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Home My WebLink About28340-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29539 Date: 06/25/03 THIS CERTIFIES that the building ADDITION Location of Property: 95 SHORE LA PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax [{ap No. 473889 Section 86 Block 1 Lot 4.17 SuJ~division Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 29, 2002 pursuant to which Building Pez~t NO. 28340-Z dated APRIL 30, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CARL & ELENA M PATCHKE (OWNER) of the aforesaid building. ~uFFO~K COUNT~ DEPARTMENT OF IIEALTH APPROV~ ELECTRICAL CERTIFICATE NO. PLU~IBE~S CERTIFICATION N/A N/A N/A A~Jize~ Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28340 Z Date APRIL 30, 2002 Permission is hereby granted to: SCHEMBRI (PATCHKE) 95 SHORE LA PECONIC,NY for : CONSTRUCTION OF A 14'X 39' DECK ADDITION TO Aig EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at County Tm Map No. 473889 Section 086 pursuant to application dated APRIL Building Inspector. 95 SHORE LA Block 29, 2002 PECONIC 0001 Lot No. 004.017 and approved by the Fee $ 150.00 COPY Rev. 2/19/98 Form No. 6 TOwN OF SOUTHOLD BUILDING DEPARTMENT TOWN m LL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Depamnent 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 ag, d sewerage-disposal (8-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement fa'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 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 unusnal natural or topograptfie features. 2. A properly ocrapleted application and a consent to inspect signed by the applicant. If a C~rtifleate 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 dweiling $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. Photocopy of Certificate of Occupancy - $ 0.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occup .a~y - Residential $15.00, Commercial $15.00 ~ '*' Date. ' New Construction: 3~ Old orPr~g c(heck one) Location of Propem/: House No. Street Hamlet Owner or Owners of Property: ~ Suffolk County Tax Map No 1000, Section __~ Block Subdivision ~ ' ~ Filed LOt: I Permit No. ~ ,2'~ Date ofPirmi~ Applican~:~ Health Dept. Approval: Underwriters Approval: Planning Board Approval: · Request for: Temporary Certificate V ,Submit ed: $ Final Certificate: yk one) Owners Nm~c: SCTM #: Dislricl: J 000 Sec~on: Pi'oject Single ~equired Rcq Project Description: REQUII~E. D FOR RJg~V!EW Permit N~O YE_ S N~umber Suffolk County Health Dept. o/ New York State D. E.C. ~/~_ Town Trustees Town Zoning Board approval: ~/ Town Planning Board approval: _~ Flood plane Elevation ??? Flood Zone: ~ ,X __ NOtes,: /.~/~ 76S-J.802 ~'~ BUILDINGDEPT. ~ INSPEI~TION [ ] FOUNDATION IST [ ] ROU~..PLBG. [ ] FOUNDATION2ND [ ]~OLATION [ ] FRAMING [//~ FINAL 765-1~Q2 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ]~,a,TION [,~ FINAL [ ] FIREPLACE & CHIMNEY REMARKS :~g-,/U,~ ~ ~ INSPECTOR .~-.~~ FO~DATION (1ST) FO~ATION (2ND) ROUG~ F~G & PL~G ~S~ATION PER N, Y. STA~ ENERGY CODE 7'// ~.;p~'~'~~ ~.~ ~DmoN~ CO~S TOWN 01~ SOUTHOLD BUILDING DEPARTMI~NT.: TOWN HALL · SOUTHOLD',NY 11971 TEL: 765-1802 Examined Approved Disapproved a/c 2002 PERMIT NO. BUILD. lNG PERMIT APPLICATION CHECKLIST ~ . . Do you have or need the following, before applying ? Board of Health ' 3 sets of.B. uilding Plans ~J Survey '-4 Check '~ 5-~ c) ~/ Septic Form NH~S.D.E.C. Trustees Contact: Mail to: Phone: Building l~t~ o~,_,..o~ FOR BUILDING PERMIT INSTRUCTIONS Date~~~ Z ~ ,200~ a. This application MUST be.completely filied 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 ar~s, and wateBvays. c. ~he work 'covered by this~ appli~ati0h may not be commenced before issuance of Buil~g P~nmt. d. Upon approval of this applicati.on, 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 a Certificate of Occupancy is issued by the Building h~spector. 