HomeMy WebLinkAbout34523-Z FORM NO. 4 -
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of .the Building Inspector"
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No; 'Z-33G20 Date: 03/25/09 •`
THIS CERTIFIES 'that the building ADDITION
' 1
Location of Property: 49450 CR 48 SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County: Tax Map No. 473889 " Section 55 Block 3 Lot 5
f
Subdivision Filed Map No_ Lot No.
conforms substantially to the Application for Building Permit heretofore
: filed in this office dated MARCH 18, 2009 pursuant to which
Building Permit No. 34523-Z dated MARCH 24, .2009
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 TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to MAR IANNE SAWICKI
(OWNER)'
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLUMBERS CERTIFICATION DATED N/A
1
-Aut&rized Signature
`Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DIJPARTIVIENT
TOWN HALT
765-1802
APPLICATION FOR.CERTIFICATE OF OCCUPANC MAR' 1`8 2009
This application must:be filled in by typewriter or ink and submitted to the Building Dep ent wi �L
_TOWN Of.SOUTHOLD
A. For new building or new use:
1. . Final survey of property with accurate location o€.all buildings,property lines,streets,and unusual natural or
topographic features..
. .2: Final Approval fin 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 installation' -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)nonconforming 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$25.00 Additions to dwelling$25.00,Alterations to dwelling:$25.00,
Swimming pool$25.00,Accessory building$25.00;Additions to accessory building$25.00,.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 Occupariey-Residential'$1.5:00;Commercial$15.00
Date. M'fi
New Construction Old or.Pre-existing Building: (check one)
Location of Property:
House No. Street Hamlet
Owner:or Owners of Property: .m /V /1 P 9,4610 i`Ck c
Suffolk County Tax Map No 1000,Section—L% Block_ _Lot ,
Subdivision Filed.Map, Lot:
Permit No Date of Permit:_ Applicant: : :
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: .
Request for: Temporary Certificate Final.Certificate: (check one).
Fee Submitted: $ 0, . C)
C� j � Applicant Signature
Fonn No.6
>> TOWN OF SOUTHOLD
BUILDING DEPARTMENT &mentwith
2 �n '� "
?" TOWN, HALL' 15 U
765'1802
APPLICATION FOR CERTIFICATE OF OCCUPANR 18 2009
This application must be filled in by typewriter or ink and submitted to the Building Dep !LN Of SOUTHOLD
'A. For new building or new use: r
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.64pre-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
L Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00,
Swimming pool$25.00,Accessory building$25.00'.Additions to accessory building$25.00,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-150.00
5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00
Date. lffq ff,C4
New Construction: Old or.Pre-existing Building: (check one)
Location of Property: / �' '"fin G 1 &ag [f
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section Block _ _Lot
Subdivision Filed Map." Lot:
Permit No. Date of Permit. Applicant:
`Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for.: Temporary Certificate Final Certificate: (check one).
Fee Submitted: $
Applicant Signature
FORM N.O. 3
TOWN OF S.OUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING. PERMIT
(THIS PERMIT MUST' BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION. OF THE WORK AUTHORIZED)
PERMIT NO. 34523 Z Date MARCH 24, 2009
Permission is hereby granted to: t
HOWARD & MARIANNE .SAWICKI
PO BOX 6.72
SOUTHOLD,NY 11971
for .
"AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
at premises located at 49450 CR 48 SOUTHOLD
County Tax Map No. 473889 Section. 055 Block 0003 Lot No. 005 ,
pursuant to application dated MARCH 18, 2009 and approved by the
Building Inspector to expire on. SEPTEMBER 24, . 2010 .
Fee $ 400 00
Authorized Signature
ORIGINAL
Rev. 5/8/02
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. ZO--3 4:� Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined ,20 noq Storm-Water Assessment Form
7— Contact:
Approved ,20:�7 Mail to:
Disapproved a/c Phone: .7(e s - K60
Expiration ,20__ja q-
D -
(C E Q V c' � Building Inspector
MAR 18 2009 APPLICATION FOR BUILDING PERMIT
Date � ( � , 20�
BLDG.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 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.
l� 'L 'CO-6u r
(Signature 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
n w n '22
Name of owner of premises ljq 9 h S/g�l���(,r,
(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.
Other Trade's License No.
1. Locatio of land on which proposed work will be done:9P
50 NO fau 26fi D `1
House Number Street Hamlet
,6 5�
County Tax Map No. 1000 Section Blbcic Lot s
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 Dee-le__ 6 FF l ewse
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 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 Rear Depth
Height Number of Stories _ r -�--
if� ls�L1
Dimensions of same structure with alterations or additions: Front ar 7�_ a
Depth Height Number of Stores
8. Dimensions of entire new construction: Front Rear i1 Pepth 3
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase o?0 Name of Former Owner H0eA) fU lV f?1& 44&E kk(
11. Zone or use district in which premises are situated &5i o:en i i n 6
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO e/
13. Will lot be re-graded? YES NO ✓Will excess fill be removed from premises? YES NO
Sooi76 in
14. Names of Owner of premises ORRIkMN� YAU) uAddress 'yQ fO MIA 64C Phone No.4e3 l- S l q-/ 9 9 5/
Name of Architect Address Phone No
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 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 Y RK)
SS:
COUNTY OFSUI(�
1 �
being duly sworn, deposes and says that (s)he is the applicant
(Name of 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 be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of Gam— 20 a�'
Vi TOMset
Notary Public Stateeo of New York ,�� �r
�QGc� No.01°f06190696
QFdTied in Suffolk County Signature of Applicant
Notary Public Commission Expires July 28,20 ��i
OF SO(/jyolo
3 Z
cOUMY,�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:
ru�
DATE / INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
b
FOUNDATION(1ST) y
c rA
FOUNDATION(2ND)
H
ROUGH FRAMING& 1 \v
PLUMBING H
Q�
C x
INSULATION PER N.Y. `�y
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
t i 0
z
m
X
b
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0
H
x
d
b
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To:Pat Page 2 of 2 2009-03-24 13:10!12(GMT) 6317614-3516 From:Joseph Fischetti,PE
PROFESSIONAL.ENGINEER
1725 HOBART.ROAD 1 PO Box 616 SOUTHOLD, NEW YORK 11971
TEL: 631.765.2954 FAX:631.614.3616 e-mail:josephafischett'i.com
Dat6: . March 24, 2009
Reference: Sawicki /49450 North Road. .
