HomeMy WebLinkAbout45141-Z o�gUEF�t�cd�, Town of Southold 11/24/2020
a
P.O.Box 1179
53095 Main Rd
Z'✓.J �ao� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41628 Date: 11/24/2020
THIS CERTIFIES that the building RESIDENTIAL REPAIRS
Location of Property: 595 Rogers Rd, Southold
SCTM#: 473889 Sec/Block/Lot: 66.-2-43
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/18/2020 pursuant to which Building Permit No. 45141 dated 8/26/2020
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:
roof repair due to storm damage as applied for.
The certificate is issued to Hale, Scott&Bjofneboe, Stephen
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
tho ' ed Xlirnature
TOWN OF SOUTHOLD
�g�FFO(kco� .
00o aye BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o
}4,V� SOUTHOLD, NY
H $
5
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#: 45141 Date: 8/26/2020
Permission is hereby granted to:
Hale, Scott & Bjorneboe, Stephen
PO BOX 635
Southold, NY 11971
To: roof repair due to storm damage as applied for.
At premises located at:
595 Rogers Rd, Southold
SCTM # 473889
Sec/Block/Lot# 66.-2-43
Pursuant to application dated 8/18/2020 and approved by the Building Inspector.
To expire on 2/25/2022.
Fees:
CO -ADDITION TO DWELLING $200.00
CO -ALTERATION TO DWELLING $50.00
Total: $250.00
BuildVg Inspecto
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
Date. 08 1-� &Odo
New Construction: Old r Pre-existing Building: (check one)
Location of Property: �C � er5 OcfU &'Adi
House No. Streett // Hamlet
Owner or Owners of Property: &A rale C ApAeo �a oroeio
Suffolk County Tax Map No 1000, Section 4 300 Block 6(. , 2— Lot
Subdivision :�3Q I LO �C� Filed Map. Y' Lot: / 0
E*
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
ica t ignature
# TOWN OF SOUTHOM BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[
] 'FOUNDATION 2ND [ ] SULATION/CAULKING
FRAMING /STRAPPING [ FINAL 106 A;OPJ '
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ " ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS: , -
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DATE 11 INSPECTOR Lnz -
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FIELD-INSPECTION REPORT DATE COMMENTS r
FOUNDATION(IST)
Q
FOUNDATION
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ROUGH FRAMING& �
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PLUMBING ® H
INSi:LATION PER N.Y. H
STATE ENERGY CODE
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FINAL
ADD C N MENTS-
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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
( _SG*-kTHOLD,NY 11971 4 sets of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX:(631)765-9502 /4 Survey
Southoldtownny.gov PERMIT NO. !! Check
Septic Form
N.Y.S.D E.C.
Trustees
C.O.Application
j� Flood Permit
Examined �/'� 20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
,t q � Contact:
Approved®v 19/14
14 ,20 107-00 Mail to-
Disapproved a/c
4 Phone: )0
lx�ir ao I_e ,20
n,ll Building spector
A U G 1 8 2020 1_�' APPLICATION FOR BUILDING PERMIT
Date ,201L
MIMING DEQ.,. INSTRUCTIONS
'rn$' 4; =a.:ThiS appli�atloiiylt%TUST 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 regulations,and to admit
authorized inspectors on premises and in building for necessary inspections. ao
Ooa. cant or name,if a corporation)635-�U�old, ,114'119 1
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
OW/)et-
Name
W/)eP-Name of owner of premises � G✓ Q e � ��8 JC�� �• U)O!'/1G'OOe
(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 k will be done:
5 c�UTJG/d�Car' f
House Number stfeet Hamlet
County Tax Map No. 1000 SectionBlock - 7— Lot 6}
Subdivision� 6SIdA'Filed Map No. Lot 16
2-;!,State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy_ Sllrqlp-�OIMIN C 0 i 6anc Q
b. Intended use and occupancy ,S"j lhi��ymj l�1'eS I UQI1C�
3. Nature of work(check which applicable):New Building Addition Alteration
RepairRemoval Demolition Other Work
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units__ of dwelling units on each floor ;3
If garage, number of cars OIIP_
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use.
7. Dimensions of existing structures,if any:Front �o� Rear, a Depth
Height P fir. 12.0' Number of Stories -fW6
Dimensions pj same structure with alterations or additions: Front Rear
Depth 63 :3'/ Height E.&. f2•8-1 Number of Stories :in/G
8. Dimensions of entire new construction:Front AIA Rear Depth
Height Number of Stories
9. Size of lot:Front C55 I Rear �7 t Depth r DU
10.Date of Purchase 0J16 VName of Former Owner l GhOe, �WIIVI
11.Zone or use district in which premises are situated
12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NOZ
13.Will lot be re graded?YES NO /Will excess fill be removed from premises?YES NO-
- � 3�0-#dd�
14.Names of Owner of premises En �Mt'b�Address J @!$ J� Phone No.
Name of Architect Address Phone No
Name of Contractors &�a� Address Phone No.
wad AM", N //19Z
15 a.Is this property within 100 feet of a tidal wetland or a shwater wetland?*YES NO
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE SQUIRED.
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--V"
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF
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
performed in the manner set forth in the application filed therewith
Sworn to before me this
day of 20
Notary Public Signature of Applicant
N SCDHS REF# R10-18-0047a SURVEY.OF PROPERTY
QilBVG A T SO UTHOLD
vo," 2 a TOWN OF SOUTHOLD
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�g oo � SUFFOLK COUNTY, N.Y.
1000-66-02-43
SCALE. 1'-20'
0 1 F MARCH 20, 2018
Yong o1 OCTOBER 16, 2018 (SEP77C AS—BUILT)
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LOT NUMBERS REFER TO MAP OF BEIXEDON ESTA 7ES
BLOCK 7" FILED IN 7HE SUFFOLK COUNTY CLERKS OFf7CE
AREA-8,250 SGS. FT. ON MARCH 16,1946 AS FILE NO. 1472.
ELEVATIONS ARE REFERENCED TO NAVD.88 I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUC77ON OF SUBSURFACE SEWAGE M Y.S LIC. NO. 49618
ANY ALTERA770M OR ADDITION TO THIS SURVEY IS A WOLA77ON DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES PECON/C SURVEYORS, P.C.
OF SEC77ON 7209OF THE NEW YORK STATE EDUCA710M LAW. and will abide by the conditions set forth therein and on the
EXCEPT AS PER SEC770M 7209—SUBDIVISION 2. ALL CER77FlC47IONS permit to construct. 631 765-5020 FAX (631) 765-1797
HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909
The location of wells and cesspools shown hereon are
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR from field observations and or data obtained from others TRAVELER STREET 1
8-110
WHOSE SIGNATURE APPEARS HEREON. SOUOUTHOLD, N.Y. 11971
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APPR VED AS NOTED Additional
DATE ' ' B P. # ,� Cadfication
May Be Required.
FEE20•60BY
NOTIFY BUILDING DE7PAPR -NT AT
765-1802 8 AM TO 4 .THE
FOLLOWING INSPECTIONS
1 FOUNDATION-TWO REQUIRED
FOR POURED CONCRETE
2 ROUGH-FRAMING,PLUMBING. 0
STRAPPING, ELECTRICAL&CAULKING
3 INSULATION -
4 FINAL-CONSTRUCTION &ELECTROILI���
MUST BE COMPLETE FOR C 0 ( AA
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
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ALL CONSTRUCTION SHALL
EET THE REQUIREMENTS OF THE
CODES OF NEW YORK STATE.
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