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, Ordh~ances or Regulations, for the c0nstmction of baildings/ad, ditions, or alterations or for removal or demolition as herein described. The applica, nt agrees to comply with all applicable laws ordinances, building code, housing cod~, and Fegtdati°ns, and to admit authorized inspect,ors on premises and in b~ilding for ne~cessary inspections. (Signature of applicant or name, if a corporation) z0 2 (Mairml~ addres~of appl~t~~1~'~.~-- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name6fownerofpremises~ ~. ~ ~------t~'"~ (as on the tax roll or latest deed) If a lica t is a corporation, si al,ure of duly au[horiz.ed officer (Name anal title of corporateloffi~er) Builders LicenseNo. Plumbers License No. Electhcians License No. Other Trade's License No. 1. Location of land on which proposed work Will be done: House Number Street County Tax M.,.~.No. 1000 Section ~ Subdivision '~[C~I~ ~' (Name) Filed Map N0.- . I Lot State e,~isting.use and occupancy of premises and intendexl use a~.,d occupancy o, fl~roposed cbnstruetion' a. Existing use and occupancy b. Intended use and occupancy ,...~tl~ Nature of work (check which applicable): New Building. Demolition Repair Removal Estimated Cost~ If dwelling, number of dwelling units If garage, number of cars ~ Addition X A2teration Otl~er Work~~~~- Fee '~lt [ I~(~) (Description) (to be paid on filing this application) Number of dwelling units on each floor If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front ~ Height .,~-" Number of Stories Rear Dimensions of same structure with alterations or additions: Front Rear Depth Height Dimensions of entire rtew e'onstmction: Front. Height ~--' Number of Stories Number of Stories Rear 53. ~)~:~Depth 9. Size of lot: Front~Rear { 4~o'~0 Depth ,0. ate o,P chase Ow. 11. Zone or use district in which praises ~e situated ~~ 12. Does proposed cons~cfion violate ~y zoning law, ordin~ce or re~lation: 13. Will lot be re-~aded ~]~ Will excess fiI1 be removed from premises: YES ~ 14. Nines of Owner ofpr~ises~,~ Address~~Phone Nme of Architect ~ Address~ PhoneNo Name of Contractor~ Addres~~Phone No. 15. Is this prope~y within lO0 feetofa tid~ wefl~d? *YES NO · IF YES, SOUTHOLD TO~ TRUSTEES PERMITS MAY BE REQUIRED 16. Provide Su~ey, to scale, with acetate fo~ati~n plan ~d distances to prop~y 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) COUNTY./~ I~ ~/~.t OF (Name ° f ind~c~) ab°7 named' says that (s)he (S)He is the ¥ /' ~/ - ~(~ontractor, 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 ail 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 - ~ ~Z~ day of ~Cs~\ 200~ ~ ~bUc S~ ofN~ Y~ N* 01~45~55 @ SURVEY OF LOT 17 NAP OF RICHMOND SHORES AT PECONIC ~ No. ~7x ~ NO~Eil~ER 20, 107~ SITUATgD AT PECONIC ]'OWN OF SOUI'HOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-86-01-4.17 SCALE 1 '=30' JUNE 24, 1999 JULY 10, 2001 ~ P~OP. ~ AUGUST 29, 2001 ~ COI~I'm,~'qK)N SURVEY FEBRUARY 1, 2OO2 FINAL SUffVqEY AREA = 22,971.96 'lml. ff. 0.527 ,ac. CARL W. PATCHKE ELEI4A M. PA'f'CHK[ WEt.LS FARGO HOME t40~TGAG[ I#C. FIRST ~ TITLE 114SUliANC[ COMPANY OF HEW YO~K TITLE No. 712-S-O$014 A. Ingegno Surveyor PflONI: (l]t)727-2~0 Fax (6,31)727-1'/27 JAMES HIGGINS ARCHITECT 50 HIDDEN ACRES PATH WADING RIVER, NY 11792 208-3351