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HomeMy WebLinkAbout29292-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~qTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCy No: Z-29373 Date: 04/22/03 THIS CERTIFIES that the building ALTERATION Location of Property: 1305 PEQUASH AVE CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 103 Block 7 Lot 18 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 14, 2003 pursuant to which Building Petit No. 29292-Z dated APRIL 14, 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 ENCLOSE EXISTING FRONT PORCH ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · "ne certificate is issued to HELEN SLEDJESKI TRUST & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNq"fDEPART%WENTOF~ALTHAPPRO~i~J~ EL~t-£~ICAL CERTIFICATH NO. PLU~4BERS CERTIFICATION DA'r~u3 N/A N/A +)~e~Si,n.ture Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29292 Z Date APRIL 14, 2003 Permission is hereby granted to: HELEN SLEDJESKI TRUSTEE 2760 RUTH ROA]D MATTITUCK,NY 11952 for : ENCLOSE EXISTING FRONT PORCH AS APPLIED FOR. THIS PERMIT REPLACES BP#17981. at premises located at County Tax Map No. 473889 Section 103 Block pursuant to application dated APRIL 14, 2003 Building Inspector to expire on OCTOBER 14, 1305 PEQUASH AVE CUTCHOGUE 0007 Lot No. 018 and approved by the 2004. Fee $ 150.00 Authorized Signature COPY Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 017981 Z Dote ..... ~.....~ ....................... , i0...~..~.' Permission is hereby granted to: .... ............................................... County Tax Mop No. 1000 Section .... ]...(~....~ ........ Block ...... .,~....~. ....... Lot No ......L.3. ............ pursuant to application doted ....... ..~.~.C~......~,~. ................ 19,.~...~.., end approved by the / Building Inspector. Building Insi:Jector 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: 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 fi.om 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 fi.om 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 "preFe~x_ isting~ land uses: 1.Accurate survey of property showing all property lines, streets, building and unusual na[ur,~l ~r toPograPhic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alteratior~.to d~lling $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- $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. April 15, 2003 New Construction: Old or Pre-existing Building: LocationofProperty: 1305 Pequash Avenue X (check one) Cutchogue House No. Street Hamlet Owner or Owners ofProperty: Lucille Stepnoski et al. Suffolk County Tax Map No 1000, Section 103.00 Block 07.00 Lot 018. 000 Subdivision ~ ~.~/.~_ .f~Q~.~,h~f',~ Filed Map. Lot: Permit No. 0179817. Date ofPermit. 4 / 03 / 89 Applicant: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ --la3:l]q:l;l:l~ c~ Underwriters Approval: Final Certificate: X (check one) ~ ~.ppl(cant Signature Barbara Goehringer CONSENT TO INSPECTION Barbara Goehringer Owner(s) Nme(s) , the undersigned, do(es) hereby state: · . on of That the undersigned 0s) l(aee~ the owner(s) of the premises in the Town of Southold, locatedat 1305 Pequash Avenue, Cutchogue, New York which is shown and designated on the Suffolk County Tax Map as District 1000, Sectionl03 ,Block 7 ,Lot 18 That the undersigned (has) (la~,~). filed, or cause to be filed, an application in the SoutholdTownBuildinglnspector's Office for the following: Certificate of Occupancy for enclosing existinq front porch 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: April 15, 2003 (Signature) Barbara Goehrinqer (Print Name) (Signature) (Print Name) 7 7~/ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [~'~RAMING [ ] FINAL REMARKS:~~k~,~__ DATE INSPECTOR 765.1~02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] INSULATION REMARKS: ] FIREPLACE & CHIMNEY DATE INSPECTOR FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME -PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT ToWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTH ....... '-. .... 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORH ................ NOTIFY TEL.: 765-1802 .;~...., 19~J. Permit No. 1."~ .~.~/..'~.. Approve Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .................. a. Tiffs 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 scak. Fee according to scm:dale. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a deta/led 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 issued 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issoance 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 Reo. ulations, for the construction of buildings, ad~ditions or alterations, or for removal or demolition, as herein described. Th~ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on premises and in building for necessary, inspections. /.~ ,-.~. J~- ,,~ . L..~, ,.~.-~--,~-~,.--,,~_-~ ~,t~ (Signature ot appcz'' ' 'licant, or name,.if a corporanon) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ........................................................................... Name of owner of premises .~. .~. -"~- -"1.'~ ....................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License Plumber's License No ......................... Electrician's License No ....................... Other Trade s Lzcense N ...................... 1. Location of land on which proposed work wil be done .... '7... ~ r.. ~ . ~. i~/~/-~../;~.,/..~.~../.~ ..... }louse Number Street Hamlet ........ .... /. ............ .... ........... Subdivision ..................................... Eilcd Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b- Intended use and occupancy ....... · ~ ch a icable' Ne~ ' 'terat on 3. Nature of work (gheclc 'h , pp /: v Building .......... Addition .......... ,u ......... Repmr . .'..'~e,'&~.. ....... Removal .............. Demolition .............. Other Work .............. (Dcscflption) 4. Estimate'd Cost ..... '..~ ................. Fee ..................................... (to be paid on filing thi~ application) 5. If dwelling, number o f dwelling units ....... ~ ...... Number of dwelling units on each floor .... ~..~ .. If garage, number of cars .......... ~ ............................................................ 6. Ifbusness commerce or mixed occupancy speci'ynattreandcxtento[cachty~eofuse , . 7. Dmensonsofex~stm structures ffany. Front ~ a ~ Dc~th Height . ,~ .......... Number of Stories ........... ~ ....................................... Dimensio(fof same structure with alterations orgdditions: Front ...... ~ ....... Rear...~,~ Depth ....... '7- ............ Ilei~t .... ~ ................ Number of Stories ..... ~ ............ 8. Dimensions of entire new construction: Front ...~D ........ Rear . ~.~. ......... Depth .. :'~ ......... Height . . ~ ......... ~mnber of Stories ..... .~. ....................... ~_ . 10. Date of Purchase .../(~Z ..~ ................... Name of Fo~er Owner .. ;~..~ ~~. 1 I. Zone or use district in which premises are situated ................. ----..-- .... t ........... 12. Does proposed construction viOate any zoning law, ordinan~;'~r regulation" ... ~ ........ W~l lot be regraded ·. ~ ...... W exces fill be emoved from premises: Yes 13. . ~ . ~ N~e of Architect ........................... Address ............ ~ .... Phone No ................ N~e of Contractor ~ ~~. ff~ff[~ Address .~ff~'~ ~.5~. ~e N~~3M 15.Is this property located within~OO f,,at of a tidal ~etland? · If yes, Southold To~n Trustees Permit may be required. PLOT D[AG~M Locate cle~ly ~d dist~ctly ~1 bufld~gs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block number or desc~ption accoId~eed, ~d showstreet n~es and ~dicate whether ot. , STATE OF NEW YORK, COUNTY OF ................. S.S ............................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. l{e is tim ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly author/zed 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 thc application filed therewith. Sworn to bet'ore me this ............. ~.~ ....... dayof .... ~'~ _- _ ,- _ ~ ......... .. ~,- ........... ~ Puetl~ ~ ~ ~ Y~ ~ (Sionature of applic~ t) ~ ~ ~h 30. ', ' PPRQV£1] AS ~01'EO DATE: ~ B.P. # , FEE: ,, NOTIFY BLJILDING DEPARTMENT AT 76,5-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TVVO REQUIRED FOR POURED CONCRETE 2. ROUGH FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENT~ OF THE N.Y. { STATE CONSTRUCTION & ENERGY