HomeMy WebLinkAbout36468-Z ;�'SUfp t Town of Southold Annex 7/31/2011
54375 Main Road
CIOSouthold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35109 Date: 7/31/2011
THIS CERTIFIES that the building DECK
Location of Property: 1805 Jockey Creek Drive, Southold,
SCTM#: 473889 Sec/Block/Lot: 70.-2-26.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
6/3/2011 pursuant to which Building Permit No. 36468 dated 6/10/2011
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:
Addition to a Single Family Dwelling:
Rear Wood Deck, 12'x 32', as applied for.
The certificate is issued to Rubin,Lawrence&Rubin,Virginia
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Auth ed Signature
`} TOWN OF SOUTHOLD
r gUFED(�
�oo�° k�aGy 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#: 36468 Date: 6/10/2011
Permission is hereby granted to:
Rubin, Lawrence & Virginia
1805 Jockey Creek Drive
Southold, NY 11971
To: Addition to a Single Family Dwelling;
Rear Wood Deck, 12' x 32', as applied for.
At premises located at:
1805 Jockey Creek Drive, Southold
SCTM # 473889
Sec/Block/Lot# 70.-2-26.2
Pursuant to application dated 6/3/2011 and approved by the Building Inspector.
To expire on 12/9/2012.
Fees:
CO -ADDITION TO DWELLING $50.00
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $353.60
Total: $403.60
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 epmpleted 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.
New Construction: " Old or Pre-existing Building: ' (check one)
Location of Property: 0 5- -J D 0—R aZ4
House No. Street, Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section 76 Block Lot 46 , ,-2
Subdivision 2 Filed Map. Lot:
Permit No. 3 6 q6 Y Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
" V
Applica6k Signature
OF SOUlyolo
• �o
couImov
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:
C� a
DATE ~27� INSPECTOR
�oy>�OF SO�Tyo�o
36 "
couffmN
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING X,, FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR
MELD INSPEE"lxQN tEPORT DATE COMMENTS.
4 • .. 6-
FOUNDATION(IST)
ca
FOUNDATION(2ND) to
ROUGH &
PLO
PLUMBING
Ch
INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
ADDITIONAL.COMMENTS .
. o
0
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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. Check Q 60 ,00 4- q,0
Septic Form 60 �T
N.Y.S.D.E.C.
Trustees
r Flood Permit
Examined A) 20 l Siiigie&Separate
Storm-Water=Assessment Fonn
/ l Contact:
Approved /0 20 ` ivlail to:
-ove c
l j Phone:
Expiration ( � ^( ' ,20 a
D EC� EDWE
Building Inspector
dUN - 3 2011 APPLICATION FOR BUILDING PERMIT
BLDG.DEP .T Date f 3 , 20 1
TOWN OF SOUTHOLD 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.
r 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, it! 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.
(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
QWNER
Name of owner of premises L Ayr fZG t+ uC7 A • R v 9 I
(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. Location of land on which proposed work will be done:
1 C60 5 0cLcr-1 G2rEIL. olkl\!E SouT1-toc.0
House Number Street Hamlet
County Tax Map No. 1000 Section y-7 C3 Block , Lot cL fo . �-
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 No ex► S n q �r-c
b. Intended use and occupancy 0 a Q E(LS OW A L UK E.
3. Nature of work(check which applicable): New Building p>;c. ._ Addition Alteration
Repair Removal Demolition Other Work ;A
(Description)
4. Estimated Cost", 5 (DO Fee �/ .4,"�.� ,
(To be`paid'on filing this application)
5. If dwelling, number of dwelling units N 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. , NJ A
7. Dimensions of existing structures, if any: Front Ni A Rear •Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front NIA Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front 3 Rear 33L Depth -
Height a� Number of Stories
9. Size of lot: Front 18 O ' Rear (aZ 0 Depth Z 2 2 S
10. Date of Purchase q Name of Former Owner CZ0 G V:,2 i ►L(L 0e,
`I1 Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X
13. Will lot be re-graded? YES NO X Will excess fill be removed from premises? YES NO X
14. Names of Owner of premises 1-(kw az,E-« R-vasi Address (rdoS JOCKS-Y ceSC-ic. Phone N06 2,0 76 5`16"
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 REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO %4
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey;to 'sc"ale, with accurate foundation plan and distances to property lines.
