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HomeMy WebLinkAbout29473-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29520 Date: 06/13/03 THIS CERTIFIES that the building ADDITION Location of Property: 90 BAY HAVEN LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 88 Block 4 Lot 26 Subdivision Filed Map No_ Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 2, 2003 pursuant to which Building Permit No. 29473-Z dated JUNE 9, 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" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DONALD C & ANN J WEBSTER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Authorized Sign ure 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. 29473 Z Date JUNE 9, 2003 Permission is hereby granted to: DONALD C & ANN J WEBSTER PO BOX 791 SOUTHOLD,NY 11971 for CONSTRUCTION OF AN AS BUILT DECK ADDITION AS APPLIED FOR. ADDITIONAL CERTIFICATION MAY BE REQUIRED. at premises located at 90 BAY HAVEN LA SOUTHOLD County Tax Map No. 473889 Section 088 Block 0004 Lot No. 026 pursuant to application dated JUNE 2 , 2003 and approved by the Building Inspector to expire on DECEMBER 9, 2004 . Fee $ 300 . 00 q T uthor ' zed Signature COPY Rev. 5/8/02 Form No.6 ---� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 13 ?�n' 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. 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 Date. Z4</Yl� // 2 u b New Construction: Old or Pre-existing Building: 4ef!:� —(check one) Location of Property: House Nor, ., Street Hamlet /o Owner or Owners of Property: JAt2,2�1e /_ />Ll2-a y f r� Suffolk County Tax Map No 1000, Section ev Block e-� ©� -Lot d 2- 6 Subdivision Filed Map. Lot: Permit No. Date of Permit. G Applicant: N h1LT7 C W&5w t Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ f22c- b`-t i Q � Applicant Signature 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROU PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING ] FINAL [ ] FIREPLACE & CHIMNEY 44 l REMARKS: s DATE D INSPE FIELD INSPECnoN REPORT DATE COMMENTS M a ' FOUNDATION(1ST) x -------------------^-"------- FOUNDATION(2ND) O ROUGH FRAADNG& "j PLUMBING INSULATION PER M Y. `3 STATE ENERGY CODE � r FINAL ADDITIONAL COMMENTS Z. m z 'p Y o a Z x ca TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board ofHealth SOUTHOLD,NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. jJ Trustees Examined e(9 20 Contact: Approved,20 3 Mail to: Disapproved a/c Phone: Expiration_ 1 2 ,20 ' 7 �( / 11 °' As ,g H- --- , Building Insp .PLICATION FOR BUILDING PERMIT 3 TM 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 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 interim, 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 described. 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. JA3 f\-O (Signature of applicant or name,if a corporation) (Mailing address of applicant) 1/ 1771 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Oze", Name of owner of premises J>i�h /c!' ,:.p Ah , /0-e6S7`re (As on the 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: ,+ 514 13 4yd�Vs�1'i House Number Street Hamlet County Tax Map No. 1000 Section e9 a Block Lot Subdivision Filed Map No. Lot (Name) 2. State existing use acid occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy JJssi+c 3. Nature of work (check which applicable): New Building Addition 'K Alteration Repair Removal Demolition Other Work (Description) 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 cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories" 8. Dimensions of entire new construction: Front 2 Z =d " Rear Z Z ' 49"—Depth Height Number of Stories 9. Size of lot: Front-12_7, /2. Rear 15 Z - 4 Depth 7. 7e,J 1 2-s- 10. Date of Purchase 7a&ZS c>/ Name of Former Owner /`y< <c 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO X, 13. Will lot be re-graded? YES_NO Y Will excess fill be removed from premises? YES=N0= 14. Names of Owner of premises 77vtia D r A-n„ Address V z" 43 A-v1.',4 ir,�rni Phone No. 7x,6` Name of Architect Address 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.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 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) SS: COUNTY 77Fon �Y OF -'A)T ) /:6/�i0I (/ty' j (/l/��S�C�� being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the fV) (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. 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