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HomeMy WebLinkAbout17408-z FORM NO.4 TOWN OFSOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z 57283. . . . . . . . . _ . Date . . . Sept: .13, 1988 . . . . . . . . . . . . . . . . . . . . THIS CERTIFIES that the building ADDITION Location of Property 3760 MINNEHAHA BLVD . SOU THOLD. . . . . . . . . . . . . . . . . . . . . . Street . . . . . . . . . . . . . . . . . . . . . . . . . et House No. Street Hamlet County Tax Map No. 1000 Section $?. . . . . . . .Block . .9 3. . . . . . . . . . .Lot . . , , 04 XX Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. .XX. . . . .Lot No. . . .XX conforms substantially to the Application for Building Permit heretofore filed in this office dated May. 10 , 1988 pursuant to which Building Permit No. �?408Z: dated Sept ; 12 , 19 8 8 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 . . . . . . . . . Deck addition to existing one family dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to S VIRGINIA M. THOMAS . . . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . N/A UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . N/A PLUMBERS CERTIFICATION DATED: N/A TRUSTEES (WAIVER) D .E . C . 9 / 12/88 E01053 13uij- .g�':I`ns-p-ecto- r Rev. 1181 FORK NO. 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) N2 017408 Z Date ....T�y.................................... Permission is hereby granted .. . .. ��.�.....�....... .... ;. lop— ..... � ...................... ...... . .. . ..... .. ./. .a'........ . .... r-�� � .. . ��....... at premises located at ....��........D.......4��`�'/fJf ... ............................................ . � ,. ..s , ....................................................... .......................................................................GG........................................................................................ County Tax Map No. 1000 Section ..........Q..2.... Block ...........w3...... Lot No. .......... .T.......... pursuant to application dated ......................................................... 19......... and approved by the Building Inspector. �( D a Fee $. W A� O)o C ......... Bu ding(/ actor 0/O 63 Rev. 6130180 FORM NO.6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ■�to the Building Inspec- tor with the following;for new buildings 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 of Health Dept. of water supply and sewerage disposal—(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4.Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25 . 00 POOLS $25 . 00 ALTERATION $25 . 00 1. Certificate of occupancy New Dwelling_$25.00, Accessory ,,$ 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 . 00 3. Copy of certificate of occupancy $ 5 . 0 0 , over 5 years $ 10 . 00 4 .Vacant Land C.O. $ 20 . 00 r 5.Updated C.O. $ 50 . 00 Date . . . . /so ..sf. . . . . . . . NeWCOnstruction . . . . . . Old or Pre-existing Building . tl. . .. . . ./. Vacant Land . . . . .'.I.f. ' / Location of Property 7� D . . . . . . . . . . . . . . . ./:!?h 11,E s h4. l�?�J@. . . . . . . . . . . . . Souk a 4 House No. Lr r Sheer Ham/er Ow n er o r 0 wn a rs o f P ro p a rty .lLQ rPIW. , „ �h V1.r-q%Yr%� N( . � aln2/S,, County Tax Map No. 1000 Section . .�. .�. . . . . . . . Block . . . . . . . . . . . . . . Lot. . .4 . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No. . . . . . . . . . . . . . Permit No.7.?.�49.8.X Date of Permit . .Applicant . . . . . . . . . . . . . . . . . . . Health Dept. Approval . . . . . . . �. . . . . .... . . . . . .Labor Dept. Approval VA . . . . . . . . . . . . . . Underwriters Approval . . . . . . . . . . . . . . . . . .Planning Board Approval . . . .:'/ . . . . . . . . . . . . .. Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . . .. . . . . . . . . . . . . . . . . . 3 as Fee Submitted $ . . .�. �. . . . . . . . . . . . . . . . . . . . . Construction on above described building and p9xpt meets all appli able codes and regulations. Applicant . . . . . . . . . . . . . . . . . Rev.10-10-78 Ace— .� s'66 y J c ,o. zi7a�3 as qw ads a FRANK A. KUJAWSKI, ,1R., President - TE EPHONE ALBERT J. KRUPSKI, JR., Vice-President BLDG.DEFT (516 765.1892 JOHN M. BREDEMEYER, III I,`.` .,., TOWN OF SOUTHOLC?_,,, JOHN L. BEDNOSKI, JR. ,�� .