HomeMy WebLinkAbout29199-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Seuthold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29316
Date: 03/18/03
T~IS CERTIFIES that the building ACCESSORY
Location of Property: 2600 DUCK POND RD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Ta3~ Map No. 473889 Section 83 Block 2 Lot 19.12
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 10, 2003 pursuant to which
Building Per,Lit No. 29199-Z dated MARCH 10, 2003
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 RICHARD J & PATRICIA A SPELLMAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLDMBERS CERTIFICATION DATED
N/A
N/A
N/A
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUIDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 29199 Z Date NL~RCH 10, 2003
Permission is hereby granted to:
RICHARD J SPELLMAN
PO BOX 1127
CUTCHOGUE,NY 11935
for :
CONSTRUCTION OF A_N "AS BUILT" ACCESSORY SHED IN THE REQUIRED REAR
YARD AS APPLIED FOR
at premises located at 2600 DUCK POND RD
County Tax Map No. 473889 Section 083 Block
pursuant to application dated MARCH 10, 2003
CUTCHOGUE
0002 Lot No. 019.012
and approved by the
Building Inspector to expire on SEPTEMBER t0,
Fee $
2004
150.00
Rev. 5/8/02
COPY
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.
New Construction:
Location of Property: ~O6
House No.
Owner or Owners ofProperty: ~7/C~t:TY~ Q- ~7'-r/C//~- ~f~]]
Suffolk County Tax Map No 1000, Section ~--~ Block
C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, 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
Old or Pre-existing Building: ~' (check one)
Street J ~J Hamlet
Subdivision
Permit No. 19~ C~ / c~ ?
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~x~'~ 0 0
Filed Map. Lot:
Date of Permit..~ ~q/E> ~33 Applicant:
Underwriters Approval:
Final Certificate:
~'~'~ (check one)
Applic t~q~gnature
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND
FRAMING
[ ] IN~,.~J~ATION
[ ~FINAL
[
REMARKS:
] FIREPLACE & CHIMNEY
INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Exam/ned ~/a ,20.
/
Expiration P~/o __, 20 /
/.
BUILDING PERMIT APPLICATION CHECKLIST
PERMIT NOd 7/
~ilding Inspector
Do you have or need the follow/ag, before applying'?
Board of Health
3 sets of Building Plans.
planning Board approval
~ Survey
Check ~ 1~ rD ~..~--~r~G '~C
Septic Form
N.Y.S.D.E.C.
Trastees
Contact:
Mail to: J'~fa
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 3
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 tiffs application may not be commenced before issuance of Bnilding 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 frmn 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 pernfit for an
addition six months. Thereafter, a new perrrdt 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 pren'fises and in building for necessary inspections.
(Signature of applicant or name, ifa corporation)
(Mail/ag address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises /'~C}xar~ o ~8T'C1¢,0~ Of Cl/nlCtD
(As on ~he 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 SET"' *'~ /OOO-OS3"OO--6'~Oo-ol~H=let -~'J~
Coun~T~MapNo. 1000 Section ~3 Block O Lot
Subdivision Filed Map No. Lot
2. State existing usb and occupancy ofprernises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~[q t" r~
b. Intended use and occupancX
3. Nature o f work (check which applicable): New Building_ Addition Alteration
Repair Removal Demolition Other Work ..% lq ~ _~
Estimated Cost ~, c~ ] ri...~ Fee 4]..~0 ~ t9 d)
If dwelling, number of dwelling units
If garage, number of cars J
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor J
6. If business, commercial or mixed occupancy, specify nai~re and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear ~' yepth
.
Dimensions of same structure with alterations or additions: Front
Depth Height. Number of Stories
Rear
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
.Depth
9. Size of lot:Front ~02~ Rear
10. Date of Purchase /~f~] Name of Former Owner
11. Zone or use district in which premises are situated ¢ccJc¢3~ 0
12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO
,]
13. Will lot be re-graded? YES ~'/~40__Will excess fill be removed from premises? YES '7 'iqO
14. Names of Owner ofpremis_es/~lc/~,/ /ga~-rC',c,~ Address~. &¢O,~t~:K/0t)~ fi~t_Phone No.
Name of Architect ~ ['¢11 ,'mrs ,~ A ddres sLitx.tr-4i o,,5 o-e._ 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.Ci 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.
STATE OF NEW YORK)
COUNTY Ol~q f'f~l ~/S)S:
[t~/C~d' '""~ljDW--'l! 19~)t::? IQ beingdulyswom, deposesandsaysthat(s)heistheapplicant
(Name of individu~ 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 ail statements contained in this application are tree 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
]0Y-~ dayof ')'vtc.~--~ 20o'~
Notary Public
NORTH FORK WOOD DESIGN
PAUUS LANE & RT. 48 · PECONIC, NY 11958
PHONE: (516)765-3090
FAX: (516) 765-(~94~3
Address ~; ~:;}}i.) ~'E.:¢0 ,~¢ / ~ Phone
City /..~,_/¢C-.¢,S/O'--___State //c'//~/ Zip
Source Load Truc
Description
Size _
Colors:
Root L
Special Instructions:
f., O ;T ,.~.4.BuILDiNC~DE pART M E NT AT
~"[ ....
FOm~ -
* s ~t T ON
P
* Am them any ~T~
. You th~ cu~to~~ f~~ -
bounda~ linesDESIGN OR CONSTRUCTI~
. We're going ~nto your yard a your request, hemfom we do no~
accept any resp~sibili~ for damages which ~ud ' '. ,
. Pla~ment of Shed. Our drivers must ~sume w~tever i~tmc~s
given by person(s) present, in accordance with t~ buyem wishe~r
in event no one is present, wedo not a~ume ms~nsibili~
ever for mispla~ment of shed. Any ml~ati~ NIl be
bwer's expe~e.
. W~. when it is exposed to t~ elements has a te~enw to shdnk
and expand. Because of ~is, we c~not accept responsibili~ for
chipping, cm~ing, minor wa~ing, etc. If there is a problem, plea~
let us know.
Options:
TOTAL
Tax
Subtotal
Deposit
BALANCE DUE
PRICE
AMOUNT
Signature
The
Nassau
An excellent "on location sales office", pool house, or
general storage for your home. A beautiful way to meet
your storage needs. Single or double doors are
available on ALL MODELS. 8' high.
The /~/$
Porch
This unique shed can be used on one side as a
changing room for the pool or storage and on the other
side as a play area for the kids. It comes in the Nassau,
Suffolk, Ranch or Colonial Barn styles.
4 Ft. Side Walls
Mini Barn
5 Ft. Side Walls
Mini Barn
This model will surely complement the natural
landscape of your property. Like other models, the
double doors will accommodate everything from tools
to heavy lawn & garden tractors.
This model gives you more headroom then the 4 foot
side wall model, but with the same great look.
NORTH '0RK-
Paul's Lane & Rt. 48, Peconic
765-3090. Fax
We Will Meet or Beat Any Competitive Price
Everything in this Catalog is Built in Peconic, on the North Fork
All of our double doors are 5' wide with 12" hook and eyes
Extra Heavy Gauge Galvanized Hinges with Solid Brass Pin
If It's Built for the Great Outdoors then
it's Built by North Fork Wood Design!