HomeMy WebLinkAbout38013-Z F tlr Town of Southold Annex 5/28/2013
P.O.Box 1179
cm c x 54375 Main Road
oy Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 36259 Date: 5/28/2013
THIS CERTIFIES that the building ALTERATION
Location of Property: 870 (aka 169)Horton Ave,Mattituck,
SCTM#: 473889 Sec/Block/Lot: 141.-2-21.7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/l/1900 pursuant to which Building Permit No. 38013 dated 5/13/2013
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"non-habitable finished basement(for storage)in an existing one family dwelling as applied for.
The certificate is issued to Solomon,George&Solomon,Eileen
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 38013 6/14/10
PLUMBERS CERTIFICATION DATED
A ed ignatu
oL co TOWN OF SOUTHOLD
�� Gy BUILDING DEPARTMENT
y TOWN CLERK'S OFFICE
o . 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#: 38013 Date: 5/13/2013
Permission is hereby granted to:
Solomon, George & Solomon, Eileen
169 Horton Ave
Mattituck, NY 11952
To: as built" non-habitable finished basement (for storage) in an existing one family
dwelling as applied for. Replaces 35679.
At premises located at:
870 Horton Ave, Mattituck
SCTM # 473889
Sec/Block/Lot# 141.-2-21.7
Pursuant to application dated 1/1/1900 and approved by the Building Inspector.
To expire on 11/12/2014.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $150.00
CO -ADDITION TO DWELLING $50.00
Total: $200.00
t
u i I d i n g 11 6V Erc- or
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 3�`6-7 9 Z Date JUNE 30, 2010
Permission is hereby granted to:
GEORGE & EILEEN SOLOMON
169 HORTON AVE
MATTITUCK,NY 11952
for
"AS BUILT" NON-HABITABLE FINISHED BASEMENT (FOR STORAGE) IN AN
EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
at premises located at 870 HORTON AVE MATTITUCK
County Tax Map No. 473889 Section 141 Block 0002 Lot No. 021 . 007
pursuant to application dated JUNE 7, 2010 and approved by the
Building Inspector to expire on DECEMBER 30, 2011 .
Fee $ 400 . 00
d.�
Authorized Signature
ORIGINAL
Rev. 5/8/02
Form No.6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAN02 MAY 2 4 2013
This application must be filled in by typewriter or ink and submitted to the Building De artm t-%� 11
BLDG. DEPT.
A. For new building or new-use: TOWN Of SOUTHOLD
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.compieted 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 eompleted 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 $1 5_00,Commercial $15.00 0o�
`. ... Date_ �Ct' �✓
New Construction: Old or Pre-existing Building:' (check one)
/l y r-
Location of Property: J' Q - p
14 /�`_Lfc�
House No. Street ) Hamlet
Owner or Owners of Property: zf o rt �e_ CC
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approvals Underwriters Approval:
Planning Board Approval:
Request for. Temporary, Certificate Final Certificate: (check one
Fee Submitted:
/;AP( 42natu're
e
SO(/l�olo
Town Hall Annex Telephone(631)765-1802
54375 Main Road y Fax(631)765-9502
P.O.Box 1179 G
Southold,NY 11971-0959 �p • �� roger.richert(aD-town.southold.ny.us
11
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: George Solomon
Address: 169 Horton Ave City: Mattituck St: NY Zip: 11952
Building Permit#: 31S 0I3 Section: '1-t 1 Block: a Lot: �)-k 11'
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 6 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors 1
Main Panel A/C Condenser Single Recpt Recessed Fixtures 4 CO Detectors 1
Sub Panel A/C Blower Range Recpt Fluorescent Fixture 2 Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 5 Twist Lock Exit Fixtures 11 TVSS
Other Equipment: replace 100a main panel. Repair water dammage
Notes:
Inspector Signature: 4AQLDate: June 14 2010
81-Cert Electrical Compliance Form
Of SOUIyo�
UMV act
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH P .
