HomeMy WebLinkAbout43897-Z �o�OWr ---�
S�FfOtK oy Town of Southold 8/29/2019
• P.O.Box 1179
co �„. 53095 Main Rd
o� f,�as Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40662 Date: 8/29/2019
THIS CERTIFIES that the building ACCESSORY
Location of Property: Private Rd, Fishers Island
SCTM#: 473889 See/Block/Lot: 7.-3-3.18
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
12/7/2018 pursuant to which Building Permit No. 43897 dated 6/24/2019
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"accessory shed as applied for.
The certificate is issued to Reid Bagley Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Autho ' ed Signature
TOWN OF SOUTHOLD
�SUFFot BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o SOUTHOLD, NY
`Z 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#: 43897 Date: 6/24/2019
Permission is hereby granted to:
Reid Bagley Trust
1318 Central Ave #475
Fishers Island, NY 06390
To: legalize "as built" accessory shed as applied for.
At premises located at:
Private Rd, Fishers Island
SCTM # 473889
Sec/Block/Lot# 7.-3-3.18
Pursuant to application dated 12/7/2018 and approved by the Building Inspector.
To expire on 12/23/2020.
Fees:
AS BUILT -ACCESSORY $328.00
CO -ACCESSORY BUILDING $50.00
Total: $378.00
Building Inspector
TOWN OrF50UT74t?LD
BUILDINC DEPAItTMEPCr
TOWN HALL
765-4 SO2
APPLICATION FOR CERT'/°b CATS OF OCCUPANCY
As C 9ke,,,btl must be filled in by typewriter or ink and submitted to the Duitding MpArtns-moi with�GAICwiau:.
A 1 or incl u.-, 09 or Qew use:
1 saarvey 0fpropext3,with'accurate Jocation of all buildingn,property Final,strm's,and tit=ft u ld tar
2- 10iographt.tcatur=,
31 Firml A Approval trout Health Dcp1,of water supply and sewerage-disposal(S-9 farm)-
Poratatc...ractrvat
4. Sworn etrjcat instaUntioa£coin Board of Fire Underwrilern.
State...,
Cointur�ci»1 bwilfrom plumber eertitying that the solder used in system contains tc&E'than of t10Alid
ding,iadush-lal building,multiple residences and sirs lar buil&ngg ami installations.!cez%ificata
Vf Cade Compliance&am architect or engineer responsible for the huifdiu&
S. Submit Planning 13oord Approval oreompleted site plan requirements.
$- .For existing bididirrgs(prior to April 9, 1957)non-conrbrming uses,or buildings and"pro-czitttmZ"land ats=
1. -Accurate santey of property showing all property!inns„streets.building and tSnamzal natural or utptagraphic
• .fcat4ucs. - ...,-
2 A prropaly completed application and consent to inspect signed by the appficauL If a Crsiificate of Ck=xpa=y is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant-
Fees
pplicantFees
1. Cortai:Fzcate of Qccupancy-Now dwelling 550.00,Additions to dwelling 550.00,Altaratioiis to dwelling%SO 4p,
•ung pagl 550;00,Accessory building$50,00,Additions to accessory building$SIJ-00,1 ===Cs$50.M
2, Ceroificateof Occupancy on Pre-existing Building- $100.00
3. Copy of C d ifcrlte of Ccctipant y-$.25
4. Updated Corsificate of Occupancy- $50.00
5. TeWporary Crrdf=cate ofOcctrpancy:-Residential$15.00,Commereial S1S.00
nate.
Constnrction; Old or�Pre-existing Buildm' a: __- — (check one)
oa of.Prvperty - 0 ^
�_ \ • c5\
Hume No: Street
or Ota nail Of.Property.
- unty Tax A4p No 1000,SWtioll 'Block ' ' Lot
UJ7 -Filed Mop. Let
Date of Permit. ApplicanC.'
Approval: Underwdteis Approval:
ird Approval:
Temporary Certificate Ficial Certi&ate: (check ones
Q Applicant Signature
CONSENT TO INSPECTION
`-e 9 2e J the undersign ,do(es)es)herebystate:
Owners)Name(s)
That the undersigned(is)(are)the owner(s)of the premises in the Town of
Southold,located at UAS N"- t;� '�IJ
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section-_,Block '3 ,Lot -1 - l q .
That the-undersigned(has)(have)filed,or cause to be filed,an application in the
Southold Town Building Inspector's Office for the following:
/yP-,o
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 located 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: \ ` gA pe
0
(Signature)
leRe�D
(Pent e)
(Signature)
(Print Name)
OF SOUTyo
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULATION _
[ ] FRAMING /STRAPPING [VT FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS: �-
DATE D� �� ! INSPECTOR `
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION (1ST)
• H
....................................
'FOUNDATION (2ND)
• O
ROUGH FRAMING& _ 1 I
PLUMBING Ny
' LA
INSULATION PER N.Y-.
STATE ENERGY CODE
FINAL
ADDI'T'IONAL COMMENTS
T Z
m
v °z
• 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
Southoldtownny.gov PERNM NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 114 .20lq Single&Separate
Truss Identification Form
Storm-Water Assessment Form
+ Contact:
Approved 12Man to:
Disapproved a/c
r Phone:
Expiration 20
B ' ng pector -11 ft1ft- tv
APPLICATION FOR BUILDING PERIVHT
Date L /%0* ,20L�L
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.
£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
/-":Z>CUB�ldipg ce of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or
t t I t4 gtila i g?6truction of buildings,additions,or alterations or for removal or demolition as herein described.The
applicant agrees 4} ly with all applicable laws,ordinances,building code,ho ing code,and regulations,and to admit
authorized impe4t6rs on premises and in building for necessary inspections.
DEC 7 2018 l
((SSig^n�/attuure Jof applicant or name,if,ancorrporation)
`�T';6 Y ;l-Y (Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
C) I)n D
Name of owner of premises 1 V,
As on the tdx 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.
i. Lo on of landhich proposed wprkwil�1 be done:
House Number Street Hamlet
County Tax Map No.1000 Section Block �J 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 S�
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work
�] (Description)
4. Estimated Cost R 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 existm structures,if any:Front Rear I C Depth
Height ' Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
S. Dimensions of entire new construction:Front Rear Depth
Height Number of Stories
9. SM o"Ylo� roront� Rear Depth
10.Date of Purchase I Name of Former Owner
11.Zone or use district in which premises are situated5► ,.. � �
12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO
13.Will lot be re-graded?YES_NOWill excess fill be removed from premises?YES_NO_
14.Names of Owner of premises Address'"3y 'D)phone No. U �P J
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..®. IKXM \faiN CO,'1 C'-s r,
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 NOA�0
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
�_ SS:
CO TY OF- �`d"t
being duly swom,deposes and says that(s)he is the applicant-
`(Name 18f indi ► ua -ii- contract)above named,
(S)He is the �frrrL _
(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.
SwonktRbefore me thisday of 20 t
o \ Public 2}%,, 22- Signature of Xpplicant
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APP 0 ED AS NOTED���
DATE. B.P.19
FEE y V BY: RETAIN STORM WATER RUNOFF
NOTIFY BUILDING DEPARTMENT AT PURSUANT TO CHAPTER 236
765-1802 8 AM TO 4 PM FOR THE OF THE TOWN CODE.
FOLLOWING INSPECTIONS;
1. FOUNDATION - T.,10 REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN CODE`
AS REQUIRED AND CONDITIONS C
tf
�P G BOAR
S WN TRUSTEES
MEL-
OCCUPANCYCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
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