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HomeMy WebLinkAbout28894-ZFORM NO. 4 TO,tN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPA~NCY No: Z-29361 Date: 04/17/03 · ~{IS CERTIFIES that the building Location of Property: 56125 MAIN RD (HOUSE NO.) County T~X Map No. 473889 Section 63 Subdivision FiledMap No. __ ADDITION SOUTHOLD (STREET) (F=AMLET) Block 3 Lot 10 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 7, 2002 pursuant to which Building Permit No. 28894-Z dated NOVEMBER 7, 2002 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 ADDITION TO AN ACCESSORY WORKSHOP AS APPLIED FOR. Re certificate is issued to LESTER M ALBERTSON (OWNER) of the aforesaid building. SUFFOLK COUAFI"fDEPi%RTI4ENT OF HEALTHAPPROVAL ELEC~fRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DAr~u N/A 72122H 04/09/03 N/A Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~DING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28894 Z Date NOVEMBER 7, 2002 Permission is hereby granted to: LESTER M ALBERTSON WATER MILL,NY 11976 for : CONSTRUCTION OF AN ADDITION TO AN ACCESSORY WORKSHOP. THIS PERMIT REPLACES 11798Z at premises located at 56125 MAIN RD SOUTHOLD County Tax Map No. 473889 Section 063 pursuant to application dated NOVEMBER Building Inspector to exlDire on MAY Fee $ 75.00 Block 0003 Lot No. 010 7, 2002 and approved by the 7, 2004. ORIGINAL Rev. 5/8/02 I~OF, M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11798 Z Permission is hereby granted to: ...... z: .~:...;~..~.i4.--.~.../~.~. ................... ..... .,~.z~.:...~..~.,~...4~ .................... ...... ~.~.,~.,'~..:.~.....y... .......................... , --:~--'.,.,. ......... .:....... '-~"/~'~ ,o ........... ~.~z.:r.-.-/~z:.~..~..:...~..~.cz:~...c ..... Z'-g.... ~. x.:,.,:~. ,.,.,,~ :...~,(~.,..4' .... at premises located at ....'~.~'.~.~.~.~. ............ ~.~..2 ..... County Tax Map No. 1000 Section ..~.~..,~.. .......... Block ..... ~..~. ......... Lot No...C~./.~) ............ pursuant to application dated ..... ~7~d?~ ........ ~ ..................... , 19 .~.....~, and approved by the Building Inspector. Fee $../.(~......'~. .......... Rev. 6/30/80 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: For new building or new use: I. 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 Plammig Board Approval of completed site plan requirements. 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. 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 ofOccupancy - Residential $15.00, Commercial$15.00 /// /g9 Date. / "~ ~ New Construction: Old or Pre-existing Building: (check one) Location of Property: .~'"6 l.~, ~ /~/4~/~/[ ) /~(7 .~'~) L~(.~ )/~j~.~O__ House No. Street Hamlet Owner or Owners of Property: ~,,~'~ t~, d?~ Suflblk County Tax Map No 1000, Section ~:~ Subdivision Permit No. ~ g Health Dept. Approval: Block '3 Lot Filed Map. Lot: Applicant: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~ ~---'""~ Final Certificate: (check one) Issue Date 04/09/2003 Electrical Inspection Certificate Electrical Inspection Service, Inc. Application Number 375 Dunton Avenue 72122H East Patchogue, New York 11772 {631) 286.6642 Issued To: Lester Albertson Street: 56125 Main Road Village: Southold . 7in~ Section: Block: Lot: Contractor: 11971 Town: Southold Lic. # Was examined and found to be in compliance with the National Electrical Code. ~.J Commercial I I NVDefects [_~i Pool Lxj lstFIoor X[~ Indoor ~'} Basement ~] HotTub [X~ Residential Xi Der. Garage [] Attic [~j 2nd Floor ~ Outdoor ]_1 Addition [xJ Survey Switches Receptacles Fixtures GFI 6 6 8 4 Dishwasher Washer/Amps Dt~er/Amps Oven Heaters A/C Fans Range/Amps Microwaves Purnace Oil Gas Circulators Smoke Detector Bell Transformer Meter Amps Phase UG/OH Jacuzzi Television CO Detector Bldg. Permit: Ot h e r ..E__q ?~i p_m e_n t~ Detached Shed 1-Sub Panel 1-240Volt Receotaclc (wall) Hugo S. Surdi President Rough Inspection: 01/24/2003 Inspector: Ed Scavelli Final Inspection: 04/08/2003 Inspector: Ed Scavelli This carol'cate must not be altered in any manner, Inspectors may be identified by their credentials. 