` FONT, N.Y. BLOCK 02.00
11715 LOT 032.000 FILE #834 — FILED MAY 10, 1927
')UARANTEED TO: JAMES M. BRODSKY & HUCK HIRSCH (631) 3E3-=2691 PI-{ONE A SITUATED IN THE VILLAGE OF
8c TO: FIDELITY NATIONAL TITLE INS. SERVICES, LLC (631) 3E.5-2892 FAX 255 FOUNDERS PATH.dwg SOUTH®L®,
SCA ^E , "� 20' 255 FOUNDERS PATH.txt TOWN OF SOUTHOLD,
SUFFOLK COUNTY, N Y.