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HomeMy WebLinkAbout29683-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP]kRTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29696 Date: 09/09/03 T~IS CERTIFIES that the building ADDITION I~)cation of Property: 1065 LEEWARD DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 7 Lot 23 Subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 29, 2003 pursuant to which Building Permit No. 29683-Z dated AUGUST 29, 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. The certificate is issued to MICHELLE S KR3kKOWKA (OWNER) of the aforesaid building. SUFI~LK COUi~rYDEPARTI~EIqT OF~kPPROV~_~ ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A 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) PERMIT NO. 29683 Z Date AUGUST 29, 2003 Permission is hereby granted to: MICHELLE S KRAKOWKA 1065 LEEWARD DRIVE SOUTHOLD,NY 11971 for : CONSTRUCT A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#16417. at premises located at 1065 LEEWARD DR County Tax Map No. 473889 Section 079 Block pursuant to application dated AUGUST 29, 2003 Building Fee $ SOUTHOLD 0007 Lot No. 023 and approved by the Inspector to expire on FEBRUARY 29, 2005. 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 Departmenl with the following: A. For new building or new use: 1, Final survey of property with accurate location of all buildings, propeily lines, streets, mtd unusual nutural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation frmn Board of Fire Underwriters. 4. Sworn statclnent from plumber certifying that tire solder used in system contains less than 2/10 of 1% lead. 5. Commercial buildiug, industrial building, multiple residences and similar buildings and inshdlations, a certificate of Code Compliance fi-om architect or engineer responsible for the building. 6. Submit Plmming Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) uon-confln'ming uses, or buildings and "pre-existing" laud uses: 1. Accurate stuwey of property showing all property lines, streets, building and dnusual natural or ~opographic 2 A propel 13 complclcd application and consm~l to mspccl signed by thc upplicant. Ifa (;c~tificalc of Occupallcy is dcmed, Iht Building lnspeclor shall state ll~e ~c;~sons th~clbr i~ x~ t~ting lo the applicant C. Fees I Ccrtil~calc of ()ccupancy New dxselling $25 00, Additions to dwelling $2500, Alto~ati.n~ h) d~xclling $2500, Swimming pool $25.00, Accessory building $25 00, Addilions lo acccssoly building $2500, Businesses $5000. 2 Certificate of()ceupanc> on Pre existing Building- SI0000 3 Copy ofCerlificalc ()t'()ccupaocy $.25 New Consh-uction: ~ . Old or Pre-existing ltuilding: (check one) House No. St~ eel Bamlct Suflblk County Tax MapNo 1000, Section 9~_ Block V Lot~5 Subdivision /~ J _ Filed Map. Lot: PermitNo. ~t~ DateofPermil. ~/~0~ Applicant: Health Dept, Approval: Plamfing Board Approval: Request for: Underwriters Approval: Temporary Certificate Final Certificate: Fee Subnfitted: $ F4 c 0%'-/o (check one) · '~ Applicant,Zlgnature 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ] INOCULATION [ ] FRAMING [~FINAL/~ []FIREPLACE&CHIMNEY REMAR~ DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG, [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [~FINAL ~ [ ] FIREPLACE & CHIMNEY REMA~ DATE FOUNDATION ( ls t) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: tI':' ' ' ' ~"' ii~i~ 'FORMNO. 3 ~ L~' ,--,w : ~ ! !~1 TOWN OF SOUTHOLD i'~\~ I C ,,~ BUILDINGTowNDEPARTMENTHALL 977 ,pprove~r .~.}.., 19~. Permit No ~ ~ ¢ ~ ~ fisapproved a/c .............................. .~}. ............................. ....... (Building Inspector) ~PklC~TIO~ FOR BHIkDI~G ~eceived ........... ,19... Date.q~}Y..~ ......... 19!!7. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sub{nit{ed to the Building Inspector, with 3 :ts 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appil- it. ion. 