HomeMy WebLinkAbout36812-Z Town of Southold Annex
o�UFFOt,� 9/11/2012
y P.O.Box 1179
cz
54375 Main Road
oy � Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35940 Date: 9/11/2012
THIS CERTIFIES that the building RESIDENTIAL REPAIRS
Location of Property: 155 Woodcliff Dr, Mattituck,
SCTM#: 473889 Sec/Block/Lot: 107.-7-27
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
pursuant to which Building Permit No. 36812 dated 11/14/2011
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:
roof damage repair as applied for.
The certificate is issued to Burke,Michael&Burke,Linda
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Autho ' S' atur
r� TOWN OF SOUTHOLD
��o�SUFFoc�-�
y� 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#: 36812 Date: 11/14/2011
Permission is hereby granted to:
Burke, Michael & Burke, Linda
155 Woodcliff Dr
Mattituck, NY 11952
To: Repair roof.damage as applied for
At premises located at:
155 Woodcliff Dr, Mattituck
SCTM # 473889
Sec/Block/Lot# 107.-7-27
Pursuant to application dated 11/1/2011 and approved by the Building Inspector.
To_expire on 5/15/2013.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
CO -ALTERATION TO DWELLING $50.00
Total: $250.00
Building Inspector
Form No.6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT
TOWN HALT.
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�mpleted 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 S50.00,
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.Oecupancy-$25
4. Updated Certificate.of Occupancy- $50.00:
5_ Temporary Certificate of Occupancy -Residential$1-5.00,Commercial$15.00
Date. - . 0 V a G 1.
New Construction: Old or Pre-existing/Building: (check one)
Location of Property:
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000,Section r-7 Block Lot
Subdivision 22 Filed Map. Lot:
Permit No. 6e tg l-P- Date of permit. //
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee-Submitted: $
�Applignature
OF SOpj�o�
6
o�yc00 ,�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION ,
[ ] FOUNDATION 1ST [ ] ROUG LBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING/STRAPPING [ FINAL .
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH)-_. [ ] ELECTRICAL (FINAL)
REMARKS: Steel -
DATE - 9INSPECTOR.
FIELD INSPECTXQN REPORT DATE COMMENTS
FOUNDATION(1ST),
FOUNDATION(2ND)
W �
ch
ROUGH FRAAMQ& O
PLUNMING H
. C>
• �. Cq
INSULATION PER N.Y.
H
STATE ENERGY CODE
' 4
FINAL
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 of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 // Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
E p Trustees
E �VJ C.O.Application
D
Flood Permit
,Examined 20 1 Single& Separate
NOV — 1 2011 Storm-Water Assessment Form
Contact: w�-C j'�(,L Jp
Approved q20_(I BLDG.DEPT.
TOWN OF SOUVOLD Mail to: G L
Disapproved a/c
Phone:
Expiration ,20 (3
��N✓vim ..
i3uilding Inspector
APPLICATION FOR BUILDING PERMIT
Date , 20/1
INSTRUCTIONS
I —
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.
(Signature of a//pppl�liit or,, nnnar,ne,, ii/fa corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
ti
APPROVED AS NOTED
DATE—IlLa B.P.#
Name of owner of premises 11 tL
(As on the t i 64 ~ eFd)
If applicant is a corporation, signature of duly authorized officer O FIFY Bui,_, -
��r ���� � 765-1802 8 aP�i .
.� R FOLLOWING
(Name and title of c,rpor �, c r) 1. FOUNDAT!Or. ,
>.� rAWFUL FOR POUF J
Builders License No. " ,F
IT Plumbers License No. ���/1 � i �� u ATE 2 ROUGH-F.Api INC,
Electricians License No—� STRAPP�N" t r• �.Jf
INSULATION
Other Trade's License No. F U 4 FINAL- C0h5TRVC71Mj FLEC;
MUST BE CO NPL E1ERe CO.
1. Location of land on which proposed work will be done: SILL CONSTRUCTloo W SHA, L N4gAT TIjE
( V YORK 5�§ r � ! 6�E�
House Number Street DESIGN OR CAajTA�;
County Tax Map No: 1000 'Section V 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 ; U 477-
< Tb P.M ���*r�rA� Td o a F
b. Intended use and occupancy
3. Nature of wo �checkich applicable):..New.Buildin__g Addition Alteration
Repair Ne< Removal Demolition ;: :Other Work
6 e (Description)
4. Estimated Cost !Z G6 a — 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 nkt ir&arid'V<ront 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
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 Owner of premises Address Phone No.
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 pro.perty::is.at 10'feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? 'k YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY Ou4
'Y \A 0�_k 1/ K duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) abovecija_med;`�
(S)He is the Cn o
(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 n (
day of = '!
