HomeMy WebLinkAbout24743-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25899 Date: 08/18/98
THIS CERTIFIES that the building ADDITION
Location of Property: 1080 NORTH FIELD LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 71 Block 1 Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 19, 1998 pursuant to which
Building Permit No. 24743-Z dated MARCH 3, 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 ONE STORY ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ROGER & KATHLEEN WILSON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 21286 07/01/98
PLUMBERS CERTIFICATION DATED N/A
Building In ector
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. 24743 Z Date MARCH 3 , 1998
Permission is hereby granted to:
ROGER & KATHLEEN WILSON
143 HOYT STREET 6A
STAMFORD,CT 06905
for
CONSTRUCT A ONE STORY ADDITION TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
at premises located at 1080 NORTH FIELD LA SOUTHOLD
County Tax Map No. 473889 Section 071 Block 0001 Lot No. 017
pursuant to application dated FEBRUARY 19 1998 and approved by the
Building Inspector.
Fee $ 75 . 00
1 ng Inspector
ORIGINAL
Rev. 2/19/98
Form No. 6Q
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 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
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 Building - $100.00
3. Copy of Certificate of Occupancy - .251�,
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15..000, Commercial $15.00
Date . .4?�� �,l, Q . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . Old Or Pre-existing Building. ./ 4�. . . . /�.
Location of Propertyj. ;� .P. . . . .[q?f; Hf.1.6 . . . !(1 . . . . . . . O1I�11b�. . . . .
House No. Street J� Hamlet
Onwer or Owners of Property. . . . . �, ! I,� � , , ��N
County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . . . . . .. . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Subdivision. . . . . . .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filedd Map. . . . . . . . 90c
t. . . . . . . . . . .
Permit N N'�f. .3 .Date Of Permit. . � .V. . .Applicant. . . .. . . �.4,� ,
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . \/
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . Y. . . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . .
C4 '�' '�L as& 1W:^ . . . . . . . . . . . . .
ReG ls1 9 J I LICANT
o��gUFFO(kcOG
co
Town Hall,53095 Main Road 03Fax 516( )
765-1823
P.O.Box 1179 Gy Telephone(516)765-1802
Southold,New York 11971
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
August 18 . 1998
Roger Wilson
1080 Northfield 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) .
BUILDING PERMIT # 24743-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
70-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG-
[ ] FOUNDATION 2ND [ ] INSU ON
[ ] FRAMING ] AL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE INSPECTO
M-1802
�G�"'
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ) ROUGH PLBG.
[ ] LUNDATION 2ND [ ) INSULATION
[ )/FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE INSPECTOR
111 7W-1802
BUILDING DEPT.
I - PECTION
[ DATION IST [ ] ROUGH PLBG.
[
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:---
DATE INSPECTOR
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ELECTRICAL INSPECTION SERVICE INC.
375 DUNTONA VENUE
EAST PATCHOGUE,NEW YORK 11772
(516)286-6642
21286
DATE: ZW18 APPLICATIONNa.ONFILE
VILLAGE: Southold TOWN., Southold
ADDRESS: 1080 North Field Lane
ISSUED TO: Roger&Kathleen RlIson
INTRODUCEDBY: LademannF_lectriclnc LIC No: 4141-E
was examined on 7-1-98 and found to be in compliance with the National Electrical Code
LOCATION: Base.. 1st ,x 2nd 3rd Attic
Det.Garage Not Tub Pool
SWITCHES RECEPTACLES I FIXTURES I HEATERS I FANS G.F.I. AIR COAD.
5 9 8 ]-paddle !
DISHWASHER DRYER CLOTHES WASIL GAR.DISP. RANGE OVEN SMOKEDETECTOR
2
FURNACE 011, GAS CIR. MOTORS BELL TRAN. SERVICE DISCONNECT
MHTSR A,VfPS PXASS
OTHER
EQUIPMENT
UGO S. SURDI
PRESIDENT
BUILDING PERMIT No. 'lies mtifcatemust nmbe altered m any memeer
Insyectmsmeybeidmfifiedby thea eedentials BLUE
ORIGINAL YELLOW COPYPINK COPY OFFICE
o��gOFFO(,� KX Town Hall
Albert J. Krupski,President cO
John Holzapfel, Vice President = y� 53095 Main Road
Jim King CO3 P.O. Box 1179
Martin H. Garrell O e Southold, New York 11971
Peter Wenczel d�O� �.ao� Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
December 11, 1997
Roger Wilson
1080 Northfield Lane
Southold, NY 11971
RE: SCTM #71-1-17
Dear Mr. Wilson,
The Southold Town Board of Trustees reviewed your survey, and
determined that your project to construct an addition 16' X 13
1/2 ' to the existing dwelling, is out of the Trustee
jurisdiction under Chapter 97 of the wetland code.
