HomeMy WebLinkAbout38264-Z ��U&FDt,fc Town of Southold Annex 8/27/2013
P.O.Box 1179
54375 Main Road
dy Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 36466 Date: 8/27/2013
THIS CERTIFIES that the building AS BUILT DECK
Location of Property: 22040 Route 25, Orient,
SCTM#: 473889 Sec/Block/Lot: 17.-6-9.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
8/12/2013 pursuant to which Building Permit No. 38264 dated 8/19/2013
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"deck addition to an existing one family dwelling as applied for.
The certificate is issued to Rose,Elizabeth&Channing, Susan
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED 12
A zed ignature
�SUKai x TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 38264 Date: 8/19/2013
Permission is hereby granted to:
Rose, Elizabeth & Channing, Susan
3069 Scarborough Rd
Cleveland Heights, NY 44118
To: as bit" deck
At premises located at:
22040 Route.25, Orient
SCTM # 473889
Sec/Block/Lot# 17.-6-9.2
Pursuant to application dated 8/12/2013 and approved by the Building Inspector.
To expire on 2/18/2015.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $502.40
CO -ADDITION TO DWELLING $50.00
Total: $552.40
Building Inspector
UJ j
Form No.6 l
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
'Ibis 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. ofwater supply and sewerage-disposal(S-4 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 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: 2 Zti W M"Ci-`l 1
House No. Street Hamlet
Owner or Owners of Property:O&W
AQ E3, U569/J!'�n d:5dr:7 W&V/l'fl A1G
Suffolk County Tax Map No 1000, Section l Block Lot
Subdivision Filed Map. Lot:
Permit No. D oZ(9 7 Date of Permit. $' c/� /3 Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$
Applicant Signature
SOUIyo
00UNT1, ,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] I LATION
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: C40
Iq
DATE 3 INSPECTOR
N. J. MAZZAFERRO, P.E.
Consulting Engineer
Construction, Estimating. Labor Law
Aug. 14,2013
To:Town of Southold Building Dept.
Re: Rear Deck Structure-22040 Main Rd.,Orient,NY
(Rose/Channing owners)—Supplement for Drawing
This deck structure was constructed and attached to the existing house in 1978.
I inspected the structure in Aug. 2013,and observed that proper practices were used in
the construction of the structure. I observed the tops of the concrete foundations.
After corresponding with the builder,I verified the concrete foundations(10"diameter)
were installed to a depth 3 feet below grade.
This structure has been erected in compliance with the local building code that was in
effect 1978.
Res"1y,
Yleholas I Mazzaferro
y�P�E OF NEW y0
D ECEHE
AUG 142013 `��o �O 0510,9
A�OFESS1010, .
BLDG. DEPT.
TOWN OF SOUTHOLD
FIELD RTSPECT N REPORT DATE COMMENTS
FOUNDAVON(1ST)
012
FOUNDATION(2ND)
s
p' vn
ROUGH FRE1MUG& o
PLUMBING
INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
IL
ADDITIONAL COMMENTS
0
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TOWN'OF SOUTH(3%LV-42100 PbitgA 19tinm 30'�..� � BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPART ME1SlI'trfl it t; girl l i 1d Sid Ito Do you have or need the following,before applying?
TOWN HALL vfg.'4tr brtpOc 20ic,94 t tFw Board of Health
SOUTHOLD,NY 11971 / !Y 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.
Trustees
Flood Permit
Examined ,2013 Storm-Water Assessment Form
Q Contact:
Approved v• ,20_0 Mail to;
77
Disapproved a/c
Phone:z4f *7/ ((Q�
Expiration.: ,20.�
- FL�_ C. E W E
Building Inspector .
' ) AUG 12 2013 APPLICATION FOR BUILDING PERMIT
BLDG. DEPT. Date O Z , 20
TOWN OF SOUTHOLD INSTRUCTIONS
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�wii#jng,'the extension of the permit,for an.
addition siic'morittis.-Thereafter",anew}iefihit;shal.l1%.—'eoilired.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of 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, ing code,and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections,
(Signature of applicant or name,if a corporation)
Mailing addres of ap licant)r
State whether applicant is owner, lessee, agent, architect, engineer,general contractor, electrician, plumber or builder
Name of owner of premises JF4� 7��
(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 Now .
Other Trade's License No;'
1. Location of land on which ro sed work will done,
o 6XI
House Number Street Hamlet
., .
County Tax Map No. 1000 Section_ Block Lot �.