[ ] FOUNDATION 2ND [ ] IN ATION
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
i
DATE J INSPECTOR
COMMNTS
BLDINSPECTION REPORT DATE ►b
I4
. r
FOUNDATION(1ST)
FOUNDATION(2ND)
z
ROUGH FRAM WQ&
PLUMBING
• y
INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
-------------------
m
e
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 q Planning Board approval
FAX: (631) 765-9502 / Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined / ,20 ® Storm-Water Assessment Form
Contact:
Approved 1� ✓�� ,20 Mail to:
Disapproved a/c
Phone: (03 j�� —y 917,
Expiration 6 ,20 4 6-�t " a 9 C/
Building Inspector O b I
E U ICATION FOR BUILDING PERMIT
D --
Date :JL4 n,Pi , 20 )0
JUN 7 2010 INSTRUCTIONS
a. is a li complete y filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plan , accurate FINIAL$G %ale. Fee ording to schedule.
b.P ocation 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 regul ions, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signautre of/a p nt or name,if a co oration)
(Mailing address of applic nt) ftS
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises - �� 11��AJ d""L d
(As on the tax roll or latest deod)
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. Locatio of la d on whichproposed work will be-done r
House Number Street Hamlet
County Tax Map No. 1000 Section JL Block.,_cam Lot..;
Subdivision Filed Map No: Lot
2. State existing use and occupancy of premis s and intended use and cupancy of proposed construction:
a. Existing use and occupancy a (Z-/9- jK}
b. Intended use and occupancy
3. Nature of wo*(check which applicable): New Building Addition Alteration
Repair to, Removal Demolition Other Work
(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 R__ear
Depth Height Number;of;S'torles7
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Deptli
10. Date of Purchase —7 11 Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zon'ng law, ordinance or regulation? YES NO /
13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO v
� �etvr�✓ /
14. Names of Owner of premise o ,&f' Ge'-�Address/4'7f--"t/I AJ& Phone No.r7?��
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 V
* 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 dat^a A7rv
ey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
V
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF
dy2 e, d bfK 0 V being duly sworn, deposes and says that(s)he is the applicant
(Name of indi al 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
S� day of 20 / 0
:�twp KA A
Nota Pub ry Public,State of New York Sign Are o Applicant
No. 02AR4711005 ty
Qualified In Suffolk Count 20 r
My commission Expires
10Sut�o Town of So"thold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
01y�d l Lt STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
iTsUict 7 ER= oc Tot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No
a. What isihe 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 on Site?
the.Scope of Work for Proposed Construction) (This item will include all run-off created by site ❑
b. What is the Total Area of Land Clearing (S.F./Acres) clearing and/or construction activities as well as all
and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of
construction activity? (S.F./Aces) impervious surfaces.)
2 Does the Site Plan and/or Survey Show All Proposed ❑
PROVIDE BRIEF PROJECT DESCRIPTION (Provide Additonal Pages asNeeded) Drainage Structures Indicating Size&Location?This
Item shall include all Proposed Grade Changes and
n 14C 40(Z./I l/ Slopes Controlling Surface Water Flow.
/, � 3 Does the Site Plan and/or Survey describe the erosion ❑
d A 1 �/y��a,� W4j 15 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.
4 Will this Project Require any Land Filling,Grading or
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 —
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 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 M
—
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 One Hundred(100')of Horizontal Distance?
the DEC has determined that a SPDES permit is required for storm water discharges.
(SWPPP'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-0-10-001.) Surfaces be Sloped to Direct Storm-Water Run-Off
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
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 the Installation of Driveway Aprons.)
Identify potential sources of pollution which may reasonably be expected to affect the
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 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 Check Mark(4)and/or Answer for each Question is Required for a Complete Application)
STATE OF NEW YORK,
COUNTY OF.. J .................SS
That I, ....... �,:�'............... .® 6 being duly sworn,deposes and says that he/she is the applicant for Permit,
(N ei)lndiv. a signing ocument)
And that he/she is the �..`� ....................................................................
(Owner,Contractor,Agent,Corporate Officer,etc.)
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 me this;
................ ..... day of. ./fit ::.............. ,20.. I
NotaryPublic: .........................t ... ..................... .. ...................
��CV1D'M:' Rfl�tit/i.....
( tgna/reofApp1iic;ani)
FORM - 06/10 No. 02AR4711005
Qualified In Suffolk County
My Commission Expires 02/28/20
S
o��pF SO(/j�o!