17. If elevation at any po.i t 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 X
* IF YES; PROVIDE A;COPY?. � �+
STATE OF NEW YORK)
SS:
COUNTY OF �� )
L A w(L�_0 L 6 A Q )0 being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named, CONNIE.D.BUNCH
Notary Public,State of New York
(S)He is the No.01BU61;85050
(Contractor, Agent, Corporate Officer, etc.) Qualified in Suffolk UOUnIV
Commission Expires Aprii 14.:P_W__
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 .
�j r j day of 20
Notary Public Signature of Applicant
i
1
�.� Town of Southold.
N Erosion, Sedimentation & Storm-water Run-off ASSESSMENT FORM I
PROPERTY LOCATION: S.C.T.M.# THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
C1 j MCI X A(o I- STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
Ti si fnct e3 won I- r — CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No
a. What is the Total Area of the Project Parcels? 1 .Will this Project Retain All Storm-Water Run-Off
(Include Total Area of all Parcels located within Generated by a Two(2")Inch Rainfall Site?
the Scope of Work for Proposed Construction) on
(S.F./Acres) (This.item will include all run-off created by site
b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all —
and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of i
construction activity? - impervious surfaces.) !;
(S.F.l Acres) !�
2 Does the Site Plan and/or Survey Show All Proposed
PROVIDE BRIEF PROJECT DESCRIPTION (ProvldeAakrdonatpagesasNee� . Drainage Structures Indicating Size&Location?This
Item shall include all Proposed Grade Changes and - — M I
25 A L k V A L ID V F_L V Slopes Controlling Surface Water Flow.
3 Does the Site Plan and/or Survey describe the erosion f
and sediment control practices that will be used to =
control site erosion and storm water discharges. This
item must be maintained throughout the Entire
Construction Period. f
4 Will this Project Require any Land Filling,Grading or cI
Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards
of Material within-any Parcel?
Ij Will this Application Require Land Disturbing Activities !
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.)Square Feet of Ground Surface?
6 Is there a Natural Water Course Running through the
Site? Is this Project within the Trustees jurisdiction i
General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or — —
Submission of a SWPPP is required for all Construction activities involving son Beach?
disturbances of one(1)or more acres: including disturbances of less than one acre that
Grade Slopes
T Will there be Site preparation on Existing ill ultimately disturb one or more acres of land
which Exceed Fifteen(15)feet of Vertical Rise to
are part of a larger common plan that w +;
Including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? j
the DEC has determined that a SPDES permit is required for storm water discharges. 1:1
(SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious I
for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off
1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right of--way? — !{
submitted to the Department prior to the commencement of construction activity.
2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, / {
required,post-construction storm water management practices that will be used and/or Removal of Vegetation.and/or the Construction of any
constructed to reduce the pollutants in storm water discharges and to assure • Item Within the Town Right-of-Way or Road Shoulder
compliance with the terms and conditions of this permit.In addition,the SWPPP shaft Area?(This Item writ Nor intrude ure installation Driveway
identify potential sources of pollution which may reasonably be expected to affect the on o vewa y Aprons.)
quality of storm water discharges. . NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark I
1.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between S,000 S.F.&1 Acre in area,
component shall be prepared by a qualified Design Professional Licensed in New York a Storm Water,Grading,Drainage&Erosion Control Plan is Required by the Town of
that is knowledgeable in the principles and practices of Storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit I
(NOTE A Check Mark(.(r)and/or Answer for each Question is Required for a Complete Appricau0n)
i!
STATE OF NEW YORK,
COUNTY OF SS
. I�
That I, being duly sworn,deposes and says that e t for Permit,
.............................................................
(Name of individual signing Document) � il�� ���
And that he/she is the -NotaryPublic,State of New York
...................................................................................::........... fVo:04i31Jt3186064....... .....
(Owner,Contraclor.Agent,Corporate Officer,eta)
Qualffied in Suffolk County
Owner and/or representative of the Owner or Owners,and is duly authorized to perfi; p Clp� yd 0d�*bjs 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 herewith.
Sworn to before nle this;
„
,
........................... ..............day of....... ... ,2U..�..�
Notary Public: ........... ?Yl.`^!' .............. .........:...[.,....
.......................................................
(Signature of Applicant)
.FORM - 06/10
BUILDING PERMIT EXAMINER CHECKLIST Date Submitted: -I I Date Reviewed: 6P
a
Applicant: �? Owner:
Architect/Engineer: Estimated Cost:
SCTMO 100d Subdivision: Zone: Conforming?
