HomeMy WebLinkAbout40844-Z ��o�r�1yFFO �o�� Town of Southold 10/31/2016
3 P.O.Box 1179
0
c 53095 Main Rd
o4, Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38630 Date: 10/31/2016
THIS CERTIFIES that the building ALTERATION
Location of Property: 2575 Skunk Ln, Cutchogue
SCTM#: 473889 Sec/Block/Lot: 97.4-13
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/14/2016 pursuant to which Building Permit No. 40844 dated 7/20/2016
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:
ALTERATIONS, INCLUDING NEW WINDOWS TO AN"AS BUILT"FRONT PORCH ADDITION TO AN
EXISTING ONE FAMILY DWELLING, AS APPLIED FOR
f
The certificate is issued to Giblin,Frances&Chin,Rebecca
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
A riz ignature
D 1 o��Of SOUIy�!
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ia
• �o
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULATION
[ ]
FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: �by -6 Cc)
DATE ANSPECTOR
��Q�sootKc TOWN OF SOUTHOLD
aye BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
�� • 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#: 40844 Date: 7/20/2016
Permission is hereby granted to:
Giblin, Frances & Chin, Rebecca
70 Washington St Apt 8T
Brooklyn, NY 11201
To: construct new alterations (including new windows) to "as-built" front porch addition to
existing single-family dwelling as applied for. Additional certification may be required.
At premises located at:
2575 Skunk Ln, Cutchogue
SCTM # 473889
Sec/Block/Lot# 97.4-13
Pursuant to application dated 7/14/2016 and approved by the Building Inspector.
To expire on 1/19/2018.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $552.80
CO -ADDITION TO DWELLING $50.00
Total: $602.80
Y
BVInspectoor
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 $15.00
Date. �p
New Construction: Old or Pre-existing Building: (check one)
Location of Property: fes. c.C.e_
House No. reet Ijamlet
4
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision) r (� Filed Map. Lot:
Permit No. "P��-6 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$ �n /
pp16.9 'Sig ature
FIELD INSF4=QN MV'ORT ))A=
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PLUMBING
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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:I(631) 765-1802 Planning Board approval
FAX: (631) 765-9502 R Survey
SoutholdTown.NorthFork.net PERMIT NO. U Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
-7/ Flood Permit
Examined D 20 Single&Separate
Storm-Water Assessment Form
Contact:
Approved 20 Mail to:
Disapproved a/c
Phone:
Expiration 20_L--
Dd( V L
L V l.S uildin pector
J U L 1 4 2016 DAPPLICATION FOR BUILDING PERMIT
Date 20 1�
BUILDING DEPT. INSTRUCTIONS
TOWN OF SOUTHOLD
a. This application-MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plan's,accurateplotplanto 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,F2 months after the date of
issuance or has not been completed within 1.8 months from such date.If no zoning amendments or•other regulations affecting the
property have been enacted in the interim,the Building lhspectorrmay,•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�
Sign plicantor e,ia 6orp�r�ion)
a
(Mailing address df applicant)
State whether applicant is owner, Jesse �arcngineer, general contractor, electrician, plumber or builder
Name of owner of premises
(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.
Othei Trade's License No.
1. Location of land on which proposed work will be done:
2L�
House Number Street Hamlet
County Tax Map No. 1000 Section Block ,Lot 3
Subdivision Filed Map No. Lot
i
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 i
3. Nature of work(check which-applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost.
4' t-7- �� � 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 I��-', Rear V,(0 l_ _ _ Depth �
Height " Number of Storiesell
/ r
Dimensions of same structure with alterations or additions:_Front o�C�a•l ear-'��:
Depth f' �/— Height l 3'- e- o Number of Sfone's
lti 3 jL �.
8. Dimensions of entire new construction: FrontRear Depth
Height Number of 8iories
i qp 4
9. Size of lot: Front_ Rear /2 ' Depth_1&qq I I '` - "�'�.�'r�'Yt/ % r` O
10. Date of Purchase Name of Former-Owner
11. Zone or use district in which,premises are situated )C- d
12. Does proposed construction violate any zoning,law,ordinance or regulation?YES= NO f
13. Will lot be re-graded?YES_ NO Will excess-fillbe removed
;from premises?YES NO, j
14.Names of Owner.of memise,
1 Address / i- hone No. - 7
Name of Architect Addres -Phone-No
Name of Contractor Address D W Phone-No./031:2VI)
15 a. Is this property within 100,feet of.a tidal wetland or a freshwater wets-and? *YES- NO
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERN UT-S"MAY BE REQUIRED.
b. Is this property within 300 feetLof a tidal wetland? * YES NO_),C
* 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:
Y- -
COUNTOF,� Zj )
��ed)_r_A —9—mu- Zd0— being duly sworn,deposes and says-that-(s)he is the applicant
(Nahie of individual signing-.contract)above named,
(S)He is the C
( ontract �Aorporite 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,appliealion;
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.
Swomt ,l fore me this -
Tij �daiv of 20
.,VNI "�M.CURWO
Notaryc lvu.4 ''ihli(, ;tate of New York atur o )cant
f�l No.01CU6100507
Qualified in Suffolk Coun
Commission Expires Oct 20tm
Scott A. Russcll ,DSOFFQIr� STORMIWA\T]ER
SUPERVISOR MIA NA.Gr]EI�� IE1NT
SOLrTHOLD TOWN HALL-P.O.Box 1179
>y
53095 Main Road-SOU'THOLD,NEW YORK 11971
Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS PROJECT IN'VOLti E ANY OF THE FOLLOWINGS
Yes No CHECK ALL THAT APPLY'
E14 A. 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.
❑ C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
EIP D. Site preparation within 100 feet of wetlands, beach, bluff or coastal i
erosion hazard area.
❑ E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
E]h F. Installation of new or resurfaced impervious surfaces of 1,000 square I,
feet or more, unless prior approval of a Stormwater Management
l;
Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces. f
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 Ownei,Design Profession gent. ntractoi,Other) ' S.C.T.M. �` I OUO Date
.A
District
NAIME
vrm Section Block Lot
FOR BUILDING DEPARTMENT USE ONLY �*�*
Contact Infoimation
Re /6"v ' � v V
//ll �/�' lTekplwne:umbu, ! 1`�.
7-� � Reviewed By: I'
Date_ '
Property Address/Location of Cons —Construction Work: I — — — — — — — — — —
�- � ! 11] Approved foi processing Building Permit.
' ! Stormwater Management Control Plan Not Required.
— — — — — — — — — — — — — — — —
! Storinuater Management Control Plan is Required.
(Forward to Engineering Department for Review)
FORM # SMCP-TOS MAY 2014