� o
Town Hall Annex Telephone(631)765-1802
54375 Main Road ax(631)765- 59
P.O.sox 1179 Q roger.richertCa'town.south�o .ny.us
• �o
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOW
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: S" � Date: Ig dwo
Company Name: QC c c- J--o')C, ,
Name:
License No.: 36
-23
Address: ,0 v 6 Gi CA v&e� re/ !/ .
Phone No,: aFr. qqs 55/0 uz' �-
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address: 167q ,� � ��...
*Cross Street: OF ('7� S�
*Phone No.: egg 4e-7!f
Permit No.:
Tax Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) ,�� ,,� x�. �,� ME(—
(Please Circle All That Apply)
*Is job ready for inspection: (YES) NO Rough In _ Final
*Do you need a Temp Certificate: YES / NO
Temp Information {If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form
SO�jyolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �l� �O
COUNT�,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
May 14, 2013
George Solomon
169 Horton Ave
Mattituck, NY 11952
RE: 870 Horton Ave
TO WHOM IT MAY CONCERN:
The Following Items(if Checked)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 Compliancg. (Town Trustees#765-1892)
Final Planning Board Approval. (Planning #765-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept
BUILDING PERMIT: 38013 — "As Built" Finished Basement (storage)
o•o p. TOWN OF SOUTHO ` PROPERTY RECORD CARD
OWNER STREET R2a VILLAGE DIST. SUB. LOT 3is
a
`
1A
FORMER O . NER N44 4 Ef.R Rrti uj t w r3r o 9 ACR.
1 F• S W JorY Nakf#f TYPE OF BUILDING
.kES. SEAS_ VL. FARM CO/Vlllh.' 1S�. M
r kt. Value
LAND IMP. TOTAL DATE REMARKS
00 300
aL
or
14 tra _ 1- )8 3
�hG �.� II)UG�CON ors/7srt•r A� L. C . oL /a �'AS 3D Lnrt• P sib
ONE ar Two
�J3o/7sS s; o1D . sor 7 1 �3
-rive, �o 11-�I fz7vti
FARM Acre Value Per Va[ae
Acre
Tillable { _ + �.� �' ft ptr !ofi h rlpp✓2 �!
i_
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Swampland I FRONTAGE ON-WATER
Brusl,land Iro p D 4J3 FRONTAGE ON ROAD 7P ,
House Plot DEPTH '
BULKHEAD
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�0P � Southold Town Building Department
�pS P.O.Box 1179 Permit#: 35679
54375 Main Road
C* ; Southold,New York 11971 Permit Date: 6/30/2010
oy'�jQ �501 (631)765-1802 Expiration Date: 12/30/2011
Parcel ID: 141.-2-21.7
BUILDING PERMIT RENEWAL LETTER
Dated: 10/25/2012
Applicant: GEORGE&EILEEN SOLOMON
Location: 870 HORTON AVENUE MATTITUCK
Work.Description: AS BUILT ALTERATION
"AS BUILT"NON-HABITABLE FINISHED BASEMENT (FOR STORAG�/�r)IN AN EXISTING
ONE FAMILY D LLWSIED FOR. � .0."� G•a�,
0
0 I ��, . roC.
01 � � V
C�
A E OF $4(50.�0 IS QUIRED TO RENEW THIS BUILDING PERMIT.
Owner: GEORGE&EILEEN SOLOMON
Address: 169 HORTON AVENUE
MATTITUCK,NY 11952
The permit listed above has expired. Please contact our office as soon as possible to begin the renewal
process. All work on the project must stop on the expiration date.
No work is permitted or authorized beyond the expiration date.
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
Southold Town Building Department
�OSUEfat,�� P.O.Box 1179
54375 Main Road Permit#: 35679
Southold,New York 11971 Permit Date: 6/30/2UT0
�41 ao� (631) 765-1802
Expiration Date: 12/30/2011
Parcel ID: 141.-2-21.7
BUILDING PERMIT RENEWAL LETTER
FINAL NOTICE
Dated: 4/10/2013
Applicant: GEORGE & EILEEN SOLOMON
Location: 870 HORTON AVENUE MATTITUCK
Work Description: AS BUILT ALTERATION
''AS BUILT'' NON-HABITABLE FINISHED BASEMENT (FOR STORAGE) IN AN
EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
A FEE OF $150.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT.