+�°� HENRY P. SMITH Lit BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD `n Town Hall, 53095 Main Road {� P.O. Box 728 +. Southold, New York 11971 July 22, 19 3760 Minnehaha Blvd. outhold, New York 11971 Dear Thomas: The following action was taken by the Board of Town Trustees during their regular meeting held on July 21, 1988 as follows: RESOLVED that the Southold Town Trustees WAIVER the need of a wetland permit for Virginia & Harold Thomas to construct a deck in accordance with the survey submitted, dated June 22, 1988. Property is located at 3760 Minnehaha Blvd. , Southold. Please be advised that this determination is not a determination for any other agency or department which may have jurisdiction in this matter. ery truly yours, JX l�Ga/ Frank A. Ku awski, Jr. President Board of Town Trustees FAK:ip cc: Bldg. Dept. `,, Board of Appeals w D.E.C. , Stony Brook file M-1802 BUILDING DE". INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ � FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL /� REMARKS: 70 DATE INSPECTOR t kA Lts �.� �A 171.o64t Cove rbnAs 7 e c K C�479) FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL Date . :�1 7. . . . . . . . . . . . . . . . .. 19 �. To PLEASE TAKE NOTICE thaf your application dated . . . . . . . :��. . . . . . . . . . . . .. 19 . � for permit to . .. . . . at Location of Property . . ? �. . . . . . . . . . . �a?!yJ . . . . . . . . . . . . �4C � House No. Street Ham et County Tax Map No. 1000 Section . . . . . .4�?. . . . Block . . . . . . . . . . . Lot . . . . . ..mil . . . . . Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . . Lot No.` . . . . . . . . . . . . . . . . . is returned herewith and disapproved on the following grounds . . LC .�Cu//. ���Q'•�f 9•'�i GQ:J. . . .3er". ?�. . . . . . . . .T/. . . . . ���? c� . . . . �n:C . . . .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :: . . . r. . .ti. . .. . . . . . . ildi Inspector RV 1/80 41-02-1 (4/86)-26a p•-� O O�r'-� - NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NO. t V 3 SETTLEMENT OF CLAIM j Section 11-0306 (11) and 9-0105 of the Environmental Conservation Law VIRGINIA THOMAS L of 3760 MINNEHAHA BOULEVARD' (Defendant) „ -"' I (Street and Number) of SOUTHOLD , N.Y., hereby offer to pay to the Department of Environmental Conservation of the State of New York the sum of Seven Hundred Fifty Dollars and no/100 ($750.00 _) dollars ggt{gggy{jig(ylapn > golpextacthe same to be in full settlement of all claims against me by. reason of my act consisting of construction of a timber deck 121 x 18, in the adjacent area to a regulated tidal wetland without required permit. the same being a violation of Section 25-0401.1 of the Environmental Conservation Law to the State of New York ' and/or the Department of Environmental Conservation Regulation Part 661 on the 28th day of July 1988 committed in the Town of Southold County,of, 8U E �O1 aL and in full satisfaction of any action or-cause of action against me now had by the People of the State of New York by the reason of such violation. Defends lt'3 Signature Dated,';. Stony Brook September 2 88 N.Y., _ 19 I respectfully recommend that the above offer of Seven Hundred Fifty Dollars _ be accepted . Stony Brook, N.Y.; September 12, 88 19 Name and Title of Officer Settling Claim Approved—Regional Attorney Captain R. Otterstedt • - Approved—Director of Division - Virginia Thomas 1.25.0401 having violated Section of the Environmental (Defendant) Conservation Law of the State of New York at the time and in the manner set forth in the accompanying offer to pay the sum of Seven Hundred Fifty (g' 750.00 ) dollars in full settlement of all claims by reason of said violation, and after due consideration having been had thereon it appearing that such settlement will be advanta- geous to the State, now therefore, , IT IS HEREBY ORDERED, pursuant to the provisions of Section 11-0305 of the Environmental Conservation Law, that the above offer be and the same is hereby accepted in full settlement of all penalties and of any action or cause of action on the part of the People of the State of New York by reason of such violation committed by the aforesaid Virginia Thomas as herein set forth. Commissioner Dated, Albany, N.Y., 19 (Settlement papers must be executed in duplicate; original for Department files, copy is returned to the person settling, " after Commissioner's signature.) 