Southold Building Dept
PO Box 1179
Southold, NY 11971
Dear Mr.,Verity,.
I have inspected the:as built wood framed decks. I certify to'the best of my knowledge
that the decks have-been constructed in accordance with New York State Building Codes and
reflect the as build plans submitted to the Town.
t�. + .
Joseph Fischetti, PE
do g Town , . of Souuthbid
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
1y�- PROPERTY LocarloN: s.c.T.M. THE FOLLOWING ACTIONS MAY REQUIRE'THE SUBMISSION OF
STORM-WATER,GRADING,DRAINAGE AND,EROSION CONTROL PLAN'
District 8 ctlon Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN.THE STATE OF NEW VOW.
——-.——--— ——-——————— ——————-——— —————— ——————
77
Item Number; (NOTE: A Check Mark(4).for each Question is Required fora Complete Application) Yes No
No
Will-this Project Retain All.Stotin-Water Run-Off Generatedbya Two(2")Inch Rainfall on Site? r —
(This item will include all run-off created by site clearing and/or construction activities as well as all Site
Improvements and the permanent creation of impervious surfaces.).
2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location?
This.Item shall include all Proposed Grade Changes'and Slopes Controlling Surface WaterFlowl El
3 Will thisProject RegUire any LandFilling,Grading or Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel?
4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of
Five Thousand,(5,000)Square Feet of Ground Surface? —
$ Is there a Natural Water Course Running through-the Site?
Is this Project within the Trustees jurisdiction or within One Hundred(100').feet of a Wetland or Beach?
6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen(15)feet of Vertical Rise to .
One Hundred(1Q0`)of Horizontal Distance?
7 Will Driveways,Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run Off'
into and/or in the direction of aiTown right-of-way?
8 Will this Project Require the Placefnent of Material;Removal of Vegetation and/or the Construction of
any Item Within the Town Right-of-Way or Road Shoulder Area? a
(This item will NOT include the Installation of Driveway Aprons.)
9 Will,this Project Require Site Preparation within the One Hundred(100)Year Floodplain of any Watercourse? .
J
a
NOTE: If Answer to.Questions One through Nine is Answered with a Check Mark in the Box, aStorm-Water,Grading;
Drainage&Erosion Control Plan is Required and Must be Submitted for-Review Prior to Issuance of Any Building Permitl
----------------=--- --= - ---------
EXEMPTION: —— - —————————
Yes" No
Does this:project meet the minimum standards for classification as an Agricultural Project? -
Note: If You Answered Yes to this Question,a Storm-Wafer,Grading,Drainage&.Erosion Control Plan is NOT Requ)redl X
----•'•---.------,--*-------------------.------ ————— ----
STATE OF.NEW YORK,.
COUNTY OF.... ..�f.::,............................SS
That I 1 i9.2/.`.�.n n �,,
r
...... :/ ... �..�14..being duly sworn,deposes and says that he/she is die applicant for Permit,
...................... ............ ....
(Name of individual signing Document)
'And that he/she is the ....................................................... .L.tl:(. ............ ................................................................................
(Owner,Contractor,Agent,Corporate Ofricer,'etc.)
Owner and/or representative of the Owner of Owner's;and is duly authorized to perform or have performed the said work and to
' Blake 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 herewith.
Sworn to before me-this;
y
y,
1
f't-(
State of New Y _
Notary Public:. ....... ...........................:....................Ne} .No Ol VICKI TOTH . . �ign.
:..: :`f06190696 Applipnt)
Qualified' •
FORM - 06/07. mmisslon pjres July 28,2
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OCCUPANCY OR
rAX IOf USE IS UNLAWFUL
J WITHOUT CERTIFICATE
OF OCCUPANCY
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e'z /I pf DATE: �' Z / Pa.P N L,L-./._.!7
a f NOTIFY BUILDING DFPAFITFOi N-, ,o
I
N1 .•. J' A� 765-1802 9-ARA TO ItPIU I-OP Ifal
?�Q` %k FOLLOWING INbPEC'11' Y;S
�1•A tjt 1; FOUNDATION • .TWO HEQtsertED
rAX LOf FOR POURED CONCRETE
p 2. ROUGH FRAMING $ PLUMBING
PdT� 6./ 3,..INSULATION
RE - 4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C.O. j
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY +
QED CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
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ALL., COI STF, , ION iC,O L �.1._ I TFI C% z
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YORK STATE. NOT REcrONSI'aLE FOR 0
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PURSUANT TO CHAPTER 236 V Z
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