HomeMy WebLinkAbout42714-Z �o�SufFOL/( , Town of Southold 7/25/2018
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P.O.Box 1179
W 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39798 Date: 7/25/2018
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 5503 Main Bayview Rd., Southold
SCTM#: 473889 Sec/Block/Lot: 78.-7-5.6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/16/2018 pursuant to which Building Permit No. 42714 dated 5/23/2018
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:
EXTERIOR STAIRWAY WITH LANDING TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Blanchard,Frederic&Beatrice
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
th d Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
CA
o 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#: 42714 Date: 5/23/2018
Permission is hereby granted to:
Blanchard, Frederic
170 John St Apt 5C
New York, NY 10038
To: construct exterior stairway with landing to existing single-family dwelling as applied for
per flood permit.
At premises located at:
5503 Main Bayview Rd., Southold
SCTM # 473889
Sec/Block/Lot# 78.-7-5.6
Pursuant to application dated 5/16/2018 and approved by the Building Inspector.
To expire on 11/22/2019.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00
CO -ADDITION TO DWELLING $50.00
Flood Permit $100.00
Total: $350.00
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Bu spector
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. f Y 1n l G
_New Construction: 2 Old or Pre-existing Building: (che�]ck one)
—Location of Property: d J Gt'1� J � 1
House No. / Street � I Hamlet
—Owner or Owners of Property: &D� �C a.ttl S'� /�, 6 �P`'() PE_Q U ERL1A1 Q
Suffolk County Tax Map No 1000, Section 07906 Block 0700 Lot 0 G! 6 =6
Subdivision Filed Map. Lot:
Permit No. VDate of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
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Fee Submitted: $ `JCS . an
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# # TOWN OF SOUTHOLD BUILDING DEPT.
cou765-1802
/ . INSPECTION
[,4 FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
Ac A-&/
DATE ANSPECTOR
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OF 0//T,�°�
TOWN OF SOUTHOLD BUILDING DEPT.
couffm 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] F NDATION 2ND [ ] INSULATION
[ FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ _] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REM KS: oz
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DATE INSPECTOR
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# TOWN OF SOUTHOLD BUILDING DEPT.
CCU 765-1802
1 NSPECTION-
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FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] LNSULATION
[ ] FRAMING /STRAPPING [ "FINALrov �' ►t�S
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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DATE Y3 INSPECTOR 04L
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FIELD INSPECTION REPORT DATE COMMS S
FOUNDATION(1ST)
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'FOUNDATION
-----------------------------------'FOUNDATION (2ND)
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INSULATION PER N.Y. a y
STATE ENERGY CODE
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ADDITIONAL COMMENTS
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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 f Building Plans
TEL: (631) 765-1802 Tanning Board approval
FAX: (631) 765-9502 ✓� f J� Survey
Southoldtownny.gov PERMIT NO. of C —1 ec
Form
F1.i�. .E.C.
es
.O pplication
Flood Permit
Examined 20� �n le&Separate
D � > VE Tis Identification Form
D -StQxm-Water Assessment Form
�3 MAY 1 6 2018 Contact:
Approved 20 —}Mail-to:
Disapproved a/c14 �' ' iq�s`b �� •
TOWN OF SO LD Phone: 0Z
Expiration 20 /14
Bui ' g spector
APPLICATION FOR BUILDING PERMIT
Date , 20
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 6f 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,c e, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signa a of applicant name, ' corporation)
3 M tw iC et Gv dkaq�
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
ow N'6<
Name of owner of premises &I-MC A-I* 96W6-- � lC' r2(� 16 <UCJ<!VA"1'1
(As on the tax roll or latest deed)
If applicant is a corporation -sigriat-ure of duly authorized officer
(Name acid title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
-Otho TLicense No. LJ
1. Location of land on which proposed work will be done:
5_501 , MCGIM ."°Aw �q 0 3�v wyf (Ctl I
House Number Street Hamlet
County Tax Map No. 1000 Section Q_1e00 Block Q '700 Lot 00 506� 4DOO
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 C_er6 zi G� A()Q j1�ON
3. Nature of work (check which applicable):New Building Addition X Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost G G , CFee
�-t o
f,c weCloo b aaid on filing this application)
5. If dwelling, number of dwelling units �' mb0 of fl�ng chit n,each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify natiire`and extent of eac l' pe of use.