4 r r fI I—, 006L-t9L(9t9) b6Ll I. AN'lo-13 Auols 04#'6PIS'ANns u0113e10,d 1eugeH auuew to neame uonoas Afolelnisau ouueyl')algo N011lWVH '1S31UVHO AdMkkk POW U0Ile"GaUe3 le4Ua W UOl1Au3 ;o luouniedea 1� 8414S 1PoA meN OWL v. a BOARD OF HEALTH . . . . . . . . . . . . 3 SETS OF PLANS . . . . FORM NO. 1 SURVEY . . . . . . . . . . . . .✓. . . . . . . TOWN OFSOUTHOLD CHECK . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . . TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL . . . . . . . . . . . . . . . . . . . MAIL TO : Examined • .9 � •/. . • • • • • . .+ Approved . /U• . . ., : . : ._ / o°. D Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y N 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BLDG. DEPT. TOWN OF SOUTHOLD uil Inspector) .APPLICATION OR BUILDING PERMIT Date y f`v., lP . . ., 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. 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. 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 necessa inspections. kP (Signature of applicant, name, if a corporation) �4. ./11 K wel,.�(+�• Q LJ.�.,. Sa m L�,1 l� .°�./14 7/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . .0.1,0 KeIr. . . . . . . . .rr.''. . . . . . . .f. . . . . . . . . ./. . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . C4.a.rP.14 T, . .V?✓t�.lYll. . .M. . .! (Z0hla5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . 6urv�2� �. • • • • • • • • • • • • • Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be donee.. . . .f. . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h J o . . . . . . . . . . . . . . . . . ./. ; ! f0.1) a% t 4. . F?.�I�a: . . . . . . . . . . . .°�r1c-46 .)� . . . . . . . . . . . . . . . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . Block . . .3. . . . . . . . . . . . . . Lot . . ..4. . . . . . . . . . . . . . . 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 . . . . . —;5.f�e.h�l(c ). . b.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . awl • f e . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . nV u 1` 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration,, Repair . . . . . . oval . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work ZX A; f'( (Des. 4. Estimated Cost . m . . . . . . . I . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If gdwellllin number of dwellingi units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . ... . . . . . . . g, Ifaraenumber ofcars • • • • , • • • • • • , , , • • • • • , • • • • • • • • • • • 7 'Jfj fI i h;-pQ d occupancy, specify nature,and extent of each type of use . . . . . . . . . . . . . . . . . . . . . b.e�7f-^�gs'�;ess;`pgCt1'il��`� �r "'ixe, , , ms,ifany: Front . . . . . . . . . . . . . . . Rear . . . Depth . . . : . . . . . . . . . . . . . 4 ht M . . . . _. . . dtur ber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; ugen ' f a ru e with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . .t; Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8.f'Dimens1gptpf jRt#,e-neW nstfuction: Front . . . . . . . . . . . . . . . Rear . . . . . . . , . . . . . . . Depth _ Height4r ;as.§i; •s .a.,,,yl : ..., lumber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size'o`ITOT-"` io—ilt . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . .'. . . .1.'/. . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises A:N-.V, . *-r6i h,kA . Address �,7/,p ,M l h•n f kAkk-Phone No. %5A/S. . Name of Architect . . . . . . . . . : . . . . . . . . . . . • • , • , •Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . : . . . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property fines. Give street and blockl,number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name individual signing• • • • • • • • • • • • • ' • • • • • • being duly sworn, deposes and says that he is the applicant contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 this . . . . . . . . . . . /.4. . . . . . . . .day of (�. . .��iV1. . . . . . .I 1gyr, Notary .A! 4/ . . Public . �y;��-:+�. . � � �.�. . County NELEN K.OE VQEye • • l..C+ �. . . . . . . . NffNo.4RY 707878,SufolktCou_nt York y � (Signature of applicant) Term Expires March 3 . _ IV F{ 1 � • \\ r � b I- a " } 3 Yx 1 s u 1 iY ' `r a � I tI4,4 I j ', '., I I �GFy '- �n(7 Q, V N �r_A 8 + y� a ( v r 4P xn [ {✓ r ' h a V I p c - 5 I i1JV ..1 � > Y� s I � I ♦ tiAa ^J t� �� Flk�r�Fr aCY u91� Y xL � v� �vF (