HomeMy WebLinkAbout37172-Z g�FFOt,f�o Town of Southold Annex 5/3/2012
P.O.Box 1179
54375 Main Road
,d x
oy �` Southold,New York 11971
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CERTIFICATE OF OCCUPANCY
No: 35575 Date: 5/3/2012
THIS CERTIFIES that the building AS BUILT DECK
Location of Property: 675 Maier Pl, Southold,
SCTM#: 473889 Sec/Block/Lot: 55.-6-28
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
4/20/2012 pursuant to which Building Permit No. 37172 dated 4/26/2012
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" 326 sa ft deck addition to an existing one family dwelling as applied for.
The certificate is issued to Jelenkovic,Bruno&Jelenkovic,Laura
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Au ed ign ure
o�gU ��co TOWN OF SOUTHOLD
Gym BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
oy • 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#: 37172 Date: 4/26/2012
Permission is hereby granted to:
Jelenkovic, Bruno & Jelenkovic, Laura
675 Maier PI
PO BOX 683
Southold, NY 11971 -
To: construct a 326 sq. ft. "As Built" Deck as applied for
At premises located at:
675 Maier PI, Southold
SCTM # 473889
Sec/Block/Lot# 55.-6-28
Pursuant to application dated 4/20/2012 and approved by the Building Inspector.
To expire on 10/2612013.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $660.80
CO -ADDITION TO DWELLING $50.00
Total: $710.80
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:
l. 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 fi-om 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 buitdings (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. /
New Construction: ✓ Old or Pre-existing Building: (check one)
Location of Property: a,(p& 66a
House No. Street Hamlet
Owner or Owners of Property: P_A.4&XZ cL_ p� ,l/(� � :.�✓LCI
Suffolk County Tax Map No 1000, Section 55 Block Lot o2
Subdivision Filed Map. Lot:
Permit No. o Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: V (check one)
Fee Submittecl: $ 150, eO?
Applicai Signature
��pF SOpr�o
cou
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN TION
[ ] FRAMING/STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR �`�
QCLD DAZ', C�NIlVl1TS•
FOUN)?ATlON ZS I
r. .......ti�.r....r �..........
FOUNDATION(2ND)
. o
ROUGH 3112T1vO& y
PLU-MlxG
INSULATION PVITL N.Y.
STATE 30.BMGY CbDB.
Ewa
IN
ADDITIONAL.C.01Y111NTS .
TO*& O " 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-1- �-� ofV+
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 `v Survey e�A C'i cQk
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined X ,20t>�- Single&Separate
Storm-Water Assessment Form
Contact:
Approved ,20 Mail to:
Disapproved a/c
Phone:
Expiration 20J
E C E W E Building Inspector
Q V PLICATION FOR BUILDING PERMIT
APR 2 0 2012
. Date
INSTRUCTIONS
BLDG.DEPT.
pletely 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 1S 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. (Signa e of applicant or name, if a corporation)
(Mailing address of applicant) �) 9 7 /
!
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
IN IV
Name of owner of premises /'? l,f iV V -J—P- L E-Nk 0 V 1 C
(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:
CO f!5 M 41 O tit`T'(-�O L -)>
House Number Street Hamlet
County Tax Map No. 1000 Section Block c0 '. 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
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work >C
(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
Dimensions of same structure with alterations or additions: Front - Rear
Depth Height Number of Stories`
8. Dynensionsof entire new construction: Front / .S� Rear asp$_ Depth l fo S- 9
eight �'9 Number of Stories o N e
� �
9. Size of lot: Front / OO Rear 100 Depth
10. Date of Purchase q� Name of Former Owner
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 A Will,excess fill be removed from premises? YES NO X
gP,t4AlO + C4144-1i 07S M6/EO PLOCE
14. Names of Owner of premises TE LENl�o y/G Address SowrHvoD,N YPhone No. 7!os -a /rf
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 X
* 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)
SS:
COUNTY OF St,{FM
y, K}-k4 P- E 1,EW)4-0 V 1 G being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the W AJ C/Z
(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
'7 day of /q-P2/1r 20 l 91,
I7��� �_ ��� MARGARET C. RUTKOWSIG No Notary PuNo,982528 ignature of AfVicant
Qualified in Suffolk County
Commission Expire&.;June 3.
Town of Southold
N Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M.#:
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
i�'strict section Nock. Lot 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?
(Include Total Area of all Parcels located within Will this Project Retain All Stom>-Water Run-Off
the Scope of Work for Proposed Construction) Generated by a Two(2")Inch Rainfall on Site?
(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 forthe proposed Site Improvements apd the permanent creation of
construction activity? (S.F.I Acres) impervious surfaces.)
PROVIDE BRIEF PROJECT'DESCRIPTION (Provide Adalt oral Pages as tJeedec0 2 Does the Site Plan and/orSurvey Show All Proposed
Drainage Structures Indicating Size&Location?This
Item shall include all Proposed Grade Changes and — FZT .
Slopes Controlling Surface Water Flow.
3 Does the Site Plan and/or Survey describe the erosion .
and sediment control practices that will be used to D
control site erosion and storm water discharges. This —
item must be maintained throughout the Entire
Construction Period.
4 Will this Project Require.any Land Filling,Grading or
Excavation where there is a change to the Natural El
Existing Grade Involving more than 200 Cubic Yards
of Material within any Parcel?
rj 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
General DEC SWPPP Requirements-: or within One Hundred(100')feet of a Wetland or El'
—
Submission of a SWPPP Is required for all Construction activities involving soil Beach?
disturbances of one(1)or more acres;including disturbances of less than one acre that 7 Wilt there be Site preparation on Existing Grade Slopes
are part of a larger.common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to
including Construction activities involving soil disturbances of less than one(1)acre where
the DEC has determined that a SPDES permit is required for storm water discharges. One Hundred(100')of Horizontal.Distance? — —
(SWPP.P's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious
for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm=Water Run-Off D —
1.The SWPPP shall be prepared prior to the submittal of the NOI.The NOI 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 % f
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 shall
Identify potential sources of pollution which may reasonably be expected to affect the Area?(This item will NOT Include the histallatlon of•DdyeNiayAprone:)
quality of storm water discharges. NOTE: If Any Answer to Questions One through(Dine is Answered with a Check Mark
3.All SWPPPs'that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre in area,
componentshall 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
(NOTE: A Cherie Marc(4)and/or Answer for each Question Is Required for a Complete Application)
UUNNIE D. BUNCH
STATE OF NEW YORK, Notary Public,State of New York
COUNTY OF...........................................SS No.01 BU6185050 i
Qualified in Suffolk
�County
/fiat I................... ....being duly sworn,deposes and sa} qni to sgie t�s lileea Ii rcarit o? b
.......................................................
(Name of individual signing Document) Pp t,
And that he/she is the ��y L L t_1 /�K v / C.:.�. ............................(Owner,,tractor.Agent,Corporate......... ..- i . ...............................................................
Owner and/or representative of the 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 herewith.
Sworn to before
gime this; e
............CPV` .. ............day of ................. 20.. U,
Notary Public: ...C .IIP...... � .............. r
... .......................................
(Sigma of Applicant)
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FC LC DWING INSPECTIONS:
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DATE: 4-16-12
JELENKOVIC RESIDEN
*' 13. Cfy
o� 675 Maier!Plii66 Southold`NV '
AA
;c; q bar CHORNQ ASSOCIATES
C L` '. architects.
f' u SOUTHOLD,NEW YORK•