7. Dimensions of existing structures, if any: Front .-Rear-,7 Depth
Height Number of Stories���'--UF Uv3,,�1 i=�p
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 4l i s n o t b Name of Former Owner 1P mow 1-k-OM c-S fn,L
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO_X1
13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO
s 5Ai mregXt C�(7)gi5 %6S
14. Names of Owner of premises l�L1fih�'��PQ Address„�a� rLudCr`�{ Phone No.
Name of Architect Address i% L(-fs:f r�Phone No Q 3
Name of Contractor I 5 Addresstj� A 1jbk one N
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
* 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)
' .�,�iS�S:
COUNTY OF��/L '
h
9 �A being duly sworn, deposes and says that(s),he is the applicant
�:C)NNIE D. BUNCH
ame of individual signing contract)above named, Notary Public,State of Neel`toric
No.01 BU61✓35050
ied in Suffoik County
(S)He is the omiss on Expires April 14,2 f
(Contractor, gent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the sai rk and to make and file this application;
that all statements contained in this application are true to the best of his kno lief; t the work wi H be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of 20
Notary Public oignalure 01-1<pIfficant
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ILEGl5riZnR OF VITA.STATI51lcs
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RECORDS MANAGEMENT OITICEII �O�
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FREEDOM OF INrORMA-nON Of"CER
O FF ICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993:
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under the Flood Damage Prevent regulations
of, the Code of the Town of Southold: "Floodplain Development, Permit
Application" (FDP(93) ) , and `Certificate of Compliance (fIr Development in
Special Flood Hazard Area [C//C(93)] .
B1_JV. DEPT
TOW;;OF SOU-MOLD
/J u i�t/h T. Te-rry
Southold Town Clerk
August 25, 1993
APPLICATION
PAGE 1 of 4
TOWN OF SOUTHOL.D
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate.
SECTION I GENERAL PROVISIONS (APPLICANT to read and sign)-
1. No work may start until a permit is issued.
2 The permit may be revoked if any false statements are made herein.
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
S. The permit will expire if ao work is commenced within six months of issuance.
6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory
requirements.
7. Applicant hereby gives consent to the Local Administrator-or his/her representative to make cmasonable
inspections required to verify compliance.
8. I,THE APPLICANT,CERTIFY THA ALL STATEMENTS HEREIN AND IN ATTACHMEN'CS TO
_ THIS APPLICATION ARE,TO TH WLEDGE,TRUE AND ACCURATE.
(APPLICANT'S SIGNATURE) DATE
/SECTION l: PROPOSED DEYELOPIr4NT 7,L completed by APPLICA M
NAME AD D R ESS TELEP H ONE
APPLICANT G
hbuo
-
BUILDER -
ENGINEER
PROJECT LOCATION:
To avoid delay in processing the application, please provide coouph information to easily identify the project
location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or well-known landmark A sketch atlachcd to this application showing
the project location would be helpful.
S7 0,3 8 FkDAA 7F6 1,0
Ste
FDP(93)
ry r
r
APPLICATION
PAGE 2OFa
DESCRIPTION OF WORK (Check all applicable boxes)
A. STRUCTURAL DEVELOPMENT
,AMVITY STRUCTURE TYPE
❑ New Structure Residendal (1-4 Family)
Addition O Residential (More than 4 Family)
❑ Alteration ❑ Non-residcuGal (Floodproofing? O Yes)
O Relocation O Combined Use (Residential & Commeraal)
❑ Dcmdlitioo' P ❑ Manufactured (Mobilo) Home (In Manu-
0 Replacement factured Home Park?. ❑ Ycs)
ESTIMATED COST OF PROJECT S
B. OTHER DEVELOPMENT ACTIVITIES:
O Fill O Mining O Drilling O Grading
❑ Excavation (Except for Structural Development Checked Above)
❑ Watercourse Alteration (Including Dredging and Channel Modifications)
O Drainage Improvements (Including Culvert Work)
j ❑ Roaftt, Street or Bridge,Construction
❑ Sub/division (New or Expansioo) j
,1 O �Pdmdual Water or Sewer System J
G Otber (Please Specify) -zz4&id`s
After completing SECTION 2r APPLICANT should submit form to Local Administrator for review-
SECTION 3• FLOODPLAFN DETERMINATION (To be completed by LOCAL AQNUMSTRATOIZ)
The proposed development is located on FMIA Panel No. . Dated
The Proposed Development:
❑ Is LDI located in a Special Flood Hazard Arca (Notify the applicant that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
O Is located in a Special Flood Hazard Arca.