�Aa _ p A
Property Address: �0� '42 � I� L city: Pre COs?
Building Permits (Open/Expired): BP -Z/C/0 Z- ,Info: BP -Z/C/O Z- ,Info:
BP -Z/C/o Z- , Info: BP -Z/C/o Z- ,Info: BP -Z/C/0 Z- ,Info:
Single&Separate Search Required? Y o UNe-terfiiination:
STaRMI� Rtt,M qF,
REQ. Lot Size: ACT. Lot Size: REQ. Lot Cov. ACT: Lot Cov.
REQ.Front ACT.Front RVQ Side ACT. Side REQ. Rear PROP. Rear
REQ. Height. ACT. Height R E ct,AmTH SIDES A C T
Proje Des iption: awjxl?- ~ 6az_ a- v-w,
Waterfront? Y o
If yes, water body: �� Panel# Flood Zone: B..ulkhead/Bluff Distance:
ADDITIONAL APPROVALS REQUIREDLgN 5� � SIGNED, SFr1LED SuRVtY
Suffolk County Health: Y or - If yes, *Bed#: *Date: / / *.Permit#' Town Septic. Y N
- If no, certification required: Y or N Received: Y or N By:
NYS DEC: PRE-DEC 9/1/75 Y or Ia- Date: —/—/ - Permit#: or NJ Letteir-Notes:
Southold Trustees: Y or I9- Date: / / Permit#: or NJ Letter=Notes;
Southold ZBA: Y org- Date: _/ / Permit#: -Notes:
Southold Planning: Y or@- I)ate: / / Permit#: -Notes:
Town Landmark C of A: Y olgDTE: /_/_ *NYS CODE Compliance(page 2 . .Y r N
CoNTRhCToIQ IIC�NSf; DIS�4B1LIT9 L1ttB11,1Ty. .....1�i/0kk1!1ENS. CoMpF,,V 4 I7YW
Notes:
Fee Structure: Calculation:
Foundation: SF 3 S x $ �0-$
First Floor: SF + Initial Fee: $ aL-0 0 U O
Second Floor: SF +Additional Fee
Other: SF SF X $ . =$
Total: SF +Initial Fee: $
C OF o FEE
-ts.D 0 O+Additional Fee (�: $,
AS BUILT FEE TOTAL: $ -5;3 m ��
NEW YORK STATE CODE COMPLIANCE CHECKLIST
CLIMATIC/GEOGRAPHICDESIGN CRITERIA:
.Ground Snow Load:20 Wind Speed: 120MPH Seismic Design Category:B
Weathering: Severe -Frost Depth:36" Termite: M-H Decay: S-M
Design Temp: 11 Ice Shield Underlay:YES Flood Hazards:
USE/OCCUPANCY CLASSIFICATION:
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION:
DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE
FULL FRAMING DESIGN ELEMENTS: YIN
HEADERS: Y/N' WALL STUDS: Y/N GIRDERS: Y/N
CEILING JOISTS: Y/N jFLOOR JOISTS:Y/N ROOF RAFTERS: Y/N
LUMBER SPECIES AND GRADE: Y/N
WINDOW AND DOOR SCHEDULE:
MISSLE TEST REQUIREMENTS: Y/N
EGRESS 5.7 S.F.: Y/N
LIGHT 8%: Y/N
TENT 4%: Y[N
NAILING/CONSTRUCTION SCHEDULE: Y/N
MEANS OF EGRESS: Y/N
PLUMBING RISER DIAGRAM: Y/N
LOCATION OF DIRE PROTECTION EQUIPMENT: Y/N
TRUSS DESIGN: Y/N
CERTIFICATION: Y/N
ENERGY CALCS: Y/N (RESCRECK)
TOTAL CGMPLIENCE? Y/N (RETURN TO PAGE ONE)
t
APPROVED AS NOTED
DAT B.P.# �YJ
FEE
NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION-TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH-FRAMING,PLUMBING,
STRAPPING, ELECTRICAL&CAULKINGp�s
3. INSULATION 1��
4. FINAL-CONSTRUCTION&ELECTRICAL:
MUST BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR 1�
DESIGN OR CONSTRUCTION ERRORS.
" o e. Q,�MPosit-�
w"'V& ova
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COMPLY WITH ALL CODES OF -
NEW YORK STATE & TOWN CODES �
AS REQUIRED A
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