Owner: GEORGE & EI,LEEN SOLOMON
Address: 169 HORTON AVENUE
MATTITUCK, NY 11952
The permit listed above has expired. Please contact our office as soon as possible to begin
the renewal process. All work on the project must stop on the expiration date.
�oz
o �
�60
SS
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
8,P. # 3541-l 9
BUILDING PERMIT EXAMINER CHECKLIST *Date Submitted: ����� Date Reviewed:
Applicant: GE-o ieC,-L-7- S o 1-, 6 Al Owner: GiE6 kGt �L C'/L E-E 1V S o L B/1 o IV
Architec f
= •'��� �- Estimated Cost:
SCTM# 1000- 7 Subdivision: Zone: >0 Conforming?
Property Address: City: Pre COs? IVO
Building Permits (Open/Expired): BP O'- 3L 1-Z/C/O Z- g S,Info: Alb BP -Z/C/o Z- ,Info:
BP -Z/C/o Z- ,Info: BP -Z/C/o Z- ,Info: BP -Z/C/o Z- Info:
Single& Separate Search Required? Y ooDetermination:
REQ. Lot Size: ACT. Lot Size: REQ. Lot Cov. ACT: Lot Cov.
REQ. Front ACT. Front REQ Side ACT. Side REQ. Rear PROP. Rear
REQ. Height. AC ;. Height
Project 1)4�scription:
Waterfront? Y o N?
If yes, water body: Panel#f '`Flood Zone: _'Bulkhead/Bluii Dist4pCe,
ADDITIONAL APPROVALS REQUIRED
1,
If yes, *Bed#: _ *Date: _/_/_ *Permit#: Town Septic: Y or
Suffolk County Health: Y or N� +1
- If no, certification required: Y or N Received: Y or N By:
NYS DEC: PRE-DEC 9/1/75 Y 010- Date: / /_ Permit#: or NJ Letter- Notes:
Southold Trustees: Y orCpDate: / / Per #: or NJ Letter-Notes:
Southold ZBA: Y of ITT - Date: / / Permit#: -Notes:
Southold Planning: Y 662 Date: _/ /_ Permit#: -Notes:
Town Landmark C of A: Y o'N TE: / / *NYS CODE Compliance(page 2): Y or N
Notes:
YIC
Fee Structure: Calculation:
Foundation: . SF 1. _SF)- (_ SF)= SF X $ =$
First Floor: SF + Initial Fee: $ 0-6 Or ® o
Second Floor: SF +Additional Fee ( : $
Other: SF 2. ( SF)- ( SF)= SF X $ =$
Total: SF ` / + Initial Fee: $
cc� + Additional Fee $ a-0 of Do
TOTAL: $ .�L0 0 , 0 0
NEW YORK STATE CODE COMPLIANCE CHECKLIST
CLIMATIC/GEOGRAPHIC DESIGN CRITERIA:
Ground Snow Load:20 . Wind Speed: 120MPH Seismic Design Category:B
Weathering: Severe . -Frost Depth: 3611 . 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 N e�
HEADERS: Y/N WALL STUDS:Y/N GIRDERS: YIN
CEILING JOISTS: YIN FLOOR JOISTS:Y/N ROOF RAFTERS: Y/N
LUMBER SPECIES AND GRADE: Y/N
WINDOW AND DOOR SCHEDULE: Olt
IYMISSLE TEST REQUIREMENTS: Y N�
EGRESS 5.7 S.F.:�Y N t
LIGHT 8%: /N
VENT 4
NAILING/CONSTRUCTION SCHEDULE: Y/N
MEANS OF EGRES S-074
PLUMBING RISER DIAGRAM: Y/6) O,�
LOCATION OF DIRE PROTECTION EQUIPMENT:
TRUSS DESIGN: Y6) dA
CERTIFICATION: YO b/V
ENERGY CALCS ON
TOTAL COMPLIENCE?�X N (RETURN TO PAGE ONE)
2009 IECC Energy
Efficiency Certificate
Insulation Rating R-Value
Ceiling/Roof 30.00
Wall 16.80
Floor/Foundation 16.80
Ductwork(unconditioned spaces):
Glass&Door Rating U-Factor SHGC
Window 0.34
Door
Heating&Cooling
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments:
ED y�T
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S� No 0 7 63
qTF OF W y°�
CERTIFICATION OF BUILDING PERMIT
REQUIREMENT
(MUST BE SIGNED BY AUTHORIZED REPRESENTATIVE)
This form MUST be completed and signed by an authorized person on behalf of
the building authority in the City/County/Parish where the repairs to the
damaged property are.to be made—whether the permit is required or not.
