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Home My WebLink About41038-Z �s�FFnt� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o e 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#: 41038 Date: 9/29/2016 Permission is hereby granted to: Wasilausky, Philip 26 Little Neck Rd Centerport, NY 11721 To: construct interior alterations to existing garage as applied for. At premises located at: 105 Private Rd #31, Southold SCTM # 473889 Sec/Block/Lot# 77.-3-25 Pursuant to application dated 9/15/2016 and approved by the Building Inspector. To expire on 3/31/2018. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 t P/1 wilding 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. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00 J - ----------- - Date. New Construction: Old or Pre-existing Building: P"*"—(check one) Location of Property: Gj-- Aro 4 0 X31 �a A-0 House No. y� Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section °� 7 Block 03 Lot '2_-r— Subdivision Filed Map. Lot: Permit No.—, �I )ate of Permit. C (,' Applicant: fwd. firms 1116,14 1 0&t- Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: V (check one) Fee Submitted:$ f5O App ica Signature SObTyo coum,��' TOWN OF SOUTHOLD BUILDING DEPT. 76516®2 INSPEUTION L ] FOUNDATION 1ST [ ] ROUGH PLRG. L ] FOUNDATION 2ND [ ] INSULATION L ] FRAMING / STRAPPING [ ] FINAL L ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ( ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: 00 WoN, V Lut P DATE tv INSPECTOR 0,0 - - 0 • IMUL ATION. �r OWN - o 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 —04 ets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 �J� --�5 rvey SoutholdTown.NorthFork.net PERMIT NO. J Check Septic Form N.Y.S.D.E.C. ees C.O. pplication [EG� Flood Permit Examined ,20 VC D Single&Separate D `S rm-Water Assessment Form SEP 15 2016 Contact: Approved 20 `1MaH-to- Disapproved a/c $,jY"INGD °E", TOWN OFSU h/T/ Phone: 3r — Z 6 t` `��;d `f Expiration 20 Bui g ctor APPLICATION FOR BUILDING PERMIT Date , 20 Id 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. � r (Sigfiatuff of applicant or name,if rporation) / S GdP.r� Cry SO r-tf-�ej d (Mailing address of appli nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 0L"I tg Name of owner of premises (��t �r/J T. fi )�qr—4,c" 1 1/qa al/it L4-1 Jcc—. (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. 4-12- �� -H Drwnvorf— Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed w rk will be done: /®.- /'�� 14®4 -#-13I SoC, Aod House Number Street Hamlet County Tax Map No. 1000 Section 7 7 Block,, 0 3 Lot '2-J_ Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use andoIIQ-,A upancy of proposed construction: a. Existing use and occupancy ' :iz K Stof b. Intended use and occupancy A..I\e aR cr--�9 �-- 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost " r''n �� " i V T be` aadlon filing this application) 5. If dwelling, number of dwelling units lulu ber of dwelling units o .e ch floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 41 11( 7. Dimensions of existing structures, if any: Front . � I "i lar'F''yjT Depth Height Number of Stories 0 Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner "G4 A4 4 tL ke✓`r 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 F3o,.✓b�9vro� fly f-✓a,c��ei�� 1'9.t G�°�- CsReF�r�/ 14. Names of Owner of premises e0le T� t� A/�gddress so ,fyrI'?