HomeMy WebLinkAbout17881-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-25781 D~ste: 06/18/98
THIS CERTIFIES that the building ADDITION
Location of Property: 195 FISHERMANS BEACH RD - CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 111 Block 1 Lot 41,1
Subdivision Filed Map No. Lot No.
conforms aubatanta.ally to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 28, 1989 pursuant to which
Building Permit No. 17881-Z dated MARCH 1, 1989
was issued, and conforms to all of the requirements of the applicable
provia ions of the law. The occupancy for which this certificate is issued
is ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to ANITA MARIE SAMUELS
(OWNER)
of the aforesaid building.
SUFFOLR COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N-454842 05/29/98
PLUMBERS CERTIFICATION DATED 06/17/98 HARDY PLUMBING & HEATING
/v
Building In,epector
Rev. 1/81
FOSM NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CfH15 PERMIT MUST BE KEPT ON TtiE PREMISES UNTIL FULL
COMPLETION Of THE WORK AUTHORIZED)
N 0 Q ~ 7 8 $ ~ Z Date ~.4.~ .Cki....~ 19. ~ ..f
Permission ~s hereby gran^tedgto: o ~
..aS.a3S....~. u-~-....(~
.5..~.r n-~}a~.s.......!~ :y.:...t.!.9.:~.~':..... .
to .t.r!:TMR~:k4s3~".. 4?,-~...~<Q:44A.Fi.4r+M.Q.ca....{Zet~tr~~j...~MA-..~~Ykkk~
`~!:*?~~..-uY~,.. ate? ..~.rs ..........I............,...OD..................... .
ct premises located at .)..r~.4?...~... ......4es~v...~i
Q:!?'-.s.~ .k-~.-........1~.-~...,~
. .
County Tax Map No 1000 Section I Block .......Q..~........ t.ot No. ~ Dd
pursuant to application dated +~.F.~rl. 19~ 9 ,and approved by the
Building Inspector.
Fee $.~.?V.:...~-
ing Inspector
Rev 6/30/80
Form No. 6
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 subm~_tted 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 Dppt. 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 12 lead.
5. Commercial building, industrial building, multiple residence:; and similar buildings
and installations, a certificate of Code Compliance from arcl;itect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requireements.
B. For existing buildings (prior to April 9, 1957) non-conforming t;ses, or buildings and
"pre-existing" land uses:
1. tAccurate survey of property showing all property lines, streE:ts, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect sil;ned 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 - .25~
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residenti..,,a//l $15.00, Commercial $15.00
Date ..°`~'.°Z~q ~ .
New Construction...........~~Oyy~~l~~d Or Pre-existing BnuiJlding.....~.....
Location of Property.~.~~.S.Y.`."~lC~. ..................~~~~J.......
House No. Street Hamlet
Onwer or Owners of Property. pp
County Tax Ma~~pyf/No 1000, Section.:F~~l....Block.. ..........Lot..! .//.'I......
Subdivision..!:'~~~ ...................Filed Map............Lot......................
Permit No ................Date Of Permit................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval...
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate.. V.......
^ee Submitted:
~~G
CC ~ a`S ~ APPLICANT........................
J LJ M ~ 1 7-98 W EL 1 0 SE P@ 3
Ube 1 ~ ~b 14J, ld ~JGJl
rel. 7c.-ISOz
~ `~y TQtVN QT SGiITSQI.~
~;;r'~,;;}c OFt:lCL• Of' BUILDIiI;~ fNSPBCTOR
u-~ tir ~ TOIVN LL
P ~ ~ SO[J'T'HU:.A. N.Y. 1 1971
'fQ' ,mss Yb0
C G R T I F I C A T I O t7
Gate ~ it 98"~
t3u~.ldinq Permlt No.
owner ~N/T/9"/f'I ~/~iY/GE«
iplcusg print)
pLum~ar ~9Rby ~s~~.~.E~P
(please erincy
T~certify tnat .ha solder used .n the water supply :~ystam
contr.}nom less than 2!10 oC 13 lead.
(p1's sign
ur~~
Sworn to before a this
19-~ ItOtary ubLic
Nota.~ E°t~'`:ic, COUnLy
EitEEN STRAND
NOTAHYNo O1$T80011d93~~k
Qu~l~f~ed u1 suNO~~
Y 17, 2000
CP~IM~on E*11kM~H
o~~gOFF~(,~~o
Gym
Town Hall, 53095 Main Road y Fax (516) 765-1823
P O Box 1179 y. ~ Telephone (516) 765-1802
Southold, New York 11971 ~ •
y~ol * ~ao~
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 1, 1998
Thomas & Anita Samuels
155 Fishermans Beach Rd.
Cutchogue, N.Y. 11935
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.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 17881-Z (ADDITION)
Please contact our office on this matter. 'Phank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
_ _ .
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FOUtdDATI0;1 ( 2nd ) m
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P,OUGH FR Ai~IE &
PLUMBING
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3. ~
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I1ISULATIOh7 PER N. Y.
STATE ENERGY
CODE
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BOARD OF HE.\LTH ..y........
3 SETS OF PLANS
FORMN0.1 SURVEY
TOWN OF SOUTHOLD CHECK # , )~30.. .
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL j a.yt Skn~uacs
SOUTtiOLD, N Y 11971 NOTIFY y ,l
~ q TEL.. 765-1802 CALL . 'I'3 J : • ~.'I'~ b•& - .
