HomeMy WebLinkAbout25302-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-26251 Date: 02/01/99
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1345 COREY CREEK LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 4 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 10, 1998 pursuant to which
Building Permit No. 25302-Z dated NOVEMBER 2, 1998
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 'ACCESSORY GARAGE WITH STORAGE ABOVE IN REQUIRED REAR YARD AS APPLIED FOR
The certificate is issued to UGO L POLLA
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building In pect
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. 25302 Z Date NOVEMBER 2, 1998
Permission is hereby granted to:
UGO L POLLA
1345 COREY CREEK LA
SOUTHOLD,NY 11971
for
CONSTRUCT AN ACCESSORY GARAGE WITH STORAGE ABOVE IN THE REQUIRED
REAR YARD OF A SINGLE FAMILY DWELLING AS APPLIED FOR.
at premises located at 1345 COREY CREEK LA SOUTHOLD
County Tax Map No. 473889 Section 078 Block 0004 Lot No. 021
pursuant to application dated SEPTEMBER 10 1998 and approved by the
Building Inspector.
Fee $ 143 . 60
+ 35.00
178.60
Building In ector
ORIGINAL
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD
BUILDINGDEPARTMENT
HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY 2 b S
A. 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
O '-'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 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 Buildine - $100.00
3. Copy of Certificate of Occupancy - .251�.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
/ Date . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. ..r . . . . . .. Old Or Pre-existing Building. . . . . . . . . . . . .
Location of Property. ./Zm . . . . . . . . . . . C? ` . . . . . . . . . . .
House Noy�L.�7. oo (� /Street Hamlet
Onwer or Owners of Property. . .4d. . . L. . .Y.�f/ . . . . . . .. . .. . . . . . ... . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . ;7ff . . . . . . .Block. .l.'f4. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . .
Subdivision. .j
. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . ..FFiled Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No.q. _. 02'. . . . .Date Of Permit.,/1/a2,!ff . . . . .Applicant. . . �3 �? . . ��. G7•�.. . . . .
Health Dept. Approval. . . . . . . .. . . . . . . . . . . . . .. . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . .. . . . Final Certicate. . . . . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
&&,x,_55 ?5
. . . . . . . . . . . . . . . . . . . . . . . . . . .
APPLICANT
co-2aas.1 �
F D INSPECTION REPORT DA _ COMMENTS= ==x---
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FOUNDATION OST)
I
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FOUNDATION OND) u
11
ow
ROUGH FRAME 6 ^
PLUMBING
II
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I
INSULATION PER N. Y. �!!
H
STATE ENERGY
CODE I I
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FINAL
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ADDITIONAL COMMENTS:
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0
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ro
H
•tIFF.00.HWU TH DBPf.A�PROY NO.
owweR: SUFFOLK COU T
• '-
H. D. REF.
19 44504* LANEDAA
H!cx.5V/ AFFY.y lsOl _ - - -� -
sewage dispo sai and water supply,
(Tel. 935-2! L) The .
been
gnSps ted for this partment as defof`ndr7�
inspeoted by this department
ARw: 20,725 xq,f-r`. to be satisfactory. `
Crii ral
DL[CIL N/A EngiDeer�a�
SE3rviaes
LOT Z4 (vac'4tfl') x?:' D �h '111 ,VI S
n` Z GAXRaev 02239Q 0
52ywE A-?-,R/AnA Tlc7
ANP-HzrVv0,k 444MGE.
:.* s9rrEEak d1_ EX�' F2><!8 1 �1
g a a
1 C) P'P y
•a lam" •� ,,• UNAUT14ORIZED ALTERATION OR ADDITION
s TO HFE5 SURVEY IS A VIOLATION.OF
SECTION 9809 OF THE NEW YORK SYATE
EDUCAT
YON LAW.
gs OF THIS
PLLAND SURVEYOR'S EIWO SEAL REARINGY MAP NOT
HER
L.OT Z? ( Lor BOSSED 5EAL SHALL NOT BE CONSIDERED
O BE A VAUD TRUE Copy,
f+�acanf) (Vaca.nt j UARANTEES INDICATED IMPEON SHALL RUN
C+� NLY TO THE PERSON FOR WHOM THE 5URV.EY
'L PREPARED,AND ON HIS D:NALF TO THE
TLE COMPANY, GOVERNMENYAL AGENCY AND
I NbING IN US11U 84MON, AND
A�y*��w�tA.., w�,r �i TMF ASSIONERS OF THE LENDING INSTI-
�'R * �M:. /=FIQ iw.a�;! RYi7IM TION.PLIARANTUS ARE NOT TRANSFERA&E
C^•" ,,.,.(,���/ �[,,,, ADDITIONAL INSTITUTIONS OR
1.... ✓O.T1 r~'sY TT°6 NER5. 11 AW
/�
! 44 E0F LOT Z/40 SdIawiAl 777`'k 40+6Eh%P%!m h� itAL
M4M 0F' COL2&Y dZgSG �5?tC Ond fa Y** ;�kf' Zdiwt js
(svffaFlk C.a: li?af. Na,�9�3j ds ;Swrvaird A.R:.N,I817
A ' .
e y *0.am¢K VAN 'TUY�. R C. ,
SAYVI OW
No, 53a 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: ��-�� J
`` CALL . !."�'.`-S.q
Examined.1Y , 19.... MAIL TO: . :. . . . . . . . . . . . . . . . . .
Approved...Xalc'..�
App 19. . Permit No. .... ..� ...............................
