HomeMy WebLinkAbout41146-Z 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�mmm _
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
Flood Permit
1JExamined 20 Storm-Water Assessment Foran
Contact:
Approved— 21 Mail to
Disapproved a!e
Expiration_, ^ 20 '
Oct 9
ICATION FOR BUILDING PERMIT
Date October 17, 20 16
INSTRUCTIONS
'Novo
a.This application MUS° e 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.
(S ignatur of applicant or name,if a corporation)
25235 Main Road Cutchogue NY 11935
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Architect
Name of owner of premises
Jack and Nancy Armo
(As on the tax roll or latest deed)
If appleapt_iSai corporation,signature of duly authorized officer
( atne,and title of corporate officer)
Builderip'License No.
Plumbis.I,Rermse No.
Electficiimn,License No.
Other Trad.���License No.
I. Location'of land on which proposed work will be done:
2400
louse-%imberr Street Hamlet
County Tax Map No. 1000 'Section 11;7 Block 02 Lot �1'
Subdivision Filed Map No. Lest
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy SINGLE FAMILY RESIDENCE
b. Intended use and occupancy SINGLE FAMILY RESIDENCE
3. Nature of work(check which applicable):New Building Addition X Alteration X
Repair Removal Demolition. Other Work
(Description)
4. Estimated Cost nfa Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units 1 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 52 FT Rear 52 FT Depth 27 FT
Height, 28 FT Number of Storied Z .M ,b
Dimensions of same structure with alterations or additions: Front 52 T Rear 52`=T
Depth 37 FT Weight 28 FT Number of ds
8. Dimensions of entire new construction:Front Rear Depth
Height Number of Stories ax, r•; t�w
9. Size of lot: Front 84 FT Rear 82 FT Depth 154 FTC,,"
10.Date of Purchase Name of Former Owner
11.Zone or use district in which premises are situated
R-40
12.Does proposed construction violate any zoning law,ordinance or regulation?YES—NO X
13.Will lot be re-graded?YES_____NO X Will excess fill be removed from premises?YES X NO�
14.Names of Owner ofp.remisesArmo Address.PO Box39 NewSuffPhone No,
Name of Architect Tom :Samuels Address25235 Main Road Phone No 734 64(1
Name of Contractor_Address Phone No.
15 a.Is this property with 100 feet of a tidal wetland or a freshwater wetland?*YES NO X
IF YES,SOUTHOLD TOWN TRUSTEES&D.B.C.PERMITS MAY BE REQUIRED.
lr,is thin propetty within 3001 feet of a tidal wetland?*YES X NO
*IF YES,D.E.C.PERMITS MAY BE REQ UIRED. See DEC NJR
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point on property is at 14 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�m_
Tom Samuels being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the Architect
(Contractor,Agent,Corporate Officer,etc.)
Z ,
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and til Nit
� k
that all statements contained in this application are true to the best of his knowledge and belief;and that the woricr i e
performed in the manner set forth in the application filed therewith.
*– c
Sworn to before me this O
�t r _day of 20 _
CL
Notary public Signature of Applicant
STO]KAWWATEK
Scott A. Russell
N,,,A\\.G1EM1E1N,1F
MIAIN
SUPERVISOR
SOUTHOLD TOWN HALL-P.O.Box 1179 Olay
53095 Main Road-SOUTHOLD,NEW YORK 11971jjTown of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
Y
N0
CHECK ALL THAT APPLY)
............
0 Clearing, grubbing, grading or stripping of land which affects more
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.
[:]ff/c. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
CEO. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
ff E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
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 Om ner.Design Professional.Agent.Contractor,Other, S.C.T.M. 1000 Date;
Ditrict
NAME: Ski, - I I-)
jmwg 'e
Section Block Lot
Contact Lnfoirnatioir
Reviewed By: J,
Date:
Propert,v Address Location of Construction Work: — --- --- -- --- — — — — — -- — -- - — — —
1-4 Approved for processing Building Permit.
Stormwater Management Control Plan Not Required.
— — — — — -- — — — — — — — — — — — -
h V. v's-6 Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
------------------------------------------- ----
......................
...........................
