HomeMy WebLinkAbout41979-Z ��4�g�FFO(,�cpp�y Town of Southold 10/11/2017
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P.O.Bog 1179
V' 53095 Main Rd
oy�jp� �yyo�� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39280 Date: 10/11/2017
THIS CERTIFIES that the building AS BUILT DECK
Location of Property: 850 Breakwater Rd.,Mattituck
SCTM#: 473889 Sec/Block/Lot: 106.-9-7.4
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/13/2017 pursuant to which Building Permit No. 41979 dated 9/19/2017
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:
"AS BUILT"DECK ADDITION WITH RAMP TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
The certificate is issued to Theodore,Maria
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
U
o ed Signature
�4�SUR914'oTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
py • SOUTHOLD, NY
�h 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#: 41979 Date: 9/19/2017
Permission is hereby granted to:
Theodore, Maria
174 Maple Ave
Patchogue, NY 11772
To: legalize "as built" deck addition to existing single-family dwelling as applied for.
Additional certification may be required.
At premises located at:
850 Breakwater Rd.,Mattituck
SCTM # 473889
Sec/Block/Lot# 106.-9-7.4
Pursuant to application dated 9/13/2017 and approved by the Building Inspector.
To expire on 3/21/2019.
Fees:
AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $1,044.00
CO -ADDITION TO DWELLING $50.00
Total: $1,094.00
A.""
Buil ing Inspector
Fot m 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. C 6 p y-6f 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: (check one)
Location of Property: (J 6-D Bled 4e)441 0 /��� - " kc-
House
No. Street Hamlet
`-
Owner or Owners of Property: 441WI A- � '00 -,,4
Suffolk County Tax Map No 1000, Secti6n f b Block ( Lot 7 ' 1
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificat : (check one)
Fee Submitted: $
A plicant Signature
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
I FOUNDATION 1ST ] ROUGH PLEIG.
FOUNDATION 2ND ],ASULATION
FRAMING / STRAPPING [VI FINAL,4 &tf-&4-
FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
REMARKS: ,
A
DATE 7' INSPECTOR�4
t 1 0 oy
F Lo is !H— M `17 0
E ;NozINUE ER.INS G
13 September 2017
850 Breakwater Road
Mattituck, NY
Building Inspector
Town of Southold
Main Road
Southold, NY 11971
Dear Sir,
I have inspected the as constructed deck at 850 Breakwater Road and certify to the best of
my knowledge the deck was installed in accordance with New York State Building Codes and the
drawings submitted for the Building Permit
WE
BOARD CERTIFIED IN STRUCTURAL ENGINEERING
JOS EFH@FIBCH ETTI.COM FISCHETTIENDINEERING.00M 63 1 -765-29S4
1 72 5 H O B A R T ROAD S O U T H O L D , N E w YORK 1 1 97 1
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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: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. qN X Check
Septic Form
N.Y.S.D.E.C.
12C[E0Trustees
'V[2
_�
® V C.O.Application
Flood Permit
Examined 11v ,20 Single&Separate
SEP 1 3 2017 0 Storm-Water Assessment Form
Contact:
Approved ,20 fl gIJMDWG YDEpT
Disapproved a/c TOWN OgSOMHOLD
to A h/dJI) on R 1�
Expiration ,20 \ e(A 11 pick v l C�
B ctor
APPLICATION FOR BUILDING PERMIT
Date , 20 7
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 a oth pplicable Laws, Ordinances or
Regulations,for the construction of buildings, additions,or alterations or for re ov 1 or lition as herein described. The
applicant agrees to comply with all applicable laws,ordinances,building code, ous ng co e, nd regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
(S gnature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
4— 0-14L�QQit�,
Name of owner of premises I r l rtYY a- / I PO W W 1-1!0
(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. /�} ,S s G
Electricians License No.
Other Trade's License No.
1. Loa
tion of land onich p oposed N�yyo��rk will be done:
f5sv e� JrP4 4C it)pf- ^
House Number Street Hamlet
County Tax Map No. 1000 Section /06 ,Block ` Lot '�
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 occupancy
b. Intended use and occupancy
�v i l-I-�C�
3. Nature of work(check which applicable):New Building Addition Al_(X� teration
Repair Removal Demolition Other Work
" -.,"�'�„ r,.lr_ � , r:.•� p (Description)
4. Estimated Cost ; 4ee
-3 (To he`d id on filing this application)
5. If dwelling, number of dwelling units "INumber,of;dwellingFunits�o each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nture'arid`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 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
11. Zone or use district in which premises are situated
r
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
14.Names of��rof�rem s Address Phone No.
Name of t �s s Address 025-1 Phone No 6
Name of Contractor Address Phone No.
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 MAYREQUIRED.
b. Is this property within 300 feet of a tidal wetland? * 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 NOA
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
(Name of ind' idual signing contrac6 above named,
/4&
(S)He is the Y
(Contractor,Age t, 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 wle and belief-, d that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
1 3410- day of 20_Lj_
�A a,, 9 1 �6ujauk_
d'Notary Public 0 TRACEY L. DWYER igna ure of Applican
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2DZ
R�r
Scott A. Russell ST1011KIM �vA NEIK
_Z)
SUPERVISOR 1AA\.NA\G)EIMI)EN C'
SOUTHOLD TOWN HALL-P.O.Box 1179 tQ ���� f
53095 Main Road-SOUTHOLD,NEW YORK 11971 ��Q f �-
Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOLES THIS PROJECT INVOLVE ANY OF THE (FOLLOWING:
(CHECK ALL THAT APPLY)
Yes No .
❑4 A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
❑Do B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑ I C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑6 D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
❑9 E. Site preparation within the one-hundred-year floodplain as depicted
-en ESI 1V�1Vfap-of-any-wat-er--cou-r--se-- -- --- ----- --- - - -
❑ 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, ign Professional gent.Contractor,Other) S.C.T.M. #: 1000 stm Date
�/ l.D�utrtct �7
NAME O ` 5 7! V /. q-13- 17 Section) Block Lot
Ns IU - -a FOR B1.21LD1`G DEP_ �ENT LSE ONL 1' 44r�
Contact Informatio
Reviewed By: j A AAA
I- - - - - - - - - - - - - - - - - — ate: q-19 —
Property
—1 'Pro ert Address / Location of Construction Work: — — — — — — — — — — — — — — — —
Approved for processing Building Permit.
Stormwater Management Control Plan Not Required
® Stormwater Management Control Plan is Required
(Forward to Engineering Department for Review.)
FORM 11 SMCP -TOS MAY 2014
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NOTIFY BUILDING DEPARAT OF THE TOV'VN CGDE.
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAh'i"r PLUMBING
3. INSULATIr'' W
QF I F- I 1 4. FINAL - r`' `)l MUST Q_
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ALL CONST,' j C.O.SHALHAL L MEET THE -
REOUIREMEN'.S OF THE CODES OF NEW Certification J-N N O
YORK STATE. NOT RESPONSIBLE FOR May Be Required. �' � A �
ao i,l II II DESIGN OR CONSTRUCTION ERRORS.
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