HomeMy WebLinkAbout26980-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27483
Date: 12/20/00
THIS CERTIFIES that the building ADDITION
Location of Property: 5000 ROCKY POINT RD EAST MARION
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 21 Block 3 Lot 16
subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 11, 2000 pursuant to which
Building Permit No. 26980-Z dated DECEMBER 19, 2000
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 17' X 17' TO EXISTING ONE FAMILY DWELLING AS APPLIED
FOR "AS BUILT".
The certificate is issued to DONALD G KING
of the aforesaid building.
(OWNER)
SUFFOLK COUNTY DEPARTM~NT OF ~i~LTH APPROVAL
ELECTRIC-~L CERTIFICATH NO.
PLUMBERS CERTIFICATION DATED
N/A
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 LrNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 26980 Z
Date DECEMBER 19, 2000
Permission is hereby granted to:
DONALD G KING
400 SECOND AVE - APT 27 D
NEW YORK,NY 10010
for :
CONSTRUCTION OF A 17'X17' DECK ADDITION TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR "AS BUILT"
at premises located at 5000
County Tax Map No. 473889 Section 02i
pursuant to application dated DECEMBER
Building Inspector.
ROCKY POINT RD EAST MARION
Block 0003 Lot No. 016
11, 2000 and approved by the
Fee $ 75.00
j/ Author ' z~ Signature
Rev. 2/19/98
ORIGINAL
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
..~Z_~,OLDr~"r'':~'"-" ~PLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
i. 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 o{ 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.
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 a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state th~
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-existinR Buildin~ - $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 December 19 ~oqq
New Construction ........... Old Or Pre-existing Building .......
- · 5000 ROCKY POINT ROAD
Location of Croperry .................................... EAST MARION, N.Y.
House No. Street Hamlet
Onwer or Owners of Property DONALD G.KING
~] 16
Gounty Tax Map No 1000, Section ............ Block ...... ~ ....... Lot ............
Subdivision .................................... Filed Map ............ Lot ......................
Permit No...26980Z .Date Of Pe~e DEC 19- 2000 ~14~o.~ MAY WATSON
Health Dept. Approval .......................... Underwriters Approval ........................ ·
Planning Board Approval ........................
Request for:
Fee Submitted:
Temporary Certificate ........... Final Certicate ...........
$ ....~9P ................... . (//~
APPLICANT
FIgLD INSPECTION RgPORT DAng COI,[MENTS
FOUNDATION
(~sT)
FOUNDATION (2ND) I~ ~
ROUGN FRAI~ &
PLIR4BING
STATE ENERGY
CODE ~. ~-
FINAL .
.............................................. ~_!L°~____c__°~s__: .........................
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971 ~.
TEL: 765-1802
Examined ]o~ }]~" ,20 DO
Approved f Z. ] I ~ ,20 O O
Disapproved a/c
ildi~g Ins~tor
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying ?
Board of Health
3 sets of Building Plans
Survey
Check
Septic Form
N.¥.S.D.E.C.
Trustees
Contact:
Mail to:
APPLICATION FoR BUILDING PERMIT
Date
INSTRUCTIONS
2000
a. This application MUST be completely filled in by t~.ewriter 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 co.n'Lmenced 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 a Certificate of Occupanc5
is issued by the Building Inspector.
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 Co~mty, 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.
(Signature of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises c--~(~'C~cxk~Q-~ ~. ~ UC~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized 6fficer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
House Number Street -- . H~,,ml,e~, ";,, ,, ,, , ,, _,/'", ,, ~ ,"~
County Tax Map No. I000 Section ~), [ 'Block '~ ......... ~ L~[ ' '~/'~' '~
Subdivision ~ Filed Map No. Lot
State ex~st~ng use and occupancy el'premises and intended use and occupancy oforonosed construction'
a. Existing use and occupanc! .~ ~ (~DV'I~ . m~
b. Intended use and occupanc~ ~ ~ ~ '~ O Afl
3. Nature of work (check which appliCable): New Building Addition
Repair Removal ! Demolition Other Work
4. Estimated Cost_ ~/~ I Fee
5. If dwelling, number of dwelling un'its ~ Number of dwelling units on each floor
If garage, number of cars
If business, commercial or mixed !ccupancy, specify nature and extent of each type of use. -
Dimensi )ns of existing structures, if any: Front to ~ Rear
Height, Number of Stories
Dimensions of same structure With alterations or additions: Front
Depth Height
8. Dimensions of entire new construclion: Front [ '~
Height lumber of Stories
9. Size of lot: Front Rear
Alteration
(Description)
(to be paid on filing this application)
Depth
Rear
Number of Stories
Rear Iq.
.Depth
.Depth
10. Date of Purchase i Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violat~ any zoning law, ordinance or regulation:
13. Will lot be re-graded
14. Names of Owner of premises
Name of Architect
Name of Contractor
15. Is this property within 100 feet of a
Will excess fill be removed from premises: YES NO
Address Phone No.
Address Phone No
Address Phone No.
tidal wetland? *YES
_ NO
· 1F YES, SOUTHOLD '] OWN TRUSTEES 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 propert~ is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
(Name of individual signing contracl
(S)He is the
(Contract.
of said owner or owners, and is'duly authe
that all statements contained in this applim
performed in the manner set forth in the
being duly sworn, deposes and says that (s)he is the applicant
above named,
~r, Agent, Corporate Officer, etc.)
:ized to perform or have performed the said work and to make and file this application;
tion are true to the best of his knowledge and belief', and that the work will be
flication filed therewith.
Sworn to before me thj, s-'--) ,
of ,
Notary'l~ublic
ELIZABETH A STATHIS
NOTARY PUBLIC, State of New York
No. 01 ST6008173 Suffolk Coun~
Term Exp res June 8,
~Si ~ature of Applicant
ApP**O~"ED Ao ,,fl,ED . ·
~ ' --..-a~..' "5/~ --~
F,~; ~J..~ ~. ~:~...~ ..
N6T~. aULLD~ DEpAR~ .AT .
BE COMPuE~F~ C.O, '
ALL CONSTR~TION' SHAL["MEET
THE REQU~EMENTS .OF THE,.N.YJ
· $TAT~.CON~iON-- & ~RGY' ,-
DES}aN OR cON~'(RUC ,'~N .'~l~Oa~
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