FORM * SMCP-TOS MAY 2014
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 olf Fire Underwriters,
4. Sworn statement from,plumber certifying that the solder used in system contains less than 2110 of 1%lead.
5. Commercial building,industrial building,multiple residences and similar buildings and instalbitions,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. October 17, 2016
New Construction-. Old or Pre-existing Building: X -(check one)
Location of Property- 2400 Grathwohl Road, New Suffolk
House No. Street Hamlet
Owner or Owners of Property: Jack and Nano' Armo
Suffolk County Tax Map No 1000,Section 117 Block 02 Lot 11
Subdivision Filed Map. , Lot:
Permit No. Date of Permit....- _Applicant: Samuels and Steelman Architects
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: .......
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
New York State Department oi Environmental Gonservation
Division of Environmental Permits, Region One
Building 40-SUNY, Stony Brook, New York 11790-2356
Phone: (631)444-0365 - FAX: (631)44 r-0-37`6v Erin M.Crotty
Website:www.dec.state,ny.us Commission'er
A
Let--
Paul Cacciopo December 23, 2003
PO Box 249
New Suffolk,NY 11956
Re: Cacciopo Property, 240.0 Grathwohl Road, New Suffolk
SCT M# 1000-.117-2-11
Application# 1-4738-03285/00001
Dear Mr. Cacciopo:
Based on the infb-rmaion you have submitted,the New or State Department of Environmental
Conservation has clef ermined at:
The property that is landward of the pre-Lznsaniz (,-o,-,ic-r to 8/2-0/777) roadway(Grathwohl Road)
which is more than 100 feet in length, as seen on the survey prepared by R. Van Tuyl,dated
3/17/60, and as seen on Tidal Wetlands Aerial Photo Mao#712,540, is beyond the jurisdiction
of Article 25 (Tidal Wetlands).
Therefore,in accordance ®t the current Tidal WetlandsL. and.Use Regulations (6NYCRR Part
661)no permit is required under tht Tidal Wetlands Act. Please be advised,lidwever, that no
construction sedimentation, or disturbance of any kind may take place seaward of the tidal
wetlands jurisdictional boundary,as indicated above,without a permit. It iq your responsibility
to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration
or disturbance to the ground surface or vegetation.within Tidal Wetlands jurisdiction wh'ch.may
result from your pJect. Such precautions may include maintaining adequate work area between
rol
the tidal wetland junisdictional boiindary and your project(i.e. a 15'to 20'wide construction area)
or erecting a temporary fence,barrier, or hay bale berm.
Please be further advised that this letter does not relieve you of the responsibility.of obtaining
any necessary permits or approvals-ftom:other-agencies.
Sineetely,
ark C. Carrara
Permit Administrator
cc: IVIHP
R. Lehnert, Boulevard Planning East,PC
File
REScheck Software Version,
Compliance Certificate �
1110V 3 2016
Project Armo Garage Storage Building
BUMDING,
Energy Code: 2015 IECC TOWN OF SOUTHOLD
Location: Southold, New York
Construction Type: Single-family
Project Type: Addition
Orientation: Unspecified
Climate Zone: 4 (5572 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
2400 Grathwohl Road Jack and Nancy Armo Tom Samuels
New Suffolk, NY 11956 PO Box 39 Samuels and Steelman Architects
New Suffolk, NY 11956 25235 Main Road
Cutchogue, NY 11935
1 631 734 6405
tom@samuelsandsteelmanarchitect
s.com
Compliance: 15.7%Better Than Code Maximum UA: 108 Your UA: 91 Maximum SHGC: 0.40 Your SHGC: 0.19
The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home.
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 394 19.0 7.0 0.035 14I
Ceiling 1: Cathedral Ceiling 394 30.0 7.0 0.027 11
Wall 1, North Elevation:Wood Frame, 16" o.c. 156 19.0 7.0 0.041 5
Orientation: Unspecified
Window 2:Wood Frame:Double Pane with Low-E 16 0.300 5
SHGC: 0.19
Orientation: Unspecified
Window 6:Wood Frame:Double Pane with Low-E 16 0.300 5
SHGC: 0.19
Orientation: Unspecified
Wall 2,South Elevation:Wood Frame, 16" D.C. 156 19.0 7.0 0.041 5
Orientation: Unspecified
Window 1:Wood Frame:Double Pane with Low-E 16 0.300 5
SHGC: 0.19
Orientation: Unspecified
Window 5:Wood Frame:Double Pane with Low-E 16 0.300 5
SHGC: 0.19
Orientation: Unspecified
Wall 3, East Elevation: Wood Frame, 16"o.c. 188 19.0 7.0 0.041 6
Orientation: Unspecified
Window 4:Wood Frame:Double Pane with Low-E 13 0.300 4
SHGC: 0.19
Orientation: Unspecified
_.PrReport Gate: 11/0
o'ect Title: Armo Garage Storage� g rage Building p �. 1/16
Data filename: \\NAS\share\Office files\Common Documents\ACTIVE PROJECTS\Armo\Building Page 1 of 2
Permit\Energy Calculation Storage Building.rck
Door 1: Solid 18 0.450 8
Orientation: Unspecified
Door 2: Solid 13 0.450 6
Orientation: Unspecified
Wall 4,West Elevation:Wood Frame, 16" o.c. 188 19.0 7.0 0.041 7
Orientation: Unspecified
Window 3:Wood Frame:Double Pane with Low-E 17 0.300 5
SHGC: 0.19
Orientation: Unspecified
Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements in
REScheck Version 4.6.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
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Project Title ..._ ...