However, this determination is not a determination from any
other agency.
If you have any further questions, please do not hesitate to
call.
Sincerely,
aa-. i 9.
Albert J. Krupski, Jr.
President, Board of Trustees
cc. Bldg. Dept.
0
5.82 50'00" E. 311Aq'
LLl O Ib'-b'
L
Q g
J SARW
PROPOSED
Q WINS
Li ppb STpRy ADDITION
O IA'-0' I"- Wo 50.FT) O
I,'-o,L 21'-6 1/2 N
N.82 30' 00" A. 281.28'
ROGER 8 KATHLEEN WILSON
1080 NORTHFIELD LANE
51 T PLAN
� I SOUTHOLD, NEW YORK 1101-TI
J� I Date: I2/3O/9
Scale: It, = 50'
(SUFFOLK COUNTY TAX MAP NO.: Dist. 1000 - Section OTI - Block 01 - Lot IV
B'OARD OF HEALTH
FORM N0. 1 3 SETS 017 PLANS . . . . . . . . . . . . . . .
TOWN OF SOUTIIOLD SURVEY,. ':: . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK :i.' ,''.'. .. . . . . . . . . . . . . . . . . . .
FEB 19 i�,y SOUTHOLD, N.Y. 11.971
O k TOWN HALL SEPTIC,FORM . . . . . . . . . . . . . . . . . . .
6LOG—nr-i
�--- 8 TEL: 765-1802 NOTIFY:
6
TOWN' /OyyF SOU'rNOLD CALL ;/Y OI$.S . . . . . .
Examined..... t''� _ MAIL TO: . . . . . . . . . . . . . . . . . . . .
Approved....... R..., 19 Permit No. .l..l ...
Disapproveda/c .................................. ....................................•
......................................................
(Buil /BUILDING
APPLICATION FPERMIT CO
..Date. /[:.3 . . .. . . . . . 19/
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wit]
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 must be drawn on the diagram which is part of
this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
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. .,
APPLICAPION IS l M- ff MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and otherL'appli, le Laws, Ordinancesor,
Regulations, for the construction of buildings, additions or alterations; or for a,"or demolition, as herein
described. The applicant agrees,to comply with all applicable laws, ordinances, Building code, housing code, and
Y/ nary inspection .
regulations, and to admit authorized inspectors on premises and in buildi for,neces
gu > nsPec premi ng .
S� 6 cant, or mime, if a corporation)
� �e of a li
(Mailing address of applicant)
State Whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, phnber or builder.
...................................(4 1 C.I n e!tiJ ................................... .........................
n
Name of owner of premises ....... .. 2 �:.. ��.. 1.:.............................
(as on the ml or la
test tdecd)
If applicant is a corporation, signature of duly authorized officer..
.........................................................
(Nam and title of corporate officer)
Builders License No. ......................... . f'
Plumbers License No. .........................
Electricians License No. .....................
Other Trade's License No. ....................
1. location of land on which proposed work will be done......................:.....:..a.........:...................
..............i..80.. t u? e... . ........! �° ........ ..................................
House Number Stree�tHamletun
County Tax Map No. 1000 . Section .....1.1......... Block ..D.I........... Lot :..�'.:�..... .
Subdivision ...................................... Filed Map No. ............... Int 4..............
(Nam)
2. State existing use and occupancy of�premises and intended
use
and occupancy of-'prop`o'sed'construction:
a. Existing use and occupazoy' ..�:Le. l �'4/.`ttY:t.�i.......... .. .-:f.....>.. ...........
b. Intended use and occupancy . .. ............. . ro, .....