Disapp ................................ .......... ..................
........................................ .... .......
D (Building Tznspec
PLICATION FOR BUILDING PERMIT p
Date. . . . . . . ✓.� . . . , 191.
i¢, BLDG.DEP ..
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector u
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 giving a detailed description of layout of property nest be drawn on the diagram which is part of
this application.
The work covered by this application may not be commenced before issuance of Building Permit.
Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
permi 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 Innspector.
APPLICAfI(R1 IS IY+MY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zane Ordinance of the Town( of Southold, Suffolk County, 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 tale, housing code, and
regulations, and to admit authorized inspectors on premises and in buil ' r neves r t'
..... .............................
(Si a of applicant, or name, if a corporation)
/.3!z4 ! ��Li-� �✓Zlc.A/.y.............
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build(
�6CYl�rr/2-..............................................................................................
Name of owner of premises ..........;v... ... Qf- : .........................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.........................................................
(Name and title of corporate officer)
Builders License No. .........................
Plumbers License No. .........................
Electricians License No. .....................
Other Trade's License No. ....................
1. Location of land on which proposed work will be donne..............................................................
i.3,tj- ..Gey.. �.. .-T�!..................... ...........................
Manse Number Street7 44 hamlet
County Tax Map No. 1000 Section .......7..Y..... Block ....,�........... Lot ...N.........
Subdivision ...................................... Filed Map No. ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
...... ................
a. Existing use and occupancy ...............................
b. Intended use and occupancy .........
.B'.,xTi.l�2.t YR7t7crA
�aY�^t�'o 0trxt;�„bii£i;z'1 Tin4ob#
yHt'u; Fz7.C&92l bvAilwJ0
,tb Yuh3aeli4 3metml'
!SII .. . , .. ..
3. Nature of work (check whidh applicable): New building Addition .......... Alteration ....,.,...
Repair ............ Removal ...,.......... Demolition ............ Other Work ..................................
(Description)
4. Estimated Cost ............. fee
fee .. .. ... ....
, gg (to be paid on filing this application)
number 5. If okielling, of dmiling units .��://// `. /:.. Nudber of dwelling) units on each floor ................
If garage, number of cars ...., .
6. If business, commercial or nibs occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing stnuctur s, if any: Front....)...... Rear ...... Depth :...............
Height ....4V.................. limber of Stories ...................... ...
Dimensions of same structure wit Ih alterations or additions: Front ..........
Depth .................... height .................... Nmber of Stories .... +.GL
S. Dimensions of entire new eonstryction: Front .... 5,....... Rear
l D ? I ,
Size of lot: Fruxhl' ,,,4p'1$;, timlber of Stories ...� �..,..,.....
gh .........
/p
/ 7l ! ,....,. Fear ..... .. ...`e� .. Depth ... ...,
9.
IO. Date of hurhase C(¢ � A� t.! .....' .1D�......
. Y
�..... Name of Former Owner .. ...
11. Zone or use district in which premises are situated ... d...............�..y..............I..................
12. Does proposed construction viola a any zoning law, ordinance or regulation: ..//.4>.................
13. Will lot be regraded ......Kll7.!.. Will excess fill be removed from premises: YES No
14. Names of Amer of preymi.seaC�11A....... Address plione No. 'Jt�
Name of Architect Address Plwre No. ....
Name of Contractor 'S(................ Address ...............................Phone No. .... .........
15. Is this property within 300 feetofa tidal wetland? * )TS .......... No . ......
*IF YES, SQIItIIHD MM 71IUST�ES PET4417 MAY BE RC(p1lED.
PLOT DIAGRAM
Ur-ate clearly and distinctly allbuildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street and la= number or description according to deed, and show street names and indicate
whether interior or corner lot.
i
!
I
srmr op raw YIAIIZ,
U"1Y O ..........✓..... / ... �S
F
. u•�... ••'• '•..:.............i................being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named,
Ileis the ............................ ............................................................
(Contractor, agent, cor ,rate officer, etc.)
of said owner or owners, and is duly and rized to perform or have performed the said work and to make and fi].a this
application; that all statement's contai in this application are true to the best of his knowledge and belief; and
that the work will be performed in ttte ma mr set forth in the application filed therewith.
9worn to before me this
...................day of .... . ...... :LI .� ....
Notary Public ...... .. ......... ..
IflOtT .�.....................
OBE1tT 1.SC
Glary Public,State Of Now ( tune of Applicant)
QuaSu Of Cou"lified in
No.01SC47C472
Term Expirse Mey 3 .
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROU PLBG.
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: 4KAZ��
DATE / INSPECTO
Town Hall,53095 Main Road Fax(516)765-1823
P.O.Box 1179 Telephone(516)765-1802
Southold,New York 11971
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
January 22, 1999
Ugo Polla
1345 Corey Creek Lane
Southold, New York 11971
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
XX An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XX The check is (not on file. ) $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984 ) .
t
BUILDING PERMIT # 253Q--Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
-� 2
765-1802
BUILDING DEPT.
INSPECTION
[ vreFOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS: _
DATE INSPECTOR 2�5 Z��
T65-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ j FO DATION 2ND [ ] INSULATION
AM
[ FRING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS.-
DATE
EMARKS:DATE l l(7 INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ J INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE //3 INSPECTOR
OCCUPANCY OR UN91"ITERS CERTIFICA
ll
USE IS UNLAWFUL REQUIRED
WITHOUT CERTIFICATE app 0 ED N6t s
OF OCCUPANCY
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