Subdivision Fi1ed'Map No. Lot
2. State existing use and occupancy of preyl s and int nded Vse and occupancy of proposed construction:
a. Existing use and occupancy yK,�'
b. Intended use and occupancyaly?qTy t7 &E
3. Nature'of work(6,6ek.which`applicable): Ne'W Building Addition Alteration
Repair Removal Demolition Other Work �l�'
4. Estimated.Cost ""'' `�',,�4 l CIO) Fee (Description)
(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 Z Rear Z- + 2, Depth + /
Height !y NLlmber of Stories
Dimensions of s me structure with alterations or'additions: Front *3 V. Rear
Depth.` - GF ,/ Height Number of Stories ?�
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories t[ 2
9. Size of lot:'Front 2 Rear 121.7 T , Depth`
10. Date of Purbhase / 7 L7 Name of Former Owner. . �1�i,OdA
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- raded?YES NO W'11 excess f 11 be removed from premises? YES NO�
p�yJ,�es� /1os�c6�i�lN�r1G
14. Names of Owner of premises Addred,4:�P1�G &4 Phone No. z3"z�7�v
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)
SS
COUNTY OFaj�
!%? • � being duly sworn,deposes and says that(s)he is the applicant.
(Name of individual signing contract)above named,
(S)He is the &AMse
(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 thi
day of��G , 20 t_�)
Notary Public Signature of Applicant
PAMM��11lotary Public,Sl ofi; ew l A
No.QlWA6140448..
Qualified in Suffolk Conn
Ca emission, E&ores January 30 J
Or --
CONSENT TO INSPECTION
CAAAMAJ6
t' the undersigned, do(es)hereby state.
Owner(s)N e(s)
That the undersigned(is) (are)the owne (s) t^he premises in the Town of
Southold,located at 2.29 If j �//U y/'t!J
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section f'7 Block 6,Lota,�.
That the undersigned(has)(have)filed,or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following: rfZ
That the undersigned do(es)hereby give consent to the Building Inspectors of the
Town of Southold to enter upon the above described property,including any and all.
buildings Iocated thereon,to conduct such inspections as they may deem necessary with
respect to the aforesaid application,including inspections to determine that said premises
comply with all of the laws,ordinances,rules and regulations of the Town of Southold.
The undersigned,in consenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws,ordinances,rules or
regulations of the Town of Southold.
Dated:
(Signature)
(Print Name)
(Signature
Sin Sit P-o se Chce rn4 rth
(Print Name)
S.C.T.M. NO. DISTRICT: 1000 SECTION:17 BLOCK: 6 LOT(S):9.2
MAIN ROAD
(NYS RT. 25)
EDGE OF PAVEMENT
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LAND N)F
OF ;
ALFRED & ELIZABETH ROSE
THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL
LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS
AND OR DATA OBTAINED FROM OTHERS.
AREA: 1 B,617.32 SQ.FT. or 0.43 ACRES ELEVATION DATUM.,
UNAUTHORIZED AL TERA 770M OR ADDITION TO THIS SURVEY 1S A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE T17LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE S7RUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY
SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: SUSAN GRELLA RODRIQUEZ;
MAP OF: WELLS FARGO BANK, N.A.;
FILED: FIDELITY NATIONAL TITLE INSURANCE COMPANY;
SITUATED AT:ORIENT
TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
P.O. Box 153 Aquebogue, New York 11931
FILE 13-133 SCALE: 1"-20' DATE: AUG. 3, 2013 PHONE (631)298-1588 FAX (631) 298-1588
N.Y.S. LISC. NO. 650882 maintaining the records of Robert J.Henneeey k Kenneth M.Weychuk
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Sol Zcki'I ' NOTIFY BUILDING DEPARTMENT r.
i 765-1802 8 AM TO 4 PM FOR T I'E.
Z �c�ess U30�S , ZXu �� S�s '�^ -�-, FOLLOWING INSPECTIONS:
s ae r 1. FOUN -71DATIONFOR oURED CONOCRETE REQUIRED
rn,��� 16'(L 2. ROUGH
FRAMING,PLUMBING,
G ELECTRICAL&CAULKING
APPIN , E
O,C ST lELECTRICAL
--- - - 3. INSULATION
4. FINAL-CONSTRUCTION &
'of NE _ MUST BE COMPLETE FOR C 0
sz N -- °s - -- A- -yo 1 - 1 w j S�Gam' L CONSTRUCTION �H.4L!MEET THE
-5P I - n AL �DFS OF NE':
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DESIGN OR CONSTRUGT�ON ERRORS
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