HomeMy WebLinkAbout41067-Z Town of Southold 10/11/2016
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P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38570 Date: 10/11/2016
THIS CERTIFIES that the building AS BUILT DECK
Location of Property: 3105 Sigsbee Rd, Laurel
SCTM#: 473889 Sec/Block/Lot: 126.-6-6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/30/2016 pursuant to which Building Permit No. 41067 dated 9/30/2016
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:
"as built"entry deck and shower stall addition to an existing one family dwelling as applied for.
The certificate is issued to O'connell,Patricia&Treder,Elinor
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
orized Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
a TOWN CLERK'S OFFICE
a . SOUTHOLD, NY
� 4 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#: 41067 Date: 9/30/2016
Permission is hereby granted to:
O'connell, Patricia & Treder, Elinor
PO BOX 982
Mattituck, NY 11952
To:
as built" entry deck and shower stall addition to an existing one family dwelling as
applied for.
At premises located at:
3105 Sigsbee Rd, Laurel
SCTM # 473889
Sec/Block/Lot# 126.-6-6
Pursuant to application dated 9/30/2016 and approved by the Building Inspector.
To expire on 4/12/2018.
Fees:
CO -ADDITION TO DWELLING $50.00
Flood Permit $100.00
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $260.00
Total: $410.00
ilding spector
" Dc-o iTT Te F De--/c
ALJ NO(-
Form No.G
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 Iocation 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).
J. 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$15.00
Date.
New Construction: Old or Pre-existing Building: 1z (check one)
Location of Property: /DP5 A-1—F) -TV 012
House No. Street Hamlet
Owner or Owners of Property: Irl G( 79 ' N N L.
Suffolk County Tax Map No 1000, Section i' Block (p Lot w
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$
F
Applicant Signature
Condon Endo esrs ng9 Poco
New York State Licensed Professional Engineers
1755 Sigsbee Road 631-298-1986
Mattituck, New York 11952 Fax 631-298-2651
condonengineering.com
September 27, 2016
Mr. Mike Verity
Chief Building Inspector
Southold Town Building Department
53095 Route 25
P.O. Box 1179
Southold, New York 11971
Re: 3105 Sigsbee Road—Mattituck
Dear Mr. Verity:
I inspected the entry stair and landing at the northern entrance to the building and found the steps
and landing to be structurally sound and to be constructed in accordance with the Residential
Code of New York State.
If you have any questions, please call me at 631-298-1986.
Yours truly,
��' 052684 = �
r
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT �.i�Do,yoii have or'need the:followirig,=before applying?
TOWN HALL •BoardaofHealth•'•
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 ;Planning'B'oar'd•approval
FAX: (631) 765-9502 Survey
SoutholdTowmNorthFork.net PERMIT NO. z.. ,1�.. - _ 'Check -' - • '
Septic Form
N.Y.S.D.E.C.
Trustees
- Flood Permit
Examined ,20 ' r Storm-Water Assessment Form
. : r �� , ,,.e:- '° , ,, ; • ' . Corifact: �•s��. �r;: � _ ' . . •� ° ,
,.3
Approved ,20 -- _ .. .. Mail �l
Disapproved a/c r,
Phone: j Q - 14 r J
Expiration !`20
x413uildin _ector,,:
SEP 3 0 2016 APPLICATION FOR BUILDING PERMIT-
. .. .- .Date ���T-:30 201-(10—
BIDING DEPT. INSTRUCTIONS
TOWN OF SOUTHOLD a r' ._ :; ; ' '
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 comrtiericed-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 ins pectio`n'throughoiit'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,zoningrtamendments-or other;r'egulatiohs'affecting the
property have been enacted in-,the:interim,the Building Inspector may authorize,_in writing,jlie extension of the permit•for an
addition six months. Thereafter,,a new permit shall be required: , . - _ _
APPLICATION IS HEREBY MAff 16&h Auiiding 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 cod','housing.code,-and;regula-ti ons, and to,admit.
authorized inspectors on premises and in building for necessary mspectiori's., ' '
(Signature'of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eiectrician;�plumber or builder
/} 1
Name of owner of premises _ InAT-el b A I`1' 01 L'o&kVl✓(iL-,,
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized off cer
(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 ro osed work will be done:
House Numbbr C� Street ,la;°*3a'mletli�.
to 'i s3
F_ s
County Tax Map No. 1000 Section 242. Blockr;�;;
Subdivision Fifed-Nlap No. Lot
2. State existing use and occupancy of:premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy YE�1'
b. Intended use-and occupancy
3, Nature of work(check which-applicable): New Building ?Addition
Repair Removal Demolition Other Work,
• - �—�ription)
4. Estimated Cost'6 LPD ;O�' Fee
. I 11 ,, , (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 alteratio`ns,or addifions:.Front ! : ; Rear .: I
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height ,Number of Stories15Q":71*.bq
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former,Owner
11. Zone or use district in which premises are situated
12. Does proposed•construction violate'any'zom"ng. law, ordinance or regulation. YES-, NO V
13. Will lot be re-graded? YES NO Will excess fill be removed from premises?YES NOIR
14-Names of:Owner of premises:;: ',.io ,� :i t: .;; Address T't. Phone No ..
Name of•Architect 'Address ',�'°(�.tL;�.: -Phone No T
Name of Contractor Phone'N – 2,60Z
e
15 a. Is this'#bpei y within 100 feet of-d tidal wetland'or•a fresliwater wetlaridT*YE `NO-
* IF YES, SOUTHOLD`TOWN'TRUSTEES`&.D:E.C.PERMITS MAYBE REQUI D.' "T
b. Is tl is property witHin'JOO6'feefof a'tidat (6tland? � 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 )
I A A V 0_0 d11V 6rYbeing duly sworn, deposes,and says that(s)he is the applicant
(Name of individual signing contract) above named, '
(S Reis 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.
Sworn to before me this
05_dayof . /
Public,StAteof Now York -
r7/
Notary Publi ®mmission Expires b l Signature of Applicant
• �JIWJ" Y
H T. TERR ! � '� P O- no., 1 17h t�
r r
'FROWN CLERK " ' ,,� . Suulhol(l Nc\" Durk 1
y �
Fax IS 101 7hS•IR�_�
ItEGISrRAR OF V1TN,STATiS11cS IC TdcRlitnc t S 1 f.1 M.S.
MARRIAOr oFrICI:R ���0�
RECORDS MANAGEMENT OFFICEII 1
FREEDOM OF INFORW'nON OFFICER
OF}:ICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993:
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under the Flood Damage Prevent regulations
of, the Code of the Town of Southold: "Floodplain Development. Permit
l 1
application" (FDP(93) ] , and ';Certificate of Compliance f&r Develo'pment in
Special Flood Hazard Area (C/C(93)] .
TOV%;1 OF SOUTP LD
/J u i�/th T . Terr
Y
Southold Town Clerk
August 25 , 1993
',♦ 1 f 1
. APPLICATION
PAGE I of 4
TOWN OF SOUTHOLD
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate.
SECTION 1 GENERAL PROVISIONS (APPLICANT to read and sien)-
1. No work may start until a permit is issued.
2 The permit may be revoked if any false statements arc made herein.
3. If revoked, all work must cease until permit is re=issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
S. The permit will expire if 6o work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory
requirements.
7. Applicant hereby gives consent to the Local Administrator or his/her representative to make rtsasonabie
inspcd.ioas required to verify compliance.
8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO
_ THIS APPLICATION ARE,TO THE BEST OF MY KNOWLEDGE,TRUE AND ACCURATE./
((APPLICANTS SIGNATURE) ��� � c�GU/G (�6� DATE
/SECTION 2: PROPOSED DEVELOP-L ENT fT(,, �c completed by APPLICAB D
NAME /� ADDRESS t I TELEPH E
APPLICANT� n C A
BUILDER ►`[t ICs
ENGINEER C^ Vr)) �
PROJECT LOCATION:
To avoid delay is processing the application, please provide, enough information to easily idcatify the project
location_ Provide the street address, lot ❑umber or legal description (attach) and, outside urban areas, the
distance to the ucarest intersecting road or well-known Landmark A sketch attached to this application showing
the project location woulddbe b/ 1 clp'ful_ ,0 —r-
j I & ,S� �e �� IMI—t I l I i�/� I V.
`�
FDP(93)
APPLICATION
PAGE 2OFQ
DESCRIPTION OF WORK (Check all applicable boxes)-
A. STRUCTURAL DEVELOPMENT
ACTIVITY — STRUCTURE TYPE
O New Structure I�Lesidential (1-4 Family)
O Addition ❑ Residential (More than 4 Family)
O Alteration ❑ Noo-residential (Floodproof-ing? O Yes)
O Relocation O Combined Use (Residential & Commercial)
❑ emolitioa ' ❑ Manufactured (Mobile) Home (In Manu-
I(Replacement factured Home Park?. O Ycs)
ESTIMATED COST OF PROJECT S L00, tD
B. OTHER DEVELOPMENT ACTIVITIES:
❑ Fill O Mining O Drilling ❑ Grading
❑ Excavation (Except for Structural Development Checked Above)
❑ Watercourse Alteration (Including Dredging and Channel Modifications)
O Drainage Improvements (Including Culvert Work)
7
j ❑ Roaflti Street or Bridge Construction �
` O Sul-' vision (New or Expansion) /
of dual Water or Sewer System �I
G Other (Please Specify)
After completing SECTION 2, APPLICANT should submit form to Local Administrator for review-
SECTION 3• FLOODPLAIN DETERMINATION CFo be completed by LOCAL ADMINISTRATOR)
The proposcd developmeuc is located on FIRM Pancl No. . Dated
The Proposed Development:
O Is MI located in a Special Flood Hazard Arca (Notify the applicant that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
O Is located in a Special Flood Hazard Arca.
FIRM zone designation is
100-Year flood elevation at lbc site is: H. NGVD (MSL)
❑ Uoavailablc
O The proposed devclopmenl is located to a (loodway
FBFM Panel No. Datcd
❑ Scc Section 4 (or additional iostruciioos
SIGNED DATE
i
APPLICATION 4
PAGE ] OF 4
SECTION 4: ADDITI NAL INFORMATION REQUIRED To he completed by L CALADMINIST'RATOR
The applicant must submit the documents checked below before the appbcalion can be processed:
Cl A site plan showing the location of all cxasling structures, water bodies, adjacent roads, lot
dimensions and proposed development.
❑ Development plans,drawn to scale, and specifications,including where applicable: details for
anchoring structures, proposed elevation of lowest floor(including basement), types of water
resistant materials used below the first floor, details of floodproofing of utilities located below
the first floor and details of enclosures below the first floor.
Also
❑Subdivision or other development plans(If the subdivision or other development exceeds 50
lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations
if they are not otherwise available).
O Plans showing the extent of watercourse relocation and/or landform alterations_
❑ Top of new fill elevation Ft. NGVD (MSL)-
Ft:NGVD MSL). For
❑ Floodproofing protection Icvcl (non-residential only) (MSL).
floodproofed structures,/ipplicant must attach certification from registered engatneer or
architect. /
❑ Certification from a'-registered engineer that the proposed activit�in a regulatory floodway
will not result in any increase in the height of the 100-year flood. A copy of all data and
calculations supporting this finding must also be submitted.
❑
Other-.
E I 5: PERMIT DETERMINATICIN fT0 be completed by LQtAL ADMIN[ RAT R
I have determined that the proposed activity. A. ❑ Is
B. ❑ Is not
in conformance with provisions of Local Law if , 19_. The permit is issued subject to the conditions
attached to and made part of this permit.
SIGNED DATE
If BOX A is checked, the Local Administrator may i-ssuc a Devclopmcot Permit upon payment of designated
fee
If BOX B is checked, the Local Administrator wdl provide a written summary of deficiencies. Applicant may
revise and resubmit an application to the Local Administrator or may request a bearing from (be Board of
Appeals
APPLICATION W
PAGE 4OF4
APPEALS Appealed to Board of Appeals? ❑ Ycs ❑ No
Heanng date:
Appeals --- .
�, Yes 9 NO
Conditions
,SECTION 6 AS BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance
is issued
The following information must be provided for project structures. This section must be completed by a
registered professional engineer or a licensed land surveyor (or attach a certification to this application).
Complete 1 or 2 below.
1. Actual (As-Built) Elevation of the top of the lowest floor,including basement(in Coastal Hieh Hazard
Areas bottom of lowest structural member of the lowest floor, excluding piling and columns) is:
FT. NGVD (MSL).
L Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL)-
NOT=` Any work performed prior to submittal/of the above information is at the risk;6f the Appl'cant•
1` f r
SECTION 7 COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to
ensure compliance with the community's local law for flood damage prevention_
INSPECTIONS: DATE BY DEFICIENCIES? O YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
SECTION 8 CERTIFICATE OF QQMPLIANCE(To be completed by LOCAL ADh4INISTRATOR)
Certificate of Compliance issued: DATE: BY:
•s
I I I
Attachment B
/! BAMP,LE
CERTIFICATE PF COMPLIANCE
for Development in a Special Flood Hazard Area
i
s
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD A-RE,A
(()WtZR MUST RETAIN THIS CERTIFICATE
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
0 NEW BUILDING
O EXISTING BUILDING
O VACANT LAND ' s
THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_.
SIGNED: DATED:
B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE #
DATED
SIGNED: DATED:
C /C ( 93)
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