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Home My WebLink About26993-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27708 Date: 05/21/01 THIS CERTIFIES that the building ALTERATION Location of Property: 4275 GREAT PECONIC BAY BLVD LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 128 Block 3 Lot 15 subdivision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 28, 2000 pursuant to which Building Fermit No. 26993-Z dated DECEMBER 28, 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 ALTERATION & RENOVATION TO AN EXISTING BATHROOM IN AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. · ~ne certificate is issued to THOMAS F & ELIZABETH HUDOCK (OWNER) of the aforesaid building. SUFFOLK COUNTer DEPARTMENT OF ~EALTH APPROV;LL ELEC]~ICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 05/19/01 N/A H-070947 03/26/01 THOMAS PACZKOWSKI 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 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26993 Z Date DECEMBER 28, 2000 Permission is hereby granted to: THOMAS F HUDOCK LAUREL,NY 11948 for : ALTERATION AND RENOVATION TO AN EXISTING BATHROOM IN AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at County Tax Map No. 473889 Section 128 Block pursuant to application dated DECEMBER 28, 2000 Building Inspector. 4275 GREAT PECONIC BAY BLVD LAUREL 0003 Lot No. 015 and approved by the Fee $ 75.00 Au~r~'z/ed~ignature Rev. 2/19/98 ORIGINAL Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FORCERTIFICATE 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: 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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 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 Buildin~ - $100.00 3. Copy of Certificate of Oc~6pancy - i .~§~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .................................... New Construction ...... ~. .... Old Or Pre-existing Building ................. Location of Property.. ~ . f.. ~.: .... ! ...... /~-. .... House No. Street Hamlet Onwer or Owners of Property...~.~.~?:v/; Z~ W-~ ................................................... o . . County 1000, Section... ...... Bloc .... .......... ;ot.. is' ? Filed Map '~-----' Lot Subdivision ~ ...... Permit No .~..~.9.?..~ Date Of Permit /~-~O Applicant /..~..D.o...C~.. . Health Dept Approval ~ Underwriters Approval ...... '.~/. . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] INSULATION [ ]~] FINAL [ ] FIREPLACE & CHIMNEY ,DATE ~//~/,,//~ / THE NEW YORK BOARD OF FIRE UNDERWRITERs 8e82558 BUREAU OF ELECTRICITY' )~-' ' 40 FULTON sTREET NEW YORK NY 10038 ' , THIS CERTIFIES THAT * ,, , I , ;J ~ Ir I ' , ~ only the e~ct. cal equipment a, descrtbed~'~ ~h~ inF~d~b;~' by ~hb ~P~JCant ~medJ ~h :th;'abov6 apptic~:numbe;'~'in th~ premi~s of' THQ~ HUD0CK, 42?5' pEcONIC BAY ~L'~, ,.'~U~L,; ~ ' , ' ", '' ' r' I w~ examined on H~CH 2~ ,'~[ a~dfound to be in compJ~nce with the NaNonal Electrical Code. FIXTUgES gANgES EXHA~Sl FANS FIGURE gECE~ACLES SWITCHES OUTLE~ DRYERS G.F.C.I:-I 4275 PECONIC BAY BLVD. I&UREL, NY, 11948 Town Halt, i3095 Main' Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit NO. ~??~ Owner: -77~4W~ ~- ~'Z,'z~c.r/~ A/~OocTC Plumber: (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Sign~ure) Swo~n~ before e~LiS day of ~ - / Notary ~Publ~c, '~ ~/~ ~ICI'ORIA WRE~ ~. ~0iWR504429~ I~otmy P,u~, State of New ~ , ~a/ified ill Suffolk Co~v ,~ / Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 BUILDING DEPARTMENT TOVfN OF SOUTHOLD Fax (631) 765-1823 Telephone (631) 765-1802 April 9, 2001 THOMAS & ELIZABETH HUDOCK 4275 PECONIC BAY BLVD. LAUREL, N.Y. 11948 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~ 26993-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FIELD INSPECTION REPORT DAT]/ COHMEI~I~S FOU~AT~O~ (~S~) ~I " ROUGH FRAME & PLUMBING INSULATION PER N. Y. STA~ E~m~ ,, Il CODE I~ I~ II II I ......................... ~ .... ~_-_-_-~=---- == ___,, ~-.