FTRM zone designation is
100-Year flood elevation at the site is:- Ft. NGVD (MSL)
O Unavailable
❑ The proposed development is located in a (loodway.
FBFM Panel No. Dated
❑ See Section 4 for additional iostruct;ons
SIGNED DATE
APPLICATION 4
PAGE 3 OF 4
SECTION 4: ADQfTI NAL INFORMATION REQUIRED To he com leted by LOCAL ADMINIS-FRATOR
The applicant must submit the documents checked below before the appficadon can be processed:
O A site plan showing the location of all existing structures, water bodies, adjacent roads, lot
dimensions and proposed development.
Cl Development plans,drawn to scale, and specifications,including where applicable: details for
anchoring structures, proposed elevation of lowest floor(including basement), types of water
resistant materials used below the first floor, details of floodproofwg of utilities located below
the first floor and details of enclosures below the first floor.
Also
O Subdivision or other development plans(If the subdivision or other development axceeds 50
lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations
if they arc not otherwise available).
❑ Plans showing the extent of watercourse relocation and/or landform alterations_
❑ Top of new fill elevation Ft. NGVD (MSL)-
0 Floodprooftng protection level (non-residential only) __ Ft:NGVD (MSL). For
floodproofed structures, ippUcaot must attach certification from r�gislered engineer or
_ architect. /
Cl Cerffication from aIregistercd engineer that the proposed acdvtt�in a regulatory floodway
will not result in any increase in the height of the 100-year flood. A copy of all data and
calculations supporting this funding must also be submitted.
❑ Other.
SE(;TIQN S PERMIT DETERMINATION (To be completed by LOCAL ADMINJaRA OR)
I have determined that the proposed activity. A. O Is
B. ❑ Is not
in conformance with provisions of Local Law , 19_. The permit is issued subject to the conditions
attached to and made part of this permit.
SIGNED , DATE
If BOX A is checked, (be Local Administrator may issue a Development Permit upon payeneol of designated
fee
If BOX B is chocked, the Local Administrator will provide a written surnmary of deficiencies. Applicant may
revise and resubmit an application to the Local Administrator or may request a bearing from the Board of
Appeals
• APPLICATION ff
PAGE 4OF4
APPEALS. Appealed to Board of Appeals? ❑ Yes ❑ No
Hearing date:
Appeals ---
Conditions
SECTION 6 AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of COmDlianee
is issued
The following information must be provided for project structures. This section must be completed by a
registered profession ga] engineer or a licensed land surveyor (or attach a certificadon to this application).
Complete 1 or 2 below.
1. Actual (As-Built)Elevation of the top of the lowest floor, including basement(in Coastal Hieh Hazard
Areas• bottom of lowest structural member of the lowest floor, excluding piling and columns) is:
FT. NGVD (MSL).
L Actual (As-BuUt) Elevation of floodproofung protection is FT. NGVD (MSL).
NOT Any work performed prior to submittaliof the above information is at the risk/if the App%cant.
f J
,SECTION 7 COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based oa inspection of the project to
ensure compliance with the community's local law for flood damage prevention.
INSPECTIONS: DATE BY DEFICIENCIES? O YFS O NO
DATE BY DEFICIENCIES? ❑ YES O NO
DATE BY DEFICIENCIES? ❑ YFS O NO
SEC'T'IONS CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADh4INISTRAT R
Certificate of Compliance issued: DATE: BY:
Attachment B
'r � BAMP,i,E
/ CERTIYCATE j7F COMPLIANCE
1 ill 11
for Development in a Special Flood Hazard Area
! i 1
i TOWN OF SOUTHOLD
CCRnFICA.TC OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
(OWNER MUST R-EITA1N THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
❑ NEW BUILDING
❑Ej(ISTING BUILDING
❑ VACANT LAND
' J
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THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_.
SIGNED: DATED:
B. COMPLIANCE IS HEREBY CERTIFIED WITH TUE REQUIREMENTS OF
LOCAL LAW # , I9_, AS MODIFIED BY VARIANCE #
DATED
SIGNED: DATED:
C /C ( 93)
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/ AS FILE NO. 114.64 Thomas C. Wolpert, Professional Engineer $�E�
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