If a Building Permit is required, a copy of the permit must be attached to
this form.
Seismic Study
For construction of a new building, or an addition to an existing building, the
building authority must indicate whether Seismic Safety Requirements are in
place.
Return documents to:
U.S. Small Business Administration
Processing and Disbursement Center
14925 Kingsport Road
Fort.Worth, Texas 76155.-2243.
If you have any questions,please contact your Case Manaaer at 800-366-6303.
5
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GEORGE SOLOMON ET AL +-
Application Number:0004294103/Loan Number:,DLH 3792626008 °-
oZZ
om
CERTIFICATION OF BUILDING PERMIT REQUIREMENT
Ns
TO: Local Issuing Authority �z
of Building Permits r
J
RE: Building Permit Requirements W-
For property of GEORGE SOLOMON and EILEEN SOLOMON
Located at: 169 HORTON AVENUE MATTITUCIC NY 11952
Please certify below the appropriate status regarding the Building Permit requirements for the above
referenced property.
A Building Permit is NOT REQUIRED for the repair/replacement construction on the
above mentioned residence.
A Building Permit is REQUIRED and a copy of said permit is attached hereto.
Seismic Study
Pursuant to Executive Order 12699 on Seismic Safety of Federal and Federally Assisted or Regulated
New Business Construction, all new building construction that is assisted by the Federal Government
must meet Seismic Safety Requirements specified in the National Earthquake Hazards Reduction Act
of 1977.
Please certify below regarding compliance with said requirements when loan funds are to be used for
the construction of a completely new building or an addition to an existin building.
All new building construction on the above mentioned property meets the 111988
National Earthquake Hazards.Reduction Program Recommended Provisions for
the Development of Seismic Regulations for New Construction."
Local building code does not include Seismic Safety Requirements.
// Local Issuing Authority of Building Permits Representative:
Date: b — a Name: L C A
Signature:—
Title:
Phone: LI) 76-5 -- ® 2
After completion please return to: U.S. SMALL BUSINESS ADMINISTRATION
14925 KINGSPORT ROAD,
Fort Worth,TX 76155-2243 *_
DATE: ISSUE
COMPLY WITH ALL CODES OF (c- 7- 10
ALL CONSTRUCTION SHALL NEW YORK STATE & TOWN CODES I5ZVtiq
MEET THE REQUIREMENTS OF THE AS REQUIRED Fve, I,
CODES OF PdE'd'v'Y�JRIt STA I E, S OLD TOWN ZBA �•29-10
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la <?0 h6p Gc7111c. - FEE D BY rn
c"KP by NOTIFY BUILDING DEPARTMENT AT z
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f Gl� L I cy TP(A) FOLLOWING INSPECTIONS: C
1A�uwil-1 O v . 1. FOUNDATION-TWO REQUIRED Am
FOR POURED CONCRETE
2, ROUGH-FRAMING,PLUMBING,
1 I STRAPPING,ELECTRICAL&CAULKING
3. INSULATION
4. FINAL-CONSTRUCTION&ELECTRICAL 3'
Q 5 ►CC I I �-$u MUST BE COMPLETE FOR C.O. Z
( � ALL CONSTRUCTION SHALL MEET THE 14.
REQUIREMENTS OF THE CODES OF NEW
—^�I ( N Eq 2 X�' 11ZIZ1N� yJl 2� YORK STATE. NOT RESPONSIBLE FOR
Q ,Q._ DESIGN OR CONSTRUCTION ERRORS. Z
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