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 issued a Building Permit to the applicant. Sucl; permit ~all 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 whatever until a Certificate of Occupancy tall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ,,ilding Zone Ordin.ance of the Town of Sou{hold, Suffolk County, New York, and other applicable Laws, Ordinances or :egulations, for [lae construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. .... Jp.h~.. ~nakowka ......................... (Signature of applicant, or name, if a corporation) 105~ Leeward Drive ..... ,q.'~.qt t h~d, . [L¥ ..;m.9:~.± ................... (Mailing address of applicant) ;tale whetlier applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pimnber or builder. ......... ~,woor ................................................................................. qame of owner of premises .... ,.Iq. 79..sq. r.5.5.e.~e. ~..19..~. ?St.k.o.V¢9 ................................. . ......... (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ~ .~J~.. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. lob: ..I~.9:4~?.d' Dr~ve ltouse Number Street ltamlet '~- County Tax Map No. 1000 Section ...... 79 .......... Block ..... 7. ............ Lot .... 2. -3 ........... Subdivisiot~e.~wa,r.c~ .AC?.e.a ...................... Filed Map No. .. J!~.9.9 ....... Lot ...... 314- ....... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... Q ~9..7. qr.~i..i.Z .d. Vg.I' k J, 9g ........................................... b. Intended use and occupa- ('ne FamilX dwc~J~ 9~;. with deck 3. Nature of work (check which applicable): New Building ' Addition ...X ....... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work .............. 't (Description) 4. Estimated Cost ~;~ .2¢;0D.,© ............................. Fee ..................................... ~' (to be paid on f'ding this application) 5. If dwelling, number of dwelling units.. 1 Number of dwelling units on each floor .... lfgarage number of cars " 6, If business, commercial or mixed occopancy, specify nat ~u[~ and,extent of each type of use ......... 7. Dimensions of existing structures, if any: Front...'. ~i'. ..... Rear .... ~ ~ .... ;,~Depth L. i ii~ii i i i Height .. ~.. d.] ......... Number of Stories ........ ,~,, .................................... $, ........ Dimensions of same structure with alterations or additiohs: Front .. ~.-~; ........... Rear ..... .dC..~. ....... ;./ Depth , . · ~ ...... Height ..... ~. ~/. ~ ,. . Number of Stones .... .~ .............. 8. Dimensions of entire new construction: Front .... ~. :/. .... i.. Rear ..... ,~..~ ...... Depth . .,.D, ~ ........ Height . /,_~-" Number of Stories . ...: ... ~ .t ....... 9. Sizeoflot: Front .... , ....... Rear .~.v.. Depth ~C c~ ........ I0. Date of Purchase ............................. Name of Fenner Owner ............................ t 1. Zone or use district in which premises are situated...P.,q ~2.c~61 ¢d.t,.La4_ ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... "!2 ...................... t 3. Will lot be regraded .... ~ .~ .l?).O. .......... Will excess fill be removed from premises: Yes ~. 4. Name of Owner of premises,]'; .h . 1.~?.~9/:c ......... Addres,~0(p~.Lq.~ ;~,~,trz:c]..L).r~.,,, Phone No...; 9~.'-..'~.0,~.~... Nane of Architect ........................... Address ................... P one No. Name of Contractor .......................... Address ................... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions fro~ ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whethe nterior or comer lot. FATE OF NEW YO-RK, S.S OUNTY Or~. · - ~ ..... .~ .I ...... . ~ ....... [c .~/.~5}).z1(k..~. ,O.~eL~."I,X'.~ ............... being duly sworn, deposes and t~J/Name of individual signing contract) says that he is the applican e is the ........................................................................................ (Contractor, agent, corporate officer, etc.) l' said owner or owners, and is duly authorized to perform or have performed the said work and to make and fiI~thi ~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that th~ ork will be performed in the manner set forth in the application filed therewith. worn to before me this ............... .(4 ..... or ...... ......... 19 .] · ore. Public ...... ....... County ........ ........ .. ...~u~tl~ s~m ot ~.. r~ // (Signature of applicant F