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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