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43702-Z
��Q�guGfQt��dG� Town of Southold 12/9/2019 n 3 P.O.Box 1179 o - T 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40904 Date: 12/9/2019 THIS CERTIFIES that the building WINDOWS Location of Property: 1655 Old Farm Rd., Orient SCTM#: 473889 Sec/Block/Lot: 26.-4-1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/26/2019 pursuant to which Building Permit No. 43702 dated 5/2/2019 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: ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Thompson,Elizabeth&Fahs,Marianne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED rth odignature, o�SU oTOWN OF SOUTHOLD �� oy BUILDING DEPARTMENT TOWN CLERK'S OFFICE ca o� • 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#: 43702 Date: 5/2/2019 Permission is hereby granted to: Thompson, Elizabeth PO BOX 464 Orient, NY 11957 To: construct repairs (including window replacements) to existing single-family dwelling as applied for. A, At premises located at: 1655 Old Farm Rd., Orient SCTM # 473889 Sec/Block/Lot# 26.-4-1 Pursuant to application dated 4/26/2019 and approved by the Building Inspector. To expire on 10/31/2020. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -RESIDENTIAL $50.00 Total: $250.00 Building Inspector t 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: location of all buildings, property lines, streets, and unusual natural or 1. Final survey of property with accurate 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- Date. 15.00Date. New Construction: Old or Pre-existing Building: (check one) —Location of Property: I&F6_7 [fit l� `F14R E 0�-f C� House No. Street Hamlet Owner or Owners of Property: FW ZU1 Suffolk County Tax Map No 1000, Section 2 Block 4 Lot Subdivision Filed Map. Lot: Permit No. Z Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: ✓/ - Request for: Temporary Certificate Final Certificate: } (check one) Fee Submitted: $ Sbit 7,jf6l 'A Applicant Sig ture v # TOWN OF SOUTHOLD BUILDING DEPT. = `ycomm '' 765-1802 INSPECTION. . . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]' FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING/STRAPPING [ FINAL 4fM6 - [- ] FIREPLACE &CHIMNEY- [ ] FIRE SAFETY'INSPECTION [ ] FIRE RESISTANT CONSTRUCTION - [ ] FIRE"RESISTANT PENETRATION [ ]- ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 6n DATE INSPECTOR / b=� FIELD.INSPECTION REPORT .DATE COMMENTS CI N FOUNDATION(1ST) --.---__.__-....................... 'FOUNDATION (2ND) rA ' � o i ROUGH FRAMING& PLUMBING y INSULATION PER N.Y. I H STATE EN)&RGY CODE' ' I FINAL ADDITIPNA LCOMMENTS t z i i ' ,H 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 www. northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined 5 ,20Contact: D Approved ,20 ��/a/VLSZ �,4frr1-to: Disapproved a/c AP 2 6 X019 R Phone: Expiration 20z v � _ O ,g® Building Ws e APPLICATION FOR BUILDING PERMIT Date , 20 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 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 regulati ns, and to admit authorized inspectors on premises and in building for necessary inspections. I 1 (Signature of applicant or name,it a corporation) O . S 4440 DPACiuT, W 119 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder 0'�J M51?_ /A P-4C,4 I Tt✓c4_ Name of owner of premises (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: IL !5F epLz> 1 6(2AM R-tzo94r-i-r House Number Street Hamlet County Tax Map No. 1000 Section 2 (v Block -4 Lot Subdivision Filed Map No. Lot, (Name) 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 r~a 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other WorkRe c- r I M m orTeA4r escription) 4. Estimated Cost4 p ,r ; Fee' , . • 7 , , __ tr(,To bye,;laid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units Wn'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 (v 2 Rea'r,70, 62 Depth 40 Height 2 5 ` Number of Stories Z Dimensions of same structure with alterations or additions: Front -GA"E Rear Depth ,1Height Number of Stories 8. Dimensions of entire new const iltio Front Rear Depth Height Number of Stories I � � 9. Size of lot: Front Rear 3 1 S Depth 3e�lv 10. Date of Purchase I `� 3 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_X_ 13. Will lot be re-graded? YES NO XWill excess fill be removed from premises? YES NO 'P 0.B-+b+- 14. Names of Owner of premises F-'A"456TH T"F'Address CTA C,01 NY 11457 Phone No. '117-V'fl-I y`I Name of Architect JFu?A%etff i 4vuffa Address 51Atit4, Phone No 56prM6 Name of Contractor t0 Address gob '50mmEa- L.R. Phone No. 6) •S767 - ZZG57 ov ` l IR 7l 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_X_ * 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. STATE OF NEW YORK) SS: COUNTY Ol F- tZ.rn,e—,-Tt+ T401%tpS-0" being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the ON tjk: z � Aae-41 rE-e-T (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 �c 1�1 day of Ao6 20 Notary Public Signature of ApplI nt TRACEY L.LER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2j02- C a L J Residence Renovation APPROVED AS NOTED �y k 1655 Old Farm Rd. - �43 16 e11� " - DATE: B.P.,# :a ' Orient, NY 11957 • �Q a `� Q FEE: BY: &�� • NOTIFY BUILDING DEPARTMENT AT oTag Lot: 1���-U26-4-1 765-1802 8 AM TO 4 PM FOR THE 0: 0 { \ FOLLOWING INSPECTIONS: FOUNDATION - TWO REQUIRED FOR POURED CONCRETE {f � 2. ROUGH - FRAMIt' _, & PLUMBING "- 3. INSULATION D 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE List of Drawings: REQUIREMENTS OF THE CODES OF NEW - -�- YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 1 List of Drawings 2 Roof Plan tv 3 North & South Elevations 4 East & West Elevations - 41 COMPLY WITH ALL CODES OF Ai NEW YORK STATE & TOWN CODES { AS REQUIRED AND CONDITIONS OF OCCUPANCY OR ` C) 4 USE IS UNLAWFUL 3T} 1i :, ARD WITHOUT CERTIFICA , R STEES ` = OF OCCUPANCY � 0 , Job Date Thompson beth - ` .Eliz •� ;�ap�•-��- - a rrsp n Architect ....__..-�' - ©P�E I.�T Rte+°•( � � P.O. Box 464 917-848-1541 Title Scale Orient, NY 11957 www.elizabeththompsonarchitect.com 1P-4 i I I--_-- _ -- ititf_- M r! =G (art_ !11�;A/C fp _ ;PC-► 4 �-M IW __zX(, �PT lZ I V ��YP '® ®F M� ��. i Job Date Elizabeth Thompson Architect �� 5�i ®�-® F `1 �� 419 cf P.O. Box 464 917-848-1541 Title Scale I Orient, NY 11957 �a - --�I-- - www.elizabeththompsonarchitect.com r��� � , b ay I f I I I i t ' 10 I-V71 P6 WAU, CAL- TU 17 'A OF H� E Job Date Elizabeth Thompson° , Architect_____ 0-PE14'r,_ Py ,Y: P.O. Box 464 917-848-1541 Title scala 1 Orient, NY 11957 www.elizabeththompsonarchitect.com -__ ° � �� _- r — -- - FLA MI �+�ry�._�[gyp/•/ �/��5 w ��J/f��(�py j[ _ _ _ vD O - r Me .00 — — — --- i17 Sfol OF HE . E Jab ��� ��P i' 1.�, Date � Elizabeth Thompson Architect6uIrr I26 1 i wy P.O. Box 464 917-848-1541 Title Scale I Orient, NY 11957 ' r www.elizabeththomptonarchitect.com