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU~N [ ] FRAMING [~I:INAL [ ] FIREPLACE & CHIMNEY REMARKS: ~ DATE INSPECTOR COMMENTS FOUNDATION ~ s t FOUNDATION 2nd 2 o ROUGH FRAME & FLUMBING INSULATION FER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 E.,am n d. Approved .~c~.cff.../.{~/ ..... 1~ Pe~it No..~ ..... Disapproved a/c . .~~~ ...... ......... (Bui~ng Inspector) AP?klCATIO~ FOR BUIk~ING P[~IT INSTRUCTIONS Application No. (../('../. · ......... 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 showhng location of lot and of buildings on premises, relationship to adjoining premises or public street: or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 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 whatever until a Certificate of Occupanc.x shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th~ Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances o: 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, bgiJ. d~ng~ode, housing code, and regulations, and tc admit authorized inspectors on premises and in buildings for necessary,in~on_s>¢- ~ ~ ...... (Sigha,~ure of a~glicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is ~wn~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nmne of owner of premises .... /~.~.~ .~.Jf7....~7( ~..~...~)%...'~. ~ .~..'. ............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder s License No...,,:~~,~..: ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwillbedone..~.'..~..-~..~....~..~../~...(~f.~.....~....~..~...(.~.. ..... ............... . . . . . ............... ¢. ., ............ ttouse NumberStreet Hamlet County Tax Map No. 1000 Section ...... 0.~)..~ ..... Block .... 0.3 .......... Lot....Q .(.0. ......... Subdivision ......... /~. .................. i ...... 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 /~5'2,"7'~'"('~ . ..~..~ b. Intended use and occupanc~ ....~.../'.././.~...~..(..~.'~..~. $. : *check ,vhich applica; :J: .~:', 2uflding .......... Aaa.:,.::: . ~:.<'× ......Alteration .... Repair ............ Removal .............. Demolition .............. Other Work ............... (Desc2ption) 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 c~s ........................................................................ 6. If business, commercial or mixed occupancy, specify n~ture and extent of each type of use ..................... .... I~, I ~ h 7. D~ensmns of ex~stmg structures, ff any: Front ............... Rear .............. Dept ............... Hmght . . ~.~ ....... Number ot Stones ...................... ~ .................. ~ ............ D~ensions of same structure with alterations or additions: Front ...d.~ ......... Rear .~.~ ............ Depth ...................... HeiSt ...................... Number of Stores ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... ..... .... ........... .......... 10. Date of Purchase ............................. Name of Fomer Owner ............................. 1 1. Zone or use disthct in which premises are situated ....... ~ ~(~(.~.~ ............................ 12. Does proposed construction vio~te any zoning law, ordinance or regulation: .................... 13. Will lot be regraded ...... ~. ~ .................. Will excess fill be removed from premises: '~i (~. ~N 14. Nme of Owner of premises .................... Address ................... Phone No ................ N~e of ~chitect ~ e /~ Address ................... Phone No ................ N~e of Contracto~ .......... ~'~ ........ Address . Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property l/nes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. f ~ 5TM · ·..~..c7..~. .............. f..~X'D'. .............. being duty sworn, deposes and says that he is the applicant (Name 6f individual signing contract) above named. 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~s ~ ~o. ~.o~k~ o, ~,,, ~o, . . ...... . ~ ?.. ......... :............~...~:..,e~...'.~.~...... .... C,~nmk~,~ ~ Su~fo~ Count~ r'.-:~ \f''~'rqr'~A~' '~ (S~gnature of apphcant)