HomeMy WebLinkAbout37153-Z �� $IF04caG� Town of Southold Annex 9/18/2012
P.O.Box 1179
54375 Main Road
co
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35961 Date: 9/18/2012
THIS CERTIFIES that the building ACCESSORY
Location of Property: 7090 New Suffolk Rd,New Suffolk,
SCTM#: 473889 Sec/Block/Lot: 117.-6-7.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
4/23/2012 pursuant to which Building Permit No. 37153 dated 4/23/2012
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:
pergola addition to an existing accessory pool house as applied for.
The certificate is issued to Samuels,Thomas&Steelman,Nancy
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
AupfiokedXignatVe
�S�1FFOl,� TOWN OF SOUTHOLD
���,� BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
a . 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#: 37153 Date: 4/23/2012
Permission is hereby granted to:
Samuels, Thomas & Steelman, Nancy
25235 Main Rd
Cutchogue, NY 11935
To: construct an accessory pergola addition as applied for
At premises located at:
7090 New Suffolk Rd
SCTM # 473889
Sec/Block/Lot# 117.-6-7.1
Pursuant to application dated 4/23/2012 and approved by the Building Inspector.
To expire on 10/23/2013.
Fees:
ALTERATION OF ACCESSORY BUILDINGS $233.20
CO -ACCESSORY BUILDING $50.00
Total: $283.20
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-digposai(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 2110 of 1% lead. .
S. 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 cate 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.$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. Eertificate 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: /v °l.('i . 3AkEEK2 PJ /VLCAJ �Z�L
House No. Street ' r, Hamlet
Owner or Owners of Property: DYYI a S c��YICC�S �- ��lC�/ ��e lww_&n
Suffolk County Tax Map No 1000, Section Ll Block Lot 7
Subdivision Filed Map. Lot:
Permit No. �S-.1 53 Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
A `licai ature
3 7�� �aoF So�Tyo
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION'-. ...
[ ] FOUNDATION. I ST [ ] ROUGH PLBG.-
[ ] F NDATION 2ND [ ] INSULATION
[ FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: "
DATE ` °� //)"'-INSPECTOR
pF SOpT�,Olo
�yeOUNiY,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING/STRAPPING [ 1, FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: Z;2
DATE INSPECTOR
RD.Il!T$�. �73tEP�7� DA= COM O1 INTS.
VOT
,rs..M«Miw..',wr*rwi.rrwrwrrro .. ..
FOUNDATION(2ND)
lA/
71
ROUE$FG&. ►��
PLUNlBIl�IG
INSULATION Pom N.Y. y.
STATE ENERGY CODE. '
o
FIl�iAL
ADDITIONAL.Ct7M1V,iENTS
d
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. 37 jS �j Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined Z' ,20� D E lam. El �l E Storm-Water Assessment Form
Contact:
Approved �� 20 7i APR 12 2012 Mail to:
Disapproved a/c
BLDG.DEPT. Phone:
Expiration Z ,20 / :3
TOWN OF UNUD
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date&Dl-i 20J;-7
INSTRUCTIONS r
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,ho ng code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections. L.
- -/Jlw—,
(Sign of applicant or name,if a corporation)
(Mailing address of applic t)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
no 1,zAtz
Name of owner of premises
(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 p•oposed work ill be done-
2a�o u
House Number Street Hamlet
County Tax Map No. 1000 Section 117 Block b G Lot 71
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occu ancy of proposed construction:
a. Existing use and occupancy a Y»i d DU
b. Intended use and occupancy i v5�
3. Nature of work(check which applicable):New Building Addition X Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost 'Q,b(,Z'S : Fee -J.
i-(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.
i
7. Dimensions of existing structures, if any: Front Depth
Height 1' 2D �g" Number of Stories /
Dimensions of same structure with alterations or additions: Front 30 ' Rear -50 '
Depth -s -R445-0" Height 20 '-��` Number of Stories
8. Dimensions of entire new construction: Front Rear — Depth
Height Number of Stories —
9. Size of lot: Front ` �I �n Rear Depth
10. Date of Purchase Name of Former Owners r (» ✓, �u
11. 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 Will excess fill be removed from premises?YES NOX
ahG c In r►-, 2� t� v, d
14.Names of Owner of premises y u Address c� Phone No. -7 34-� S
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 X
* 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 S )"
G a being duly sworn, deposes and says that(s)he is the applicant
(Name Af 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
�O day of—APJ
s 201-, ,
19tA d�i��OYI� � �,H
Notary Public W •0, R[&0gzj 07 tGutiallifiev.
r6 of Applianf c : -
0aalifirc in Suffolk :OUM�
CO"amissl� rea � in Suffolk .,ounty
y . . e?Av :nmiss! .. ,eq. 30, 204_
SOUTyolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �ikl �Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
September 11, 2012
Thomas Samuels
Nancy Steelman
25235 Main Rd
Cutchogue, NY 11935
Re: 7090 New Suffolk Rd
TO WHOM IT MAY CONCERN:
The Foll ng Items Are Needed To Complete Your Certificate of Occupancy:
Application for Certificate of Occupancy. (Enclosed)
Electrical Underwriters Certificate. (contact your electrician)
A fee of$50.00.
Final Health Department Approval.
Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84)
Trustees Certificate of Compliance. (Town Trustees#765-1892)
Final Planning Board Approval. (Planning #765-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
BUILDING PERMIT: 37153 - Pergola
114
D
SCTM # 1000-117-06-7.1
ROAD ......... ................. ............... PROPERTY: 7090 NEW SUFFOLK ROAD
FAN ............. ........... 22-6-87 NEW SUFFOK ROAD
........... METER ........... OWNER: NANCY STEELMAN
WATER ....... TOM SAMUELS
25235 MAIN ROAD
CUTCHOGUE, NY 11935
A- 1 . . . .. ............. .......
.. . ... .... ............ ..
......
.. . . .
0" . .... . . .. . .. ............ S 706SO FT. 1 .622 AC. 0
14' ITE:
...... .. .. ...... ...... . .............
AREA
.... ......
113.44 ZONING: R-40
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SURVEYOR: JOE NGEGNO z
PO OX 1931
RIV RHEAD, NY 11901 o
63 727-2090 W 0
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DATE:
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NOTIFY BUILDING DEPARTMENT AT
................
765-1802 8 AM TO 4 PM FOR THE SCALE:
..................................... FOLLOWING INSPECTIONS: 1/1699 1' oil
............. . 1. FOUNDATION-TWO REQUIRED
....... ...........
....................................... OR POURED CONCRETE SHEET TITLE:
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4. i INAL-CONSTRUCTION&ELECTRICAL SITE
MT BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE PLAN
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
OR
SCALE: 1116" =1'-O" USE SHEET NO:
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