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Home My WebLink About29286-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29568 Date: 07/10/03 T~IS CERTIFIES that the building ADDITION (aka ? Middleton R4) Location of Property: 390 MIDDLETON RD GREENPORT (HOUSE NO.) (STREET) (HAMLET) Co%u~ty Tax Map No. 473889 Section 40 Block 5 Lot 2 Sul)division Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 8, 2003 pursuant to which Building Permit No. 29286-Z dated APRIL 11, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. ~e certificate is issued to ROSEMARIE MYERJACK (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTME/~T OF ~LT~ APPRO~I~-L gI~¢'l~IfaL CERTIFICATE NO. PLUMBEHS CERTIFICATION DA'£~U3 Rev. 1/81 N/A N/A N/A Authorized Sig~ure 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. 29286 Z Date APRIL 11, 2003 Permission is hereby granted to: ROSEMARIE MYERJACK GREENPORT,NY 11944 for : CONSTRUCTION OF A 96 SQUARE FOOT DECK ADDITION AS APPLIED FOR at premises County Tax Map No. 473889 Section 040 pursuant to application dated APRIL Building Inspector to expire on OCTOBER located at 390 MIDDLETON RD GREENPORT Fee $ 150.00 Block 0005 Lot No. 002 8, 2003 and approved by the 11, 2004. COPY Rev. 5/8/02 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 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. Ifa 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 $15.00 j / Date. New Construction: Old or Pre-existing Building: (check one) House No. Street Flamlet Owner or Owners o f Property: ~,.~,oi ,,+rt. t'~ Suffolk County Tax Map No 1000, Section ~ ~:5 Block Subdivision Permit No. ZTZ~& Health Dept. Approval: Lot Filed Map. ~ Lot: Date ofPermit~-~?./(. Zo2p ~ Applicant: O~r ~),~.,-~,./,q~ Underwriters Approval: Plamfing Board Approval: Request for: Temporary Certificate Fee Submitted:$ ftc aw Final Certificate: (check one) BUILDING DEPT. i/NSPECTION [/] F/OUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPL~'~ & CHIMNEY REMARKS.~- 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO~/I~PLBG. [[ ]]~OR~4~ION 2ND [~FiNA~ATION [ ] FIREPL~CHIMNEY DATE~~NS~ FH~LD INSPECTION REPORT ,[~ ~~ ~...~____DATE iI FOUNDATION (2ND) ROUGH F~G & -- PL~B~G ~S~ATION PER N. Y. STATE ENERGY CODE ~DITION~ COMMENTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 7654802 FAX: (631) 765-9502 w~wv. northfork.net/Southold/ NO. BUILDING PERMIT APPLICATION CHECKLIST Examined_ ~?{//¢"L 20 ~ Approved ~ ]20~ Disapproved a/c / Expiration J~ ,20~ Buildin tspector Do you have or need the ~[bllowing, before applying'? Board of Health 3 sets of Building Plans Planning Board approval Sm:vex Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: 8 9~qq APPLICATION FOR BUILDING PERMITq/~/ff'/_/~ Date _, 20 INSTRUCTIONS a. Tiffs application MUST be completely filled in by t~ewriter or in ink and subm/tted 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 prerrfises, relationship to adjoining prem/ses or public streets or areas, and waterways. c. The work covered by this application may not be connnenced 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 ora 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. -(Si~t{a'J oX~applicant or name, if a corporation) t ' iMail~g address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ~~lectrician, plumber or builder Name ofownerofpremises ~.,77rwr;,,- /ff~'ae;,~t{:" ..... / (~s 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. ~ ~' ~[ ~L~ ~ Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposeA work will be done: House Number Street County Tax Map No. 1000 Section /~ 0 Block Subdivision Hamlet (Name) Filed Map ~o. Lot Lot State existing use and occupancy of premises and ihtended use and occupancy of proposed constr~ction: a. Existing use and occupancy b. Intended use and occupancy Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost ~'-~'~2 m If dwelling, number of dwelling units If garage, number of cars Fee Addition~ ~ Alteration Other Work (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 construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO ~/"Will excess fill be removed fi.om premises? YES 14. Names of Owner ofpremises~,,~/¢ ~,e<.j,vc{~"Address 7,~,,.)d/,~,, r~'d', ~aZ Phone No. 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 o£a tidal wetland? * YES NO * 1F YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, xvith 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 OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing 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 tree 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 tb4~x , ,, 'T d ) of_Cd3a,.2. 20 N~tar~ Public LYNDA M. BOHN NOTARY PUBLIC, State of New York No, 01 BO602093~ Oualified in Suffolk Counit/ Term Expires March 8, 20 < 0