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Home My WebLink About36461-Z Qc,VFF01,�� Town of Southold Annex 11/19/2012 P.O.Box 1179 co 54375 Main Road oy • O��w Southold,New York 11971 col CERTIFICATE OF OCCUPANCY No: 36051 Date: 11/19/2012 THIS CERTIFIES that the building AS BUILT ADDITION Location of Property: 260 Oak Dr, Cutchogue, SCTM#: 473889 Sec/Block/Lot: 104.-5-27 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 6/1/2011 pursuant to which Building Permit No. 36461 dated 6/8/2011 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: "as built"outdoor shower stall addition to dwelling as applied for. The certificate is issued to Bowe, Scott&Stacy (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED � t Autho ' Sign ture Q�gUFFOt,�cQ TOWN OF SOUTHOLD �a aye BUILDING DEPARTMENT y 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#: 36461 Date: 6/8/2011 Permission is hereby granted to: Campbell, James & Campbell, Ariene 118 Third St Garden City, NY 11530 To: outdoor shower stall addition to dwelling At premises located at: 260 Oak Dr, Cutchogue SCTM # 473889 Sec/Block/Lot# 104.-5-27 Pursuant to application dated 6/1/2011 and approved by the Building Inspector. To expire on 6/7/2012. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -ADDITION TO DWELLING $50.00 Total: $250.00 Building Inspector i IForm No.6 i TOWN OF SOUTHOLD. BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY. IThis application must be filled in by typewriter or ink and submitted to the Building Department with the following: i I i A. For new building or new use: I1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natural or I topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal (S-9 form). I 3. Approval of electrical installation from Board of Fire Underwriters. j 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: L ' 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: House No. Street Hamlet Owner or Owners of Property: _�� -' Al2 "- 4E- C--��/ Suffolk County Tax Map No 1000, Section Block . S Lot Subdivision Filed Map. Lot: 1 Permit No. Date of Permit. Applicant: Health Dept.'Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: V (check one) Fee Submitted: $ Ql° nt Signature 3w� �OF SOUIy�� cOUNi'1,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATJON [ ] FRAMING / STRAPPING [ INAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: /�16L DATE l INSPECTOR �D 81 ECTzC1N 3t jP T DATE COMMENTS. FQUNP010N aST) • •� MNNMONI. f{ w � .. i .(,i FOUNDATIQX(2ND) ROUGH MAAMC& PLUMBING ►•� INSUL•AUON PDA N.Y. y STATE ENERGY CODE' ' t. FINAL ADDIT16NAL COIVZIV ENTS . z 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 South oldTown.NorthFork.net PERMIT NO. Check Septic Form N,Y.S.D.E.C. Trustees Flood Permit Examined 20 Single&Separate -Siorin-Water Assessment Form / Contact; '`, � � ;:. , Approved X ,20 Mail to: Disapproved a/c Phone: Expiration G' 20 EgEBuilding Inspector APPLICATION FOR BUILDING PERMIT Date , 20 INSTRUCTIONS mpletely filled in by typewriter or in in](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 Pennit. d. Upon approval of this application,the Building Inspector will issue a Building Pennit 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 montlis 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 pennit 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 a ' 2t 45ees,to=c_omply_with all applicable laws, ordinances, building code, horsing code, and regulations, and to admit 1 a Xzedlnspectors;o1y,piAmises and in building for necessary inspections. )G„h" v;t-l�-L (Signature of applicant or name,if a corporation) �1 M,o I S�&�t � NY 0 T71 (Mailing address of applicant) oO State whether applicant is owner, lessee agent, architect engineer, general contracttr, eUER1 ffM �//or builder Atio-at p �, FEE: Bl' Name of owner of premises J>f'CF► �5 x , I C Y BUILDIN; DEPARTMFN` A' (As on the tax roll or Iat&Lc NG INSPECTIONS: If applicant is a corporation, signature of duly authorized officer 1. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE (Name and title of corporate officer) 2. ROUGH-FRAMING,PLUMBING, Builders License No. STRAPPING;ELECTRICAL 8 CAULKING 3 INSULATION Plumbers License No. 4 FINAL CONSTRUCTION&ELECTRICAL Electricians License No. MUST BE COMPLETE FOR C.O. Other Trade's License No. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done: DESIGN OR CONSTRUCTION'ERRORS. is IniG House Number Street Hamlet County Tax Map No. 1000 Section Q Block Lot 2-? 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 &y(L S�iCi�-� _�T ' y 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work. r- .