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Home My WebLink About26534-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27216 Date: 07/26/00 THIS CERTIFIES that the building ADDITION Location of Property: 635 CHURCH LA CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 96 Block 1 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 20, 2000 pursuant to which Building Permit No. 26534-Z dated MAY 30, 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 NEW BLOCK CHIMNEY ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HELEN BROWN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A A horized Signature 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. 26534 Z Date MAY 30 , 2000 Permission is hereby granted to: HELEN BROWN PO BOX 145 PECONIC,NY 11958 for NEW BLOCK CHIMNEY AS APPLIED FOR. at premises located at 635 CHURCH LA CUTCHOGUE County Tax Map No. 473889 Section '096 Block 0001 Lot No. 015 pursuant to application dated APRIL 20, 2000 and approved by the Building Inspector. Fee $ 75 . 00 Aut ized S nature ORIGINAL Rev. 2/19/98 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the build inspector with the following: for new building or new use: 1. Final survey of .property with accurate location of all buildings, property lin: streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 fo-a� 3. Approval of: electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contain: less than 2(10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buil 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 '.'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, bui.2ing and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applica 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 Occupancy - _ .25�,. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . 7-.ids-Q 6. . . . . . . . . . . . . . . . . New Construction. ..!/ . ... Old Or Pre-existing 1 Building. . . . . . . . . . . . . . . . Location of Property. . ..�Jt�7. . . ��.. . .Vn � .'. . . . . . . . . . . . . House No�.1 Street Hamlet Onwer or Owners of Property.. .4�'�� .� �(1. . . . . ../. . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . �. . . . . ..Block. . . .,/ . . . . . . . . . .Lot. . . . .1.5�. . . . . . . Subdivision. . . . . . . . .. .. . . . .. . . . . .. .. . . . . . . . . �. ./. . .Fipl�ed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . Permit No. �� `'� ..Date Of Permit. ..^l:.2.V:.G6Applicant. . . . . . . . .. . .. . . . . . . . . . . . Health Dept. Approval. . . ... . .... . . . . .. . . . . . .. . .Underwriters Approval. . .... . . . . . . . . . . . . . . . . Planning Board Approval. . . . . .. . . . . . . . . . . . . . . . . . J Request for: Temporary Certificate. .. . . . . . . . . Final Certicate. . . ./. . . . . . Fee Submitted: $. . . .? ��. . . . . . . . . . . . . . . . APPLICANT C0 70-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSyLATION [ ] FRAMING [ref FINAL [ ] FIREPLACE & CHIMNEY REMARKS: �z DATE_ INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS--- ----------------- , R FOUNDATION ( I ST) II N FOUNDATION (2ND) FOUND----=_______________ II ii n II 11 ROUGH FRAME & --------------------------- PLUMBING ------------- -II INSULATION PER N. Y. II STATE ENERGY li ii CODE II 11 14b Ile? A ' II II ------------------------- — II II II �� FINAL u e ADDITIONAL COMMENTS: H I H v OO z l H BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Name: Reviewed: w Architect/ Date Engineer: Submitted: SCTM #: � District: 1,000 Section: Block: , Lot: Project Subdivision Location: �'� U"��-+`� _ Name: Single&separate Required certification: (Yes/No) Req. Req. "Zoning District: [Lot size: Actual: ] [Lot coverage Proposed: ] Req. Req. Req [Front Yard Proposed: [Side Yard Proposed: 1 [Rear Yard Proposed: ] r Project Description: Of AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A./ NO YES Number Suffolk County Health Dept. New York State D. E. C. v Town Trustees v Town Zoning approval: Board a roval: Town Planning Board approval: Flood Plane Elevation??? r Flood Zone: Notes: BOARD OF HEALTH . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: CALL . . . . . . . . . . . . . . . . . . Fvminsed. .. .. .. .., 20.G° / MAIL TO: . . . . . . .. . . . .. . . . . . Approved. .... . ...,� Permit No. ..:x5'! �T..�r.. Disapproveda/c .................................. ........................I....... ...................................................... ...... �... (Builth Inspector) APPLICATION FOR BUILDING PERMIT AM2 0 Date./'. .Z 25_ . . . . . . , 20.63 INSTRUCTIONS a. is lication most be completely filled in by typewriter or in ink and submitted to the Building inspector 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan stowing location of lot and of buildings on premises, relationship to adjoining promises or public streets or areas, and giving a detailed description of layout of property mist be drawn on the diagram which is part o this application. c. The work covered by this application may not be camienced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Sur 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 have been granted by the Building Inspector. I 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 Canty, New York, and other applicable laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein destined. The applicant agrees to comply with all applicable lass, ordinances, building code, mousing code, and regulations, and to admit authorized inspectors on premises and inJm4Ning for necessary inspections. OCCUPANCY OR USEIS f N A{AILM I C (S gnat a of applicant, or`rname, if a corporation) WITHOUT J'nC�lE1YRI11FFICAT1i '(Mailiaddress f applicant)` .F OCCUPANCY State whether app scant is owner, lessee, agent, architect, engineer, general contractopR iap,AW or buil. ........... ........ aA :.�" R,• NJ .. s3 Name of owner of premises ...........yl.el fn......` ..........� (as on the tax roll or latest deed) NOTIFY BUILDING DEPARTMSRT A If applicant is a corporation, signature of duly authorized officer. 785-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ..................................................... FOR POURED CONCRETE (Name and title of corporate officer) 2. ROUGH - FRAMING A PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST Builders License No. ......................... BE COMPLETE FOR C.Q. Plumbers License No. ......................... ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. Electricians License No. ................. STATE STATE CONSTRUCTION A ENERGY Other Trade's License No. .rz'I .1.-� .h.Z CODES. NOT RESPONSIBLE FOR DpTSIGN OR CONSTRUCTION ERRORS 1. location of land on which proposed writ will he done..... .4�.4��:4:1Y.....V.��:,........................... .......... r...........Q,�........ . ..................................................... House Number Street Hamlet County Tax Map No. 1000 Section ....t(0......... Block .......I ....... Lot ....1.1�5 ....... Subdivision ...................................... Filed Map No. ............... Lot ............... (Naos,) 2. State existing use and occupancy of premises and tended use and ogcupancyy of proposed construction: a. Existing use and occupancy ...... .... ....cy.-I .... .. . ................................................................... b. Intended muse and occupancy ....... in{ 1 ..................................................... .�V'S 3. Nnuire of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............ Removal .............. Demolition ............ Other Work NPi:V.�1A{4 4�.1„r��!'.3'o11 (Description) 4. EsLimoterl Cost ......................... fee .............................................. (to be paid on filing this application) 5. if dwelling, number of dwelling units ............ limber of dwelling units on each floor ................ Ifgarage, number of cars ...................................... 6. If IuLsiness, eom arcial or mixed occupancy, specify nature and extent of each type of use...................... 7. Oimensicxhs of existing structures, if "t Front................ Rear ............... Depth ................. Ile ight ......................... timber of Stories ...................... Dimensions of same structure with alterations or additions: Front ............... Rear ............... Depth .................... Heignt .................... Nmber of Stories ............... 8- Dimensions of entire new construction: Front ................ Rear ............... Depth .............. lleiytnt ......................... Nmber of Stories ..................... 9_ Size of lot: Front ._...... . .fN .. ............ Rear .................... Ikptln ........... . ..,..».. 10. Date of Purchase ..................... Nae of Former Owner ........................................ I1. Zone or use district in which premises are situated .............................................................. 12. Ibes proposed construction violate any zoning law, ordinance or regulation: , 13. Will lot be regraded .................... Will excess fill be removed from premises: YES ND 14. Nacos of Owner of premises .��I ..�2bla�F.... Address .(Cur...!^ 1 E......... Phone No. Nano of Architect - ............................ Address .s............................. Phone No. ............ Nave of COntIaCtOr . .�A>`, t`.....�`{��.YyG.S�........ Address ..cZ� ..�'2}!l�F}^',�0,[3eX(p�Rone No. 15. is this property within 300 feet of a tidal wetland? * YCS .......... ®.......... *IF YES, SOLMUD 'lUA IMSILES PEFMIT MY BE W!QIfIR[D. ' Y PLOT DIAGRAM doc:ate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions, fmn property lines. G;ve street and blcrl( muter or description according to deed, and show street names and indicate whether interior or corner lot. ! w ditf i, ;,r fsq -1111J �J y" IU330l "0 ffiN1 }-.'i to • r. 7 . •Y . ... - • S.S' . ... Y ...............being duly sworn, depoGes and says that he is the applicant (tlnme c .a ryhdua,( t,ignnug contract) lieis Lhe ....... ......... !. A C'�6 rj......................................................... (Contractor, agent, corporate officer, ere.) of. said Owner or owners, and is duly authorized to perform or have performed the said work and to make and file this appl icatiornn; [hal: all SLatanenLS contained in this app].ication are true to the best of his knowledge and belief; and that the work will. be perfornecl in Lhe manner set forth in the application filed therewith. Sworn Lo before me [his Q? .......da of ...... 2 ar,.. N Shgrha. 07 '�; PNmro Yak NoT'�1Yi1jtiBSIMl g,