V d �J -
Notary Public,State of New York
No.01T06190696
Nota ublic ua i o in suffolk County Signature of App icaiit
rY Commission Expires July 28,20�C�'
Town o'f Southold
Erosion, Sedimentation & Storm-Water Run-oft ASSESSMENT FORM
PROPERTY I OCATiON�s.GT IN�: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A 41 t
�S3 cboi� s orc cl_ —� SfO—CERTIF�D BY A DESATEk IGN PROfESSI G AND EROSION O NTROL PLAN
N THE STA>l E OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION MM# /WORKASSES=wr�� yes No
a. What is the Total Area of the Proled Parcels?
(Include Total Area of all Parcels khcatW wlfflgn 1 Vni I this ft)ect Retain All Storm-Water Rtm-Oti
the scope of work for Proposed Construcgon) Generated by a T'wo M Inch pe;nIM on Site?
br What is the TotatArea of Land Cleating W AC-) Rhls•�n wi3 lndIUde a1 ft nlF aeaW by sb ' _ D
clog and/or construction oclhn'fies.as well as aq
and/or Ground Dishirbaitce for thg proposed consbucJion a~ Site Improvements and the permanent creation of
IS/Am) impervious surfaces.)
PROVIDE BRW PROJECT'DESCRwhoN �0>>,1.A yxgt Paso astladed) 2 Does the Site Plan and/or Survey Show Ati Proposed
Drainage Shmhifes Indicating Size d Location?This —
Item-shall include all Proposed Grade Changes and -
�� _ 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
control iite erosion and storm water discharges. This F-1—
/e0 item must be maintained throughout the Entire
Construction Period.
Q Will this Project Require any Land Flung,Grading dr r
Excavation where there is a change to the Natural
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(1007 feet of a Wetland or-
Submission of a SWPPP is required for an Construction achvitles imoNrng sod Beach?
disturbances of one(1)or more acres; including disturbances of less than one acre that , •7 -Will there be Site preparation on Existing Grade Slopes
are part of a larger common plan that will unrnialely disturb one or more acres of land;
Including Construdtion activities khoNing soi disturbances of less than one(1)acre where which Exceed Fifteen(15)feet of Vertical Rise to
the DEC has determined that a SPDES permit is required for stone water discharges. One Hundred(100')of Horizontal Distance?
(SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 VVIM'Driveways,Parking Areas or other Impervious
for Storm Water Discharges hom Construction activity-Permit No.GP-0-101001.) Surfaces be Sloped to Direct Storm--Water Run-Off
1-The SWPPP shall be prepared prior to the submittal of the NOT.The NOt Shan be subm into and/or in the direction of a Town right-of-way?
itted tb the"Department prior to the commeneement•of wmbudion axjtvny
2_The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material.
required,post-consbuctlor storm water management pradkes that win be used and/or Removal of Vegetation.and/or the Construction of arty
constructed to reduce the pollutants in storm water discharges and Io assure i
complbrm With dhe terms and conditions of this permht In bddi bi%the SWPPP:shal Item Within the Town Right-ol-Way or Road Shoulder F-1
knentify.potentlan sources of pohrtion which may reasonably be expected to affect the Area?f rta;►wst troy xrchhu.m.Instanatlon a orNeway !
quaiityof storm water discharges- NDTE: If Any Mswa'to Questiops.Or 9 ghrougli Nine Is Answered with a Check Mark
3.AD SWPPP3 that require the post-construction storm water management practice in a Dox and the construction site disturbance Is between 5,000•S.F.d,1 Acre in area.
component shall be prepared by a qualified Design Professional Licensed In New York a Storm-Water,Gradhrg,Drainage 3 Erosion 0071"1 Plan Is Required by the Town of
that b krWhedgeable in the pMclples and practices of Storm Water Management. Southold and f�hrst be Submitted for Review prior to Issuance of Ary Building Permit
NOTE: A Check Mark fJ)arW rAnswer%r each Queslron b Mnp*d Vora Complete AppGcatien) ! .
S1 A1-E OF NEW YORK,
..................
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l 1
COUN'I'Y O ........ .
r
1�IatI,
(Norm of tnaAGi.r e9 Oociirnent). duly sworn,deposes and says that he/she is the applicant for Permit, ; !
And that he/she is the ......................».»............
%►9r M.Coipoiate Officer,eiGj»...».....»»..».......................»....»...»...».
Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to i
make and file this applicagon;that aU statements contained in this application are true to the best of his knowledge and belief;and E !1
that the wdrk:will be performed in the manner set forth in the application filed herewith. I I
Sworn to before me this;
of--....._. U y i
............_-...............20.....
Notary Public_ ._.:._.R
! r
FORM - 06110
VICKI 70TFi (Signature of ApprKant)
i
Notary Nob01Y06 90696 W York
Qualified in Suffolk County
Commission Fxnires lull,28.20�_
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