~~- _~ ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] R/~OUGH PLBG. [ ]~FF~MNDATION 2ND [ ] INSULATION lNG [ ] FINAL [ REMARKS: ,/ ]FIREPLACE & CHIMNEY l / INSPECTOR//~~~ TOW~ OF SOUT~OLB Examined ' , 20 , Appi'oved : ,20 . Dis'approved ~c FORM NO. 3 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL:' 765-1802 l,'fldii~ Inspector 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.Y.S.D.E.C. Trustees APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ,20 a. This application'MUST be completely filled in by typgwriter or in ink and submitted to the Building Inspector with 3 sets of plans,' accurate plot'plan to sale. Fee according to schedule. b. P.lot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or area§, and g.iving a detailed.description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be cbn~-nenced before issuance of Building Permit. d. U.l~on approval of this application, the Building Inspe¢or.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 whatever until a Certificate of Occupancy shall'hove b~en granted by fhe Building Inspector. .:. APPLICATION IS:HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Bui!ding Zone Ordinance df the Town of Southold, Suffolk County,.New York, and other applicable Laws, Ordinances or Regulations, for the constflh~tion of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to compl~;'with all applicable laws, ordinances, building code, housing code, and regulations, and to admit autliorized iLqspectors on premises and in building for necessary inspections. , ~_~.._..---,~ (Signature of applicant or name, ifa corporation) (Mailin~ address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremi~es ~.~/om~z ~ (as on [he ;tax roll or latest deed) If a~plicanJ is a corporation, signature of duly authorized officer '" (Name and title ot~corporate officer) Buiiders License No. 5 Plumbers License No. .'. $~c ~c Electricians License No. ': J'ec <' . Other Trad$'s License N(~. sgc'c Location of l~d on which prot House Number Stre~ County Tax Map No. 1000 Se Subdivision (Name) State existing use and oceupan, a. Existing use and occup~ b. Intended use and occup osed work will be done: Hamlet Lot /5- Filed M. ap No. Lo.t. :y of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which a~plicable): New Buildlng Addition Repair Removal ~ Demolitioh .' Other Work 4. Estimated Cost "#X'~ o~, l! Fee °lPT~.o ~ (Description,) ~ (to be paid on filing this applicati6n) 5. If dwelling, number ofdwellin~ units / Nurnber.ofdwelling units on each floor,, .: If garage, number of cars ~ / 6. If business, commercial or mix :d occupancy, specify nature and extent of each type of use .... 7. Dimensions of existing structm ~'s, if any: Front Rear l~epth Height. N ~mber of Stories ./' Dimensions of same structure ~ ,ith alterations or additions: Front Rear Depth Iq eight .Number of Stories 8. Dimensions of entire new consl ruction: Front Rear Depth Height qumber of Stories 9. Size of lot: Front Rear .Depth i0. Date of Purchase.. /?/~/?rf Name of Forrri~r..Owner ,/~//fw~,~ 11. Zone or use district in which pr ~mises are situated 12. Does proposed construction vic late any zoning law, ordinance or regulation: 13. Will lot be re-graded /i/~ Will.exc?s fill be removed from premises~ YES NO' 14. Names of Owner of premises Address Phone No. Name of Architect , Address Phone N(~ Name of Contractor Address Phone No~. 15. Is this property within 300 feet c fa tidal wetland? *YES NO ~ · IF YES, SOUTHOLD TOWN TRUSTEES PgRMiTS MAY BE REQUIRED. : of project, ' ' 16. Provide survey, indicate scope to scale, with dlstances to property lines. 17. If elevation at any poin~t on prop, ~rty is at 10 feet of below, must provide topographical data"on survey. STATE OF NEW YORK) '... SS: : COUNTY O~ ~of~ [/kL) ,. "'7'"/~'~ ~.. J'-/C~Z)O¢/~_ I being duly sworn, deposes and says that (s)he'i,s the applicant. (Name of individual signing contract) above named, (S)He is th~ OtO/v~'tt ., (Contr [ctor, Agent, Corporat~ Officer, etc.) ,:· "' of said owner or owners, and is duly au :horized to perform or.hav~ performed the said work and to make and file this application; that all statements contained in this apl: [ication are true to the'be, st of his knowledge and belief; and that the work will'be performed in the manner set forth in th~ application filed therewith· ' ' " Sworn to before me this- , N~I~IE. LI)Ii~OFtN~ 2. ' ~ Signature of Applicant Notary putilio, ,'State of New York , No. 4951364 ~ ' Oualilied in Suffolk Count~[ : , Commission Expires May 22, Z,~ ~f ', , ~r'~v~r,i Alteration ,~/~-:~,..~?~,d k~hY 3:o"x All