`,-i �it46 "' tR i�f z •?..� � i r_�ml
33 ( Ly J
;T2e96
.. e.,Y i .1 � 1��i a, FF,,4,:P
3. Miture of work (check which appl I icable): New Building .......... Addition ...."..... Alteration ..........
Ite hrr � a Ilemlition .. otherork (Oescrtio
ton)
4. Estimated Cost / Fee (to be paid on Filing this application)
I tion)
5. if dwelling, rxnlxhr of dwgllingiunits '... ........ Number of dwelling knits on each floor ................
ifgarage, n fiber of cars .....1................................
6ssofexisting cialstructures,
rowed occupancy, specify nature and extent' of each type of use.... ....
. Dimensions
if any: Front...�?.. ..... Rear ..API;-7 ....... Depth .. r*' .4. ....
llei it ....... •} amber of Stories .0M .............
Dimensions of same structure with alterations or additions: Front ... . Rear ..fit ......
Depth .......... Height .................... Ami)er of Stories ...4� I�e.. ..
S. Dimensions of entire new construction: Front . Rear .l(ii'r r( .... Depth
Height ........:......:.. .'....� Nhnber of Stories ...ONE...........
11 I
9.. of Size
lot: Front ..... I:........ Rear .....J b.� 1........ Depth ......:.....
... IS!4!"r...... Name of Former Owner ........... •.......••••••
district11. 7xioe or use nieh premises are situated ......� 1�..................4..........................
12. Does proposed cohstructiohvi6lpte any zoning law, ordinance or regulation: —W. ...............
1 n. Nares of be regrer aded
ices .... Will excess fill be removed from
premises. US
I`. Will lot be f premises���.,.. ...... �eh?9xJ... Address ../.4.�'4.✓f�L� ........ ... wre x��S p6Q
Name of Architect lYhr:`t`.hr~c'r.v.l w . .....�(. :tt'h:..... Address l�O( ' i .�Q.. ... hone No.
Name of Contractor ................... Address
15. is Ilds property wifin 300 feet of a tidal wetland? * YPS .......
*1F YLS, SOUIlI(HD 1DWN 4R[ISITfiS PRRMFf MAY I1L REQUIRED.- 11�`I119]
PLOT DIAGRAM
Locate clearly and distinctly r 11 buildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street arxi block nnber or description according to deed, and show street nares aril indicate
Miether interior or corner lot.
I
eotuAmtmor
II
SI'Alli (Ar f&hF-Y(•A8F= ......... S.
OOIINIY ('? F`A1:2.R��.•�'.....A...
QS?Y.F... .7.:'Y.I �6.6—being duly swoni, deposes and says Lhat he is Lite applicanL
(Manx: of individual signing contract)
above named,
lkis Lite ................�W .1......................................................................
(Cortraclor, agent, licorporate officer, etc.)
of said (wrier or owners, and is duly'authorized to perform or have perronned Lhe said work sited to make aril file this
application; that all staterenCs con�aihhed in this application are true to the best of his knowledge and lxil.ief; arxl
that the work will the perfoned in the nahnher set forth in Lite application Filed therewith.
Sworn Lo before me this
i
.......I; .........day of Z&(rV? ..19 9.d.... 1 n �• VI/
Notary Pohl is tet ' ............
V
Sig"'
i rnl'u. .
of Alicant)
ANTOP. ,� �:?,a�." �'���TONIA D. CANNET(J
NOTr, Mr' �` 'NOTARYPUBLIC
MYCOMMISSIONEXWhE3MAY 1 MY6*MISSIONEXPIRES MAYSI,9M
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, I . I IPROVIDE SMOKE-DETECTING LW�U L
;+ ALARM DEVICES u � � � }
AS To PART. WITHOUT CETIF�CA T -4c� � *1 .
-
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- ,� N.Y.S BUILDING CQDE.
OF OCCUPANCY 1. II . . . - I . L . r 1. .1 9'L 1, . .
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11PPROVED�kS NOTED Geol � t-q .��Y-o �1 r
PROVIDE OPENINGS FOR DATE: B.P#�`t p Q.: : r - o i - c c-
EMERGENCY ESCAPE AS FEE: -7t,- W �. _ ,
REQUIRED BY PART. 714 OF NOTIFY BUILDING DE AT ' .' 11
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765-1802 9 AM TO 4 PM EOR THE i 5 ,,rt�> 'I L -N ;
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