HomeMy WebLinkAbout28732-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29486 Date: 06/03/03
T~IS CERTIFIES that the building ELECTRICAL
Location of Property: 3040 SKUNK LA CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
Coul~ty T~ ~ap No. 473889 Section 97 Block 8 Lot 12
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 10, 2002 pursuant to which
Building Permit No. 28732-Z dated SEPTEMBER 10, 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 ELECTRICAL SERVICE INSTALLATION IN AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
~e certificate is issued to MARIA CASTRO
of the aforesaid building.
( OWNER )
SD-FFOLK CO[~l~f DEPAR~qT OF F~L~LT~{ ~PRO~L~L N/A
EI~CTRICA~ CERTIFICA~ NO. 1082276 11/18/02
PLUMBERS CERTIFICATION DA'£~D N/A
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)
PERb~IT NO. 28732 Z
Date SEPTEMBER 10, 2002
Permission is hereby granted to:
MARIA CASTRO
PO BOX 1051
CUTCHOGUE,NY 11935
for :
NEW ELECTRICAL SERVICE TO AN EXISTING SINGLE FAMILY DWELLING
REQUIRES AN UNDERWITERS INSPECTION ON SITE.
at premises located at 3040 SKUNK LA CUTCHOGUE
County Tax Map No. 473889 Section 097 Block 0008 Lot No. 012
pursuant to application dated SEPTEMBER 10, 2002 and approved by the
Building Inspector to expire on MARCH 10, 2004.
Fee $ 150.00
~~gnature
ORIGINAL
Rev. 5/8/02
Form No. 6
OF SOUTHOLD
TO~ 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. Cornmercial 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 ;urvey 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 $25.00, Additions to dweliing $25.00, Alterations to dwelling $25.00,
Swimnmng 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
New Construction:
Location of Property:
Old or Pre-existing Building:
3Oq'O Skctnk h~ne
Owner or Owners of Property:
House No.
Date. [4o~ Zq, 2003
o,/ (check one)
Street O
Hamlet
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No. ~ g ~ 3 9. - ~ __ Date of Permit.__
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ 2~/~-,n a
Block
Filed Map.
__ _ Applicant:
Underwriters Approval:
Final Certificate:
Lot
Lot:
(check one)
AppJdcant Signature
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
UNDERWRITERS CERTIFICATE
REQUIRED
APPROVED AS NOTED
FEE: ~')_K'~ r~ BY:
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
I FOUHND~,T;~N - ~WO
~F. QB.P. QURE~C(~I CRETE
2.--q@LIGH - FRAMING & PLUAAB~NG
4, FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATS CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
By THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD Of FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of upon premises owned by
JOHN LUDEMAN MARIA CASTRO
P.O.BOX 621 3040 SKUNK LANE
NEW SUFFOLK,NY 11956 CUTCHOGUE, NY 11935
Located at 3040 SKUNN LANE CLITCHOGUE. NY 11935
Application Number: 1082276 Certificate Number: 1082276
Section: Block: Lot: Building Permit: BDC: NS11
Described as a Residential occupancy, wherein the premises electrical system consisting
electrical devices and wiring, described below, located in/on the premises at:
Basement, Outside,
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was
found to be in compliance therewith on the 18th Day of November, 2002.
Name QTY Rate Rating Circuit Type
Service
1 Phase 3W Service Rating 150 Amperes
Service Disconnect: 1 150 cb
Meters: 1
1 of 1
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
· ' BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YoRK BOARD OF FIRE UNDERWRITERS
2003
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 1OO38
CERTIFIES THAT
Upon the applicallon of
upon premises owned by
JOHN LUDEMAN
P.O.BOX 621
NEW SUFFOLK,NY 11956
MARIA CASTRO
3040 SKUNK LANE
CUTCHOGUE, NY 11935
located at
3040 SKUNK LANE CUTCHOGUE, NY 11935
Application Number: 1082276
Certificate Number: 1082276
Section: Block: Lot: Building Permit: BDC: NS11
Described as a Residential occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Basement, Outside,
was inspected in accordance with the National Electrical Code and the deta~i of'the installation, as set forth below, was
found to be in compliance therewith on the lgth Day of November, 2002.
~ ~ Rate gifting Circuit
Service
I Phase 3W Service Rating 200 Ampe~cs
Service Disconnect: ] 200 cb
Meters: 1
1 of 1
This certificate may not be a,emd iq any way arid is validated only by the presence of a raised seal at the/0ca/ion indicated·
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined
Approved
Disapproved a/c
Expiration ,20__
PERMIT NO. 2t~' ~ ~.2 ~-
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans
Planning Board approval
Survey.
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
- ~uilding Inspector
Phone:
APPLICATION FOR BUILDING PERMIT
Date
/NSTRUCTIONS
~/~FJ///~ ~ ,20
'/
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 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 interin~ 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 descr/bed. 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,
/ / (Signature o~apphcant or imme~ ifa corporation)
' (Mailing ~dress'of applicgot) _ ~
State whether applicm~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner ofpremises
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name mid title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No. ,k] ~ ~ ~
Other Trade's License No.
1. Location of land on which proposed w~ork will be done:
House Nmber S~eet
Lot
County Tax Map No. 1000 Section ~;/-7 Block ~'
Subdivision Filed Map No.
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy rfi'f't~9
b. Intended use and occupancy
Nature of work (check which applicable): New Building.
Repair Removal Demolition
Estimated Cost
If dwelling, number of dwelling units
If garage, number of cars
Fee
Addition Alteration
Other Work ~-~?~./~-'rc_ ~/ ,.~'~,-~,/c.
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height, Number of Stories
Rear
Depth __
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear .Depth
9. Size of lot: Front Rear .Depth
Rear
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed constmcfion violate any zoning law, ordinance or regulation? YES NO__
13. Will lot be re-graded? YES__
NO Will excess fill be removed from premises? YES__ NO __
14. Names of Owner of premises/~g/a/,--'
Name of Architect
Name of Contractor
Address'~c J~ ~ zC'~r~,..Phone No.
Address Phone No
Address~, ~c,>' ~,,~/ Phone No.~/F' ' ~ ~ ~",~,
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.C. 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 fotmdation 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)
SS:
COUNTY OF )
%/'7~/f~7 ,~ ,-,' ~/~ ~-'~ ~ ~ ~/ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual sign/rig 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 o
./~.) ~2~ dayof ,,~Z~ 20 O:~LJ
LINDA J. COOPER
Notary Public, State of New York
Signature of Applicant
UNDA J. COOPER
No 4822563. Suffolk Coun~
Term ~oires December ~1,1~