(°Description) 4. Estimated Cost Fee (To_be paid;on;filing tYis,`applicatioi ) 5. If dwelling, number of dwelling units Number of dwelling units ea If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature.and extent of.e`,ch', ype 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 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 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) COUNTY OF ) being duly sworn, deposes and sa66W[ j is t e applicant (Name of individual signing contract) above named, UNCH Notary Public,State of New York No.01 SU6196M (S)He is the Qualified in Suffolk County (Contractor, Agent, Corporate Officer, etc.) res Apri.114,2._ 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 �_ 20] Notary Public S ignat o��st" k Town of Southold J Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM I PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A b� � STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN s c ec oTn -B-loek- ` t- 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? .Will this Protect Retain All Storm Water Run Off (Include Total Area of all Parcels located within Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) (This-item will include all run-off created by site — ❑ (S.F./Aces) i 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 j construction activity? impervious surfaces.) (s.F./Acres) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DFSCRE ON (Paine Additional Pages as Needed) . Drainage Structures Indicating Size&Location?This Item shall include all Proposed Grade Changes and — qkAS V U- Slopes Controlling Surface Water Flow. 3 Does the Site Plan and/or Survey describe the erosion j ( and sediment control practices that will be used to — ❑ j 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 j! Excavation where there is a change to the Natural i Existing Grade Involving more than 200 Cubic Yards of Material within-any Parcel? p- 15 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand j (5,000 S.F.)Square Feet of Ground Surface? I I j� 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. EJ 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 Will 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; i which Exceed Fifteen(15)feet of Vertical Rise to i Including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? the DEC has determined that a SPDES permit is required for stone water discharges. I (SWPPP's Shall meet the Minimum Requirements of the SPDES General'Pennit 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 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 when: 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 shall Area?(This Item will NOT include tire Installation of D Identify potential sources of pollution which may reasonably be expected to affect the Driveway Aprons.) quality of storm water discharges. . NOTE: If Any Answer to Questions One through Nine 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, 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 Toxin of j 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 PerniL I (NOTE A Check Mark(4)andfor An n' for a Complete Apprication) Nutc of Now Yoric it ...............SS Qualified SPATE OF NEW YOM No.01 BU6185050 � COUNTY OF in Suffolk County Commission Expires ApnT 14,2._ That ..being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) And that he/she is the ....: ?=!mil .r............. ... I (Owner,Contractor.Agent.Corporate Officer.air-) 1 i 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 application;that all statements contained in this application are true to the best of his knowledge and belief;and i that the work will be performed in the manner set forth in the application filed herewith. { Sworn to before me this; 1.... day of..... .,20..... Notary Public: ...... j�^-P......� .. ........... (Signature of Applicant) j . FORM - 06/10 tio��OF SOUTyolo Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 G �Q Southold,New York 1 1 97 1-0959 �yC4UNTY,Nct� BUILDING DEPARTMENT TOWN OF SOUTHOLD August 9, 2011 Jerry Cibulski PO Box 598 Southold, NY 11971 Re: Campbell Residence —260 Oak Dr, Cutchogue TWO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of$25.00. / Final Health Department Approval. ✓ Plumbers Solder Certificate. (All permits involving plumbing after 411/84) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT : 36461 — Outdoor Show Stall o��pF SO!/ryol Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �Q �ycOUNT`1,� BUILDING DEPARTMENT TOWN OF SOUTHOLD December 20, 2011 Jerry Cibulski PO Box 598 Southold, NY 11971 Re: 260 Oak Dr., Cutchogue TO WHOM IT MAY CONCERN: The Following Item(s)Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of$50.00. Final Health Department Approval. ZPlumbers Solder Certificate. (All permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. Final Fire Inspection from Fire Marshall. — Bob�Fisher Final Landmark Preservation approval. BUILDING PERMIT: 36461 — Outdoor Shower Stall {f e� F t y * y . w 1 Y y^ . s r .�. :� ( • r�� 44,^}•'' 'y,«: `i�a.� �.z �'�r - � '�"t-mil '. �..