/Phone No. 63(^ 2-V^'FO6 of Name of Architect Oow(A J, AAgk q Address��'`} '<<'`°�' Phone No -ffC— 2-9k— s^)0 2— Name Name of Contractor fir✓ a.rmsla- / xu Address r'4St, Phone No. 21f> 666 �_ P- `� 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO ci * 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 f * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF S UtW, Phi 1 ,25dau s�Q being duly sworn, deposes and says that(s)he is the applicant (Name of indivi ual signing c ntract)above named, (S)He is the Ower (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 day of 2010 RACEY L. D- i r / otary Publi NOYARY PUBLIC,STATE OF NEW YORK Signature f A plicant NO.01 DW6306900 (QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 20,2-0 Scott Am Russell ��4Su �� STORMWATER SUPERVISOR A\� 1A NA\(G 1EA\41EN`]F SOUTHOLD TOWN HALL-P.O.Box 1179 a 53095 Main Road-SOUTHOLD,NEW YORK 11971Town of Southold 10� CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) -- - - - - - - - - -- - - - - - - DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) ®�A. Clearing, grubbing, grading or stripping of land which affects more Ell / than 5,000 square feet of ground surface. E E �. Excavation or filling involving more than 200 cubic yards of material ,/ within any parcel or any contiguous area. E EJ C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. [l'*D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. E[]E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. EF. 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. Disn ict NAME �'' � r 7 7 3 2S� Ac4-C Section Block Lot yk `` FOR BUILDING DFP_,-1.ItTN1f_NT ON11 Contact Information ? Z C t — L'6 6'V- Reviewed By —v, &""A - Date. Property Address / Location of Construction Work — — — — — — — — — — — — — — — — Approved for proceaaing Building Permit Stormwater Management Control Plan Not Required / -\ 1>J Stor nTvvater Managcment Control Pian 1J Required 11 (Forward to Engineering Department for Re—view) FORM " SMCP-TOS MAY 2014 i t I Philip I Wasilausky 575 Goose Creek Lane Southold,NY 11971 September 15,2016 I Re: Premises- 105 Private Road,#31 (575 Goose Creek Lane) 1 Southold,NY 11971 To Whom It May Concern: j Attached hereto is a completed application for a building permit and an application for a certificate of occupancy with which I request that the Town of Southold Building Department issue an alteration permit for my garage located at the above-referenced premises due to additional minor framing work to be done. This will allow a Certificate' of Occupancy-to be issued for the work done on the house under Permit 440530. Thank you. Very truly yours, I Philip I Wasilausky i _ -# - 1 b oo .b. -7 7 -- ?p `'25 TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET � 60 VILLAGE DIST. SUB. LOT � Ybr�� as�l��S� Ali- 2 . 3 1 s� ` -�l� s ACR. � REMARK 50 /,�3 -3 Wa3dau-SINAV-1,5w TYPE OF BLD. PROP. CLf�S! ctIA, - 61Q� G`ID.3 B- LAND IMP. TOTAL DATE DATE FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL TOWN- OF, SOUTHOLD "PROPERTY RECORD CARD (�LOWNER{ F Cj e n Fe r r-) �� G STREET VILLAGE DIST. SUB. LOT q—Iq f PA m SN FORME�k OWNE�&`_Ff'�7_ �f ea,-01, �'J',`N 0 E ACR. I/ �1+_Susovi /V 1) \e\l In 6f-Q'1-4jn �n6e 9 uq�b 06, S W TYPE OF BUILDING -A P, RES. 6 SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 2- 4-9 711 3o-n 2,Z�tl -7 7 L 5>rSA7 p,;?4_G -We 4 700 50o( n 141-2,&A 70 Q 6-0 -73003 1N/,F';� 0? /7) 0//,!5 lkho vo mdlor) AGE BUILDING CONDITION 199,-/)-4 7- NEW NORMAL BELOW ABOVE e1c _j .�, Ilq,5 76-- A 4-C, FARM Acre Value Per Value /Q/,9 V Acre 9113A�T _. k`e1v1qwq1) A,1, 6 , Tillable FR6NTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH / L House P ot,,,- BULKHEAD �' 37 Total DOCK i .,,,• Mn .■... ■.■.■■.■■■■■■■M ■■■■.■■..... .■..■......■■■IN M MEN■ ��■.■■..■■.NONE.............. .` .�ONE....■■.....■.■■■ ■.■■■ .. .tt ■ .......■.Q■■.■..ENO ..... { to qYr yrrS r {xc' *r' .....■.■E� ■«.■■■■■■.■■..■■. Y ME ME I No C■■■OMEN.■71ONO ■...irr■N■.�..■irM.■. ......■■..■ ■■■� ■■■■MEN■«■..■■■.■■■.■■■■e ■■ �..■■o■.�i■.■..■...■■■■■■.. �■■. ��iii�ii■i■■iiiE■Ei�"' ..■■.®■..■E■■■■.■■..OMEN■Ei�iE ■W■■..■■■..■■.■■■.. .r i J