E~ammed ~`"-t~~~ti--//v~~` ~ 19~, t MAIL TO .
,\pproved ~.~S+f\ J.. 19~Q Pci-mtt NoJ ? S
Disapproved a/c - UU lil
~~1
_
(Building Inspector) TO\nir!,CF SOJTHftD~
APPLICATION FOR BUILDING PERMIT
Date .3~1~89 15.
INSTRUCTIONS
a. Tlus application must be completely filled m by typewriter or m ink and submitted to the Building Inspector, wrti
sets of plans, accurate plot plan to scale Fee according to schedule.
b. Plot plan showing location of lot and of buIIdings on premises, relationship to ad~ommg premises or public stre.
or areas, and giving a detazled description of layout of property must be drawn on the diagram which is part of this app.
'cation.
c. The work covered by this application may not be commenced before issuance of Building Permrt.
d. Upon approval of this application, the Building Inspector will issued a Building Prrtnit to the applicant. Such perk
shall be kept on the premtses available for inspection throughout the work.
e. No building shall be occupied or used to whole or in part for any purpose whatever until a Certificate of Occupan
shall have been granted by the Building Inspector
APPLICATION IS HEREBY MADE to the Buildtn~ Department for the tssuance of a Building Permit pursuant to t
Building Zane Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construcnon of buildings, additions or alterations, or for removal or demolition, as herein describe
Tha applicant agrees to comply with all apphcabte laws, ordinances, building code, hoasin~ cod and regulations, and
admit authorized inspectors on premises and in building for necessary mspecho
~J: 'r1.~riiIl.~Q .~!W . ! . .
{Signature of applicant, or name, if a corporation)
25235 Main Road, Cutchogue, NY 1193
(hfaAmg address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build=
Applicant. is .Architect.
. . . .
Name of owner of premises ,Thomas E. And Anita Samuels
. .
(as on the tar roll or latest deed)
If applicant is a corporarion, signature of duly authorized officer
(Name and title of corporate officer)
Builder's License No Contractors have not been chosen
' ~ for the work at this time. Names
Plumber's License No. of successful bidders will be submitt
. . .
to the building department at the tiir
Electrictan'sLicenseNo the contract >.s awarded.
Other Trade's License No ,
tS$ Rd C~v,~
1. Location of land on winch proposed work will be done Fisherman's Beach; Nassa Point
. .CUtchogJZe.
House Number Street, Hamlet
County Tai ~tup No 1000 Section - 111... Block ......1. Lot AO , 41 , 51~-$
Subdivision P.eeonie .Bad .Prop's. , • S.nc. Filed Atap No , 786 , , , , , Lot r 3....... .
(Name) •
State ettsUng use and occupancy of premises and intended use mid occupancy of proposed construction
a Eris[ing use and occupancy R°..~=;t~ritidl.
.
b ln[ended use and occupancy ....Residential.. y-2 W,t~17 , . _ _ .
3. Nature of work (check which apphcable)~ New [ludding . , Addition X Alteration .
Regan . Removal , Demolition Other 1Vork .
(Descnption
4. Estimated Cost , X10, 000 :00 _ ,Fee .45.~:
.
([o be paid on filing this apphcanon)
5. If dweIImg, number of dwelling units . na Number of dwelling units on each floor .
If garage, number of cars .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of eYtstmg structures, if any Front Rear 8... Depth ,6 .
Height ......9........ Number of Stones ,one
Dimensions of same structure with alterations or additions Front 8 Rear .
Depth lg Height l~ ...Number of Stones ......0~?......... .
8. Dimensions ~ enure new construction Front .....8, .Rear , . Depth ...12, , , , .
Height ....10.. .....Number of Stones . ..or1e .
4 Size of tot Front , ...1~Q , Rear . , , ,138. _ , Depth ..2.40 .
10. Date of Purchase .145 ...Name of Forrtier Oi er Nltlrray, , , , _ , , , . , • , . _ .
11. Zone or use district m which premises are situated , , , _ Residents al ~a
12. Does proposed construction violate any zoning taw, ordinance or regulation , , no , , , , , , , , , , , , , , ,
13. Will lot be regraded .A4........ wIll excess fill be removed from premises• 7C>~d~X
14. Name of Owner of premises T...E. Samu61S... ,Address p~. 89B, Cutchogue Phone No. 7.~4-5~~9$ .
Name of Architect .Satnuals. & .StOQ,>,tq~n... , ,Address ?5235. Main Ril_ phone No..7,34,-b405 _ , _
Name of Contractor .Address ............Phone No...... .
IS.Is this property located with in 300 £eet of a tidal wetland? *YES.X_.130....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dunensions fn
property lines. Grve street and block number or descnption according to deed, and show street names and indicate when
intenor or corner lot.
see enclosed
STATE OF NE1V YORE, S S
COUNTY OF .:~s.~~G.~.IL... .
Thomas C . Samuels being duly sworn, deposes and says that lie is the applic:
(Name of individual signing contract)
above named.
(Ie is the , , , , . Arehi tect
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authonzcd to perform or have performed the sa,d work and to make and file t
application, that all statements contained m this application are true to the best of his knowledge and belief; and that t
work wdl be performed m the manner sci forth in the application filed thcrewrth.
Sworn to before me this
.day of .~-4i~f244-u.-L~f 19~.
JI
otary y
N Public, k..4~.~.. Count
LIN~ J COOPER
Notary Public, Since , lewYork (Signature of applies
No 48225fi3,Sur:~7, :ouMy
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