HomeMy WebLinkAbout41576-Z r
SUFFOc�
Town of Southold 6/2/2017
3� y� P.O.Box 1179
a
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38991 Date: 6/2/2017
THIS CERTIFIES that the building ALTERATION
Location of Property: 10505 Sound Ave.,Mattituck
SCTM#: 473889 See/Block/Lot: 122.4-3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/27/2017 pursuant to which Building Permit No. 41576 dated 4/27/2017
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:
WOOD FRAME ENTRY TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Sisson,Mark
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
A th ed Signature
�S�FFot,r TOWN OF SOUTHOLD
moo oozy BUILDING DEPARTMENT
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#: 41576 Date: 4/27/2017
Permission is hereby granted to:
Sisson, Mark
10505 Sound Ave
Mattituck, NY 11952
To: Landing/steps/entry as applied for;
Replaces BP#39773
At premises located at:
10505 Sound Ave., Mattituck
SCTM # 473889
Sec/Block/Lot# 122.-1-3
Pursuant to application dated 4/27/2017 and approved by the Building Inspector.
To expire on 10/27/2018.
Fees:
PERMIT RENEWAL $212.80
Total: $212.80
Building Inspector
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.--Temporazy_Certificate_ofOccupancy�ResidentiaL$15.00,_Commercial_$-1.5 OQ ____T_.__—______ _ --
Date. �0&/
New Construction: Old or Pre-existing Building: V (check one)
Location of Property: L�j"p5 � -oulo /'1/ /W 7717 A,-
House No. Street Hamlet
Owner or Owners of Property: 144-leg And gew
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. �i l s� !O Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $ Sy
p'plic Signature
J pE so
do
Comm,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] IX§ULATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
OK V
DATE INSPECTOR
Ii 1
IN5UL ATION PER N.Y.
STATE • • r
1%I/I/GAMWAIF ���
Y
�j
i
�w�
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL ,„Board,ofHealth
SOUTHOLD,NY 11971 I ' L 4 sets of Building Plans'
TEL: (631)765-1802 � b AO Planning Board approval
FAX: (631) 765-9502 •Survey, r.
SoutholdTown.NorthFork.net- PERMIT NO. ji�' Check
t �: ` :_, t1,S li'.• t; 'Septic,Forin
N.Y.S.D.E.C.
Trustees'
I I �; C.O.Application
�✓1 i I Flood Permit
Examined ',20, ; i. j I Single&Separate
_<
MAYI
� �M 1 6„/; Stoiin-Water'Asses'sinentForm
(J Contact:
P
Approved ,20 _ :?I Mail to:
Disapproved a/c
Phone: �' )
Expiration ,20
x; A
;i. ui ding I ke6tor ,
APPLICATION FOR BUILDING,PERMIT
-- ----_.�J— --.- -- - Date -ajl 2,7 - ---- ' 20 1
INST$UCTIONS, .1 A I
a. This application MUST be completely filled in•by,ty/pewriter or in ink and submitted to the Bu_ilding,Inspector with4
sets of plans,accurate plot plan to scale.Fee accordfng 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 applicatiori,'tlie'Buildirig In"spector will tssue'a Building Permit°to th'e'applicant.' Such'a permit
shall be kept on the premises available for inspection throughout the work. r
e.No building shall�be occupied`Wused in whole'b'r,in`part'fo'r'any'purposer what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permitshall expire if the.N.ork 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
'. . /'� vi e.. , fi 4 ,Q 2 I I �,
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 co e,a egulations' and to admit
authorized inspectors on premises and in building for necessary inspectibris° i
(Sig a re of applicant or name,if a corporation)
d L D S(�I)iU,,,
` (Mailing address of appl`cant)'
. ' 1/�/ /14 Z-
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
r
Name of owner of premises
(Ason'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 done:
House Number Street Hamlet
A,"
County Tax Map No. 1000 Section �o� �'°''`'' $iockr'^ ; .6'�” '`''f`'` '`" Lot of
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'oe'cupan'cy�,?t7
b. Intended use and-occupancy ai -Y,- -S 7U
.,:. _' _ ., ;'��`��,`I "'� •ars ,,.
