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Home My WebLink About29495-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29534 Date: 06/20/03 THIS CERTIFIES that the building ALTERATIONS Location of Property: 2130 BROADWATERS RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax F~ap No. 473889 Section 104 Block 9 Lot 13 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 16, 2003 pursuant to which Building Pez~nit No. 29495-Z dated JUNE 16, 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" PORCH ALTERATION AND BATHROOM ALTERATION AS APPLIED FOR. The certificate is issued to HOWARD R MEINKE (OWNER) of the aforesaid building. SUFFOLK COUNT"fDEPARTMENTOFHEALTHAPpROVA~ ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION D~r~u Rev. 1/81 N/A N/A N/A 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. 29495 Z Date JUNE 16, 2003 Permission is hereby granted to: HOWARD R MEINKE PO BOX 78 CUTCHOGUE,NY 11935 for : CONSTRUCTION OF AN "AS BUILT" PORCH ALTERATION AND BATHROOM ALTERATION AS APPLIED FOR. at premises located at 2130 BROA3DWATERS RD CUTCHOGUE County Tax Map No. 473889 Section 104 Block 0009 Lot NO. 013 pursuant to application dated JUNE Building Inspector to ex~pire on DECEMBER 16, 2004. Fee $ 300.00 16, 2003 and approved by the ORIGINAL Rev. 5/8/02 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 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 - $I00.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Conunercial $15.00 New Construction: LocationofProperty: ~] ~'~ House No. Owner or Owners of Property: _ Suffolk Comity Tax Map No 1000, Section Subdivision Old or Pre-existing Building: Street Permit No. ~-/~2/ J._~ Date of Permit. Health Dept. Approval: (check one) Hamlet Block a9 ~2'O 7 Lot Filed Map. Lot: Applicant: .~,A/~/~ /~' Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Subafitted: $ Final Certificate: x~' (check one) 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. i } :OFL~MNiDNA~ION2ND [[ ] ~~iNAU~ATION [ ] FIREPLACE & CHIMNEY DATE INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (2ND) -- PLUMBING - -- INSULATION PER N. Y. STATE ENERGY CODE ~D~T~ONb~ COMMENTS TOWN OF SOL~THOLD 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__ ,20 3 BUILDING PERMIT APPLICATION CHECKLIST PERMIT NO. 7 P-5 lspector APPLICATION FOR BUILDING PERMIT 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: INSTRUCTIONS Mail to: Phone: Dated ~ //~ __, 20_0 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 s~s 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 adjoi~fing premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Pem~it. 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 fbr any purpose what so ever mini 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 achnit authorized inspectors on premises and in building for necessary inspections. / V _ (Signa~tare of applicant or h~/ie, ifa corporation) ~~ilJlg a d~ress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner ofpremises d~W/~ ~-~ f-~,.~ /~']/J ~ ~ (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. Electhcians License No. Other Trade's License No. 1. Location of land on which proposed w~ork will~bg done: House Number Street Hamlet County Tax Map No. 1000 Section~ fa ~ Block ~:~ Subdivision Filed Map No. (Name) Lot Lot b. Intended use and occupancy [ ]m",,~/~//Z 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition 4. Estimated Cost Fee State existing use and occupancy of premises and intended use and.occupancy of proposed constmctiog: a. Existinguseandoccupancy I f~.,~ I'q .~ l-. Y" Addition Other Work Alteration (Description) If dwelling, number of dwelling units If garage, number of cars (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. 4~t~ / 7. Dimensions of existing structures, if any: Front Rear 4 ~9 Depth Height. 2-8 t Number of Stories }"9.~ - Height Number of Stories 9. Size of lot: Front 70~'' Rear / 7~9 / Depth 10. Date of Purchase / ~,,~ Name of Former Owner /t~o q] ,,*t.~g:) 11. Zone or use district in which premises are situated ~ - ~ 0 Dimensions of same structure with alterations or additions: Front z~,~ ' Rear Depth ,~,0 ' Height ~-- ~ / Number of Stories Dimensions of entire ne~v construction: Front ~ / Rear~ Depth 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO 13. Will lot be re-graded? YES NO v'/Will excess fill be removed from premises? YES __ NO 14. Names of Owner of premises t'{o/.,P'~t ~ fi/,~A/,4~dress .%{.go - F3/2~,4~,¥~-~r/--.5 ~/Phone No.~'- Name ofArchitect~ty~a,i, utff, dF~Z f~e,~,,q Address ~7//o ,~i~-t ~'77- PhoneNo Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater ~vetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES NO * IF YES~ D.E.C. PERMITS MAY BE REQUIRED. NO 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 belo~v, must provide topographical data on survey. STATE OF NEW YORK) COUNTY ~'~ J~, ~ being duly sworn, deposes and says that (s)he is the applicant (~ne of individual sign~g 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 ~efore me tbJ, s ~ (.a''¢v'~ day of _~-~,-,~-~ 20O'x.) Notary Public IAR[iARA ANN RUDDER H~tmy Public, State of N*w York No. 4855~05 Qu~litiad In Suffotk Coun~ Ctmmlssion ~plms A~i114, ~ Signatdre of Apl~icant