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HomeMy WebLinkAbout23189-z L � FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24105 Date JANUARY 3, 1996 THIS CERTIFIES that the building ADDITION Location of Property 1355 KENNY'S ROAD SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 59 Block 7 Lot 18 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 12, 1995 pursuant to which Building Permit No. 23189-Z dated DECEMBER 18, 1995 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 AN "AS BUILT" DECK ADDITION IN THE REAR OF A ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to PETER & ELLEN HARBES (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ilding Inspector 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) Date... ......... .................... NP 23189 Z Permission Is hereby grantedto: z % ........ .. .... .. ....... /.. ........................ ........................ n ... ........ ........a. . .................... .............. zi '? ' to ......�� ................... . ........... .....a�1�7...... ...............I............................................... ..................................................................................................1....1.1.......I......................I................. ..................................I............................................................................. .............................. -.1 ................................I...... at premises located at.........../..'3 . . ....... .............."!.................I........... ......... .. ..................... ................. .......... County Tax Map No. 1000 Section ...... Y..... Block..........;7 . ........... Lot No. /'..;................. pursuant to application dated ...........-C.�P-6�4...... 19 ....... and approved by the Building Inspector, Fee$ . ......... . ........... Building Inspec Rev. 6/30/80 Form No. 6 Y"i TOWN OF SOUTHOLD ? BUILDING DEPARTMENT TOWN HALL DEG 19�6 765-1802 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-0 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 17 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 Buildina - $100-00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . 7 I . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . old Or Pre-existing Building. . . .of-; �,k.. . . . . . IL Location of Property. . . . . . . . . . . : . . . . . . K. . . . . . . . . . . . . . House No. Street Hamlet pp Onwer or Owners of Property. . . . . . rC ;�erqq. . . C.US.J. . . . . . . . . . . . . . . . . . . . . . . . . .GG. . . . . . . . . . . . County Tax Map No 1000, Section. . . . . . . . .Block. . . . .P. .7. . . . . . .Lot. . . . . . . . . . . . . . . . . Subdivision. . .�_.C�yv C\.,Pl 11- . . . . . . . . . . . . . .Filed Map. . . .W.RP. Lot. . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate4e. . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 P 7:e. . . . . . . ... . . . . . . . I . . . . . . . . 0 'APPLICANT FIIti1.D-ItISPhp;TlOtlj It F1,O II P DAI 11 t:OMFIEN t'S __ =maga=:a=_:mamaam=m= I'UIIPIDA'I'ION ( I!i'I') I N d FOUNDATION==aa UND)mma= - - - >=m_amaaa_amamaa-:=gam IIUIIUII FItAFlli d o _ I VI INSULATION PEI( N. Y . -------------- '� STATE ENERGY COUI! --------� -------------_..-_....----'-- -- ------------ aamaaaamaamaaa---------- m mmal =ma=.�_aaamaaama=amaaemaam=ammma-=gammaaemaa=mag=maamma -_ -- -- --; ---- - --------------- F1 - --- -- --'---------- - -- -- __ _-� NAI. ------------------ --------------magam==aaamoama==aaADDI'ITONAL-UOMt1LNT5=m�amaaamaaamm_ -------------------------------=-----------'----------------- ------- ---'--'----'------ -. - -- - M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ 1 SOLATION [ 7 FRAMING [;/FINAL / REMARKS: DATE f INSPECTOR M-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: Lez---�. fa DATE_�7LINSPECTOR cop-1 W/1 ov 17 ---------- -------- Ile eel 46 ec 16 )(21 36 All mox-evto\ C-C-,A 1p?-e—SSvlRe -Meflk { i +r + *-I , if ext i �( QCA- l -... _.._. .__...„.u_` ....�_ uU,11,U U it"nLL1i . . . : 11 �yv FORM NO. IJ SETS OF PLANS . . . . . . . . . . J TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CIIECFj DEC 1 21995 TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ttOT I FY ; 9p CALL �•CY. lZ►�Y.�� . Examined . !. . 19/. 1 hIAIL TO : ` Pn�X 1731 . .►Mb9 ;�4��C. Approved 1v. . Permit N a Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aRQ 3 00 (Building Inspector) ICATION FOR BUILDING PERMIT Date . . . .1.�". a.�2 . '.�S• .> 19 . . . INSTRUCTIONS a. This application must be completely filled in by typewriter 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :cation. 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 issued a Building Permit to the applicant. Sucln 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. 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 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 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. . . . . . . . . . . . .Qtnwne r— . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . .P . > b :g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applican.tisi cnorporation, signature of duty authorized officer. a. tN 4,...:.: . e 17.1 ame and,title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . I. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .�Q�- ,a �.�. . . . v . . . . . . . . . . . .. House Number Street Hamlet I County Tax Map No. 1000 Section . . . .�.Sq . . . . . . . . Block . . . ©.'7. . . . . . . . . Lot . [�. . . . . . . . . . Subdivision . . . �^ . . . . . . . . . . . . . . . Filed Map No. . . . . . . Lot . . . . . 1 . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . .ppf . . . . . . . . . . ... 2 Ger . . . . . b. Intended use and occupancy . . . . . . . . .Y .r! A�.� . . . . . . . .,'r! .I?✓)'. .1.y d Lu e_ - r h. . . . . l 3, Nature of work ( PP check which applicable): New Building . . . . . . . . . . Addition . , . . . . . . . . Alteration . . . . . . . . . . Repair Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other World . . . . 10,>, Of— (Description) 4. Estimated Cost . . . . . �da. . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . • . . . . . . If garage, number of cars , . . . . . : . . . . . . . . . . . . • . 6. If business commercial or mixed o ccupancy, specify nature and extent of each type of use . . . . . . . . . . ' . . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . • . . , . . , . . Height . . . . . . . . . . . . . . . Numbe of Stories . . . . . . . . . . . . . . . . . . . . . . . P alterations or additions: Front . 6 . . . . . . . . . . . . . . . Rear . . . . . . , . , . , . . . . . . . Dimensions of same structure . .. . Height . . . • . . • . . . . . . . . I . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . Depth 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . • . . . . . . . . . . Depth . . , . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . , . . . • . , . . . . . . , , . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . , . . . , . , 1 . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10, Date of Purchase ' • ' ' • • . • • Name of Former Ownerr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premi ses are situated . . . . . . . . . . . . . • . . . . . . . . . . • . . . . . . . . . . . . . . . . 12• Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . • , . . , . . . . . . . 13. Will lot be regraded . • . . . . . . . . .'',. . . . . . . . . I . , , , . , • Will excess fill be removed from premises: Yes No Name of Architect 14. Name of Owner of premises . . . , .1' • • ' • . • ' • • • • Address . . . . . . . . . . . . . . . . . . . Phone No. . . . • . . . . . . . . . . . . . . . . . . . . , .'' Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . Name of Contractor . . Address . . Phone No. . 15. Is this property within 309 feet of a tidal wetland? *Yes„ . . . . • No „ *If- yes, Southold Town Trustees Permit may be required. ' PLOT DIAGRAM Locate clearly and distinctly all bi'ildings, whether existing or proposed, and.indicate all set-back dimensions from ' property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. APP OV 0 ' X= ' DATE; 8,R# 041 :41� .diilj FEE: ` ggyy f • , p 11-'.t n u4 °�r NOTIFY BUILDING OEC AT 766.1802 S AM TO d PM FOR THE FOLLOWING INSPECTIONS: i��°� 1, FOUNDATION tWO REQUIREDrl ( k FOR POURED CONCRETE �`,,.i<' �'..i,r;^ 5`r z, 's r, �q,; �„•y 2. ROUGH • FRAMING & PLUMBING 8, INSULATION 4, FINAL A CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL. CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE & 000E6,C UCTION NOT RR SPONSIB ENERGY FOR DESIGN OR CONSTRUCTION ERRORS STATE OF N QRS p /� S. COUNTY Fb • • • ' v C. •�-• • • � • S• • • . • • • . . . . . . . . . . , being duly sworn, deposes and says that he is the applicant (Name of individual sign m (contract) above named. He is tile . . . . . . . . . . . . . . . . . . . . . Civ v. J. . . , . . . . . . , . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me t 's . . . . . . . . . day of. . . . . . ., 19 Notary Public, . . . . . . , . . , , . !. . . . . , . County CLAIRE L.GLEW Notary Public,State of^tew York . . . . . . . . . . . . • . . . . . . . No.48786Q8, ! • • • • Qualified in Suffolk County to (Signature of applicant) Commission Expires December 8,19 'I P A� p i in C d' Q ko; Qo. Za - k6 1" 2 op � u•�" w' 9 O o. Pfn d tip. I 'A. p t ,rn < p 4 4 �o p v -� • < \ Alb x, r, ,, SURVEY FOR JAMES KI MBI S a PATRICIA KI M B I S propa'ed in murdanco with tits 'nirAnwm AT SOUTHOL D siondards for title wrvsP oe atabtlrMd by rowN OF sou rf�loen the L. A.L.S. and approved and adopNd For such us* by The Now York bids Lend SUFFOLK COUNTY N.Y. lata Atsocimion. wb(e4 +ell * 8^07-0,10 ,t t�OF Nlk u e CERT/F.ED TO: SSP t MFT �O�A SCALE ,1 = 30 AMERICAN T/TLEINSURANCE 0 to +> COMPANY- TITLE NO. 07' 10715700 '"i AN. 28, 1985 F1R5T NATIONWIDE SAVINGS tm lil; a JAMES K/MB1S ti PATRICIA K/MBIS �II(S IMti.� Ar �. �6ery J R LOT NOS. REFER "' 'MAP OF SUBDt, ION LAN OR KNOWN AS KENNI.':r'00D + FJLED 54 AS N.YS.LTC.NO. 49618 MAP NO. 2/S 0. t16) 727-7118 96 ROANOKE AVENUE'' '�VERNEAD, N.Y, 11901 R.05•/_i/