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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~ .":: '...:(~:'?..: ':: · ~. ': , :..