HomeMy WebLinkAbout43554-Z �s11FFat/(, Town of Southold 3/12/2019
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=o Gy P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40258 Date: 3/12/2019
THIS CERTIFIES that the building WINDOWS
Location of Property: 935 Rosenburg Rd, East Marion
SCTM#: 473889 Sec/Block/Lot: 21.-1-2
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/12/2019 pursuant to which Building Permit No. 43554 dated 3/12/2019
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"window replacments in an existing seasonal one`family dwelling as applied for.
The certificate is issued to This is the End Rd LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
i
t o ' ed Signature
z� TOWN OF SOUTHOLD
�SUF�oc,r�o
moo �y BUILDING DEPARTMENT
y x 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#: 43554 Date: 3/12/2019
Permission is hereby granted to:
This is the End Rd LLC
43 Sydney PI
Brooklyn, NY 11201
To: as built" window replacments as applied for.
At premises located at:
935 Rosenburg Rd, East Marion
SCTM # 473889
Sec/Block/Lot# 21.-1-2
Pursuant to application dated 3/12/2019 and approved by the Building Inspector.
To expire on 9/10/2020.
Fees:
AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $400.00
CO -ADDITION TO DWELLING $50.00
Total: $450.00
i
Bui i nspector
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-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 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 I
' Date. l
New Construction: Old or Pre-existing Building: (check one) _
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Location of Property: �j rVIS�GI YNR 2 Pt /c/ ,A, r l i/ze- IeO" 4/3 G��otV Uy�
House No.
treeett 1Hamlet
Owner or Owners of Property: / t/L 5
Suffolk County Tax Map No 1000, Section Block "" Lot _
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applic nt ignature
FIELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION(1ST)
'FOUNDATION (2ND)
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STATE ENERGY CODE
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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
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved ,20 'Mail to:
Disapproved a/c
Phone:
Expiration ,20
DBuilding Inspector
MAR 1 2 2019 APPLICATION FOR BUILDING PERMIT )
L
Date �3 , 20
'3 MD:RG .0- INSTRUCTIONS
TOWN OF SOUTHOLD
a. This application MUST be completely filled in by typewriter or in ifik 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'Bui'l'ding 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 applicant,or,name,if a corporation)
(Mailing,address of applicant)
State whether applicarit'is wner/lessee, agent, architect, enginee , general contractor, electrician, plumber or builder
r7
Name of owner of premises 1 �S v,_ C�Gt
(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 proposed work will be done:
House Number Street II Hamlet
County Tax Map No. 1000 Section a l Block I 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
b. Intended use and occupancy_ C,,S � (AJ(-(&CJ(JJ E
3. Nature of work(check which applicable):-New Building Addition Alteration
Repair 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 ,-' g. :Rear>,f
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?'*YESNO
* 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.
/ f
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) CONNIE D.BUNCH
SS: Notary Public,eta o New York
No.®ISU0183505®
COUNTY OF ) Qualified in Suffolk Counly
being duly sworn,deposes and says that(s)he is the applicant
(Name of 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 I
performed in the manner set forth in the application filed therew'
w\o �to before me t
day of8;- 20 l
Notary Public ignature of Ap licant
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S A L A R A P L R S A L A S R
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Panel Panel Panel Hinged Panel Panel
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