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 dwellling units on each floor
If garage, number of cars k;
6. If business, commercial or m'itre`d 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:-Front Rear_
Depth Height '� � ' ` '`}4''' "' Number of Stories
8. Dimensions of entire new construction Front ` 'r; i 'i �_'}.m % `Rear" -f Depth
Height Number of Stories
9. Size of lot: Front Rear- w " f°}i„f' :Depth
10. Date ofPurchase Namort
e of Fner"Owner
11. Zone`or u'se'district'in•which premises'ar'e'situated'`'�` '�" "'QC'Y "a' g� `
1
r1il rr oa i(tt'
12. Does proposed constructioifviolatezl , dlation?,Y" Eu S';r
NO ',V
V
. aw, oriu
13. Will lot be re-graded? YES . NQ, `✓:,Will.excess4fl;be{rernoyed from..premises? YES: NO_ _
14. Names of Ow4ner.ofpremises.(,Ie4. 4-t5'5;ta1J, .Address2.cl
Name of Architect a } FAddress" +_ ''Phone,No
Name-of Contractor +' A:ddressjr "t 't` �-Pliond'No:`
15 a. Is this property within'-100 feet of h;tWal=weflarid'o`r a'freshw,ate_r`wetlai'd? *YES 'NO"
IF YES, SOUTHOLD'TOWN TRUSTEES &``D.E..C':PER:%TS'MA.Y'BE`REgUlRRED:
b. Is this prop erty'witftin`30,0`feet of a tidal wetland? * YES Nb
* IF YES, D.E.E PERMITS MAY EE'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 51 01 K
cto In r,�An C �
being duly sworn,deposes and says that(s)he is the applicant
(Na e o individual signing contract)'above•named,
(S)He is 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 b&-
performed
e.performed in the manner set forth in the application filed therewith.
Sworn to before me this I i
day of 2015
JA aaw 9. - Dgj�
Notary Publi TRACEY L. DWYER Signature of Applicant
NOTARY PUBLIC,STATE OI' YORK
NO.01 DW6306900
QUALIFIED.IN SOFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,220 11
7
V'
Scott A. Russell 01 IFO]Kl��l WAX]EIK
SUPERVISOR r 1\\4ANA\G]EAM[]ENIF
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 '�� Town of Sou th o lGL
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
Yes (CHECK ALL THAT APPLY)
��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
❑Wwithin any parcel or any contiguous area.
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. -
❑ E. Site preparation within the one-hundred-year floodplain as depicted
- - on-FIRM Ma-p--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 Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date
fa— Dis1tiict ^7
NAME 'f"`��— n Kt°� P6U
_6iris / 3
�r„�o � 11�� Section Block Lot
1 L/¢re, (� K.”' FOR BUILDING* DEP ARTN-1LN_l, LSF: ON
Contact Information `ZO
Telephone�nihcr -
Reviewed By
Date 5 -7- Is
Property Address/ Location of Construction Work: — — — — — — — — — — — — — — — — —
I oSo S C)/,D cSoL)ND A,/ Approved for processing Building Permit
Stormwater Management Control Plan Not Required.
Nl a J'+6 CK k Y, 1152 � Stormwater Management Control Plan is Required
(Forward to Engineering Department for Review)
FORM # SMCP-TOS MAY 2014
Southold Town Building Department
FF04, 1 P.O.Box 1179
o`� oG. Permit#: 39773
y� 53095 Main Rd
Southold,New York 11971 Permit Date: 5/15/2015
(631)765-1802 Expiration Date: 11/13/2016
Parcel M: 122.4-3
BUILDING PERMIT RENEWAL LETTER
Dated: 4/6/2017
Applicant: Sisson,Mark& Sisson, Lauren
Location: 10505 Sound Ave,Mattituck
Work Description: ALTERATION
Landing/stcps/entry as applied for.
A FEE OF $212.80 IS REQUIRED TO RENEW THIS BUILDING PERMIT.
Owner: Sisson, Mark& Sisson, Lauren
Address: 10505 Sound Ave
Mattituck,NY 11952
The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please
submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building
Department, P.O. Box 1179, Southold,New York 11971
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
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