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. Armo Garage Storage Building Report date: 11/01/16
Data filename: \\NAS\share\Office files\Common Documents\ACTIVE PROJECTS\Armo\Building Page 2 of 2
Permit\Energy Calculation Storage Building.rck
BFUG I AM �t<AU-LINt!P-Ll--W^TION-7.0 t�I. -1 SLOPE 5% 1
WEST Z GRADE LINE ELEVATION bb PT. r hle,Suffolk 11;56
CREEK I'MIIL 2"MAX. '---6'4 FT 1 OWNER: Jack
5.4 FT--� and Nancy Arno
PO ox 39
New Suffolk,NY 1195
A130��jj4S17-F LK COUNTY DEPARTMENTOF HEALTH SERVICES TOP OF POOL SITE AREA: 12,509 SG!.FT.=0.29 AC.
I FEI�XIIT FOR APPROVAL OF CONSTRUCTION FOR A CHIN 4.1 FT� FLOOD: AE&X
MEAN HIGH I l VIE.+525' SEPTIC POOL ZONE
WATER MARK NCLE FAMILY RESIDENCE AND E.+45' E30T OF POOL
K- 2:7 FT. N.A.V
le..501 TANK ELEVATIONS ARE REFERENCED TO tu
IE.+4.5'1' N 6 D.1989 DATUM =
f BOT 0 - - SURVEYOR: John C.Ehlers L
f3uoyoncu Cole-Ula lon5 or aptir- Ton ZL-
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SE-PTIC, el-ffy 0- 6 East Main Street 2
(1,2o&got,aft dto x Ert ht) DATE TANK+05 Riverhead,N.Y. 11901
-Lii H.S.REF,No. J"<,1,0- 00 Tel.#631369 8288 (4
�IK COUNTY DEPART
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Sas Ic
k,1�200 gal(Eft dt./.5Pt ht)Height 4,1100'be(o =)APPF�o VIED' LICENSE 050202 IL
llqutd-IOPOO fib� DATED,.8-31-2005 0
561,16 Tank grovor(MI;d1c;t6lWn thk�)-�5,550 lits SEPTIC TANK W C
So die 0� , I TOTAL MAXIMUM BEDROOM LOCATION MAP
If Cover ob ft deep x die-40.2 at x`5 11:79/0 5�015 1 S1 77T MONOLITIC,BASE SEPTIC PRO-FILE
1,Tank (N.T-S,) RR
empty, It it E EXPIRES THREE YEARS FROM DATE OF A lIPRO11
ta+
5r.0 The+10,005
40 llc�+�,550 The+ 15 21,41S The LL
tic Tank full: PROPOSED NEW SEPTIC SYSTEM
ooeti
471F.2 The+to The+10,008 It'.+S,.I50 1 SIADI The FOR A 4 BE12ROOM RESIDENCE AN17&ARA&E VIP
-1200 GAL SEPTIC TANK(5T) z
DI laces I;of round Hater due to Septic Tank Water Line(s)MUS Be Inspected By The -(-I)WDIA x 2'HIGH LEACHING POOL(LP) 0 C
7 LOCATION OF EXISTING
Septic Tank dtsploc�t(partially awkwnergact) CountyI -FUTURE LOCATION rop-(4)VDIA x 2'HIGH
Uffolk Of Health Services, SANITARY SYSTEM TO LEACHING POOL(EXP LF)
Tank EMPTY)
BE REMOVED AS NOTE: PROVIDE 1852-5700,48 Hours In Advance, IDE CROSSOVER PIPES BETYNIEEN 0
Me I
water elevation+0.1%Bottom of Saptic Tank+0,5 REGUIR-W DISTRIBUTION FOOLS AND LEACHINC,POOLS z
chedule Inspectlon(s).
Total displacement of ground Hater-02' Ill
Displacement height x area of"ptle tank,02'x8027'a 10.05 c,?Hater n n
Hater 152.43 les/cp -RTE
ST B
>Water Lie C
L5uffol
__r
8 -5 ,4 H
1 52 7 0 8
cUl I
hd e n--
,0_ ,Hater
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62.45 10�05 621.42 Its{weight of displaced ground ,I,of optic tonk) 1000-117-2-10
Sdptk-Tank empty-21,475 11. LAND N/F OF
21.415 The 627.42 It. 5422 aafa1uI factor
CUROTT PHYUJS W
LAND N/F OF RESIDENCE WITH
J
CUROTT PHYLUS W PUBLIC WATER&SANITARY SYSTEM
Sapti.Tank displacement(PartlallI,I evbmarged) 2500 Grothwohl Rd. New Suffolk, NY 11956 q,
(Septic.Tank FULL) VACANT a 153.72'
r-rovnd Hater elevation+O.T,Bottom of Septic.Tank+o.5' S 573*21*00"E
Total oloplaeomont of ground Hater=0.2'
Displacement haft x area of septic tank,0.2'x - OD5 cf Htz r
Hater-6:14,3 lb.10 + to
Septic Tank fu BIASI be LP IS,
62.45 x 10.0r,- ad ground Hater of sept tank)
'1!21.42 lbs(Y4.1911hit of d1splar
51,4a]The/677.42 It.=50.17 safety factor 4 LP r
LAND N/F OF
WICKHAM WILLIAMI QDU-117-2-211
_J1
Septic Tank displacement(fWlq&11rn14 q, VACANT EXISTING LAND N/F OF
(Septic T-+-MA-U WELL TO BE GRODSKI STAN
Area of Septic Tank(6ft da x 5ft ht)=5077tf(Mt dna)x 5?t ht-2 1.95 41, RESIDENCE WITH
2 2ABANDONED GRODSKI ALEXIS
I2I6pIQ&wmoht of 9aumd Hater If septic,tank(full)is f-119 evb"113-11 WELL WATER&
2EIh cf x 6245 lbsicf(orator)= 15,6141.71)Ice
6.4+ SANITARY SY
Septic Tank full-51,461 The RATIIIINOI-Iq LP LP 0 weh New Aul" 'f-
51,40]lbs 1 15,61I1.16 be 2,0 safety factor
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BY MARK MCDONALD GEOSCIE
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CAbandonr�qent Ofc,-�js ino sanitary s stem mu
SOUTHOLD,NEW YORK 11971 St be
Comfornance vvfth-d pi-ti-nent requ- ement�Libinl
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weer nr=.
TEST HOLE DATA 712112 ELEV.+62
rapleted form WW
1.0 FT. DARK BROWN LOAM OL -as of. I exjsi� RIVE Ay FL
SITZ
4-0 FT- BROWN SANDY SILT ML • PLA
5-6 FT- BROWN SILTY SAND SM 0-0,
0 1000-117-2-17.4
WATER IN BROWN N7 0 W relghborin LAND N/F OF
_L6.0 FT. SILTY SAND SM 6 5ele'ric,LINE FROM Hall GRODSKI STANELY SI10FT M
LAND N/F OF 1000-117-2-12 GRODSKI ALEXIS
WATER IN BROWN SUFFOLK COUNTY LAND N/F OF GARAGE TO RESIDENCEVACANT
FINE TO MEDIUM SAND SP VACANT PROPOSED N HATE 11 SITE "LAN 705 George Rd
23 FL KLOS LOIS A FAM 2011 IRR TRT r
LINE FROM TER MAIN RESIDENCE WITH PROPOSED NEWR SCALE:1"=20-'-0" Now Suffolk, NY
COMMENTS:WATER ENCOUNTERED
AT ROAD TO GARAGE WELL WATER LINE!FROM RE511 OE 11956
6.6-BELOW SURFACE,ELEV 0.7- SANITARY SYSTEM
2300 Gmthwohl Rd New Suffolk 11956 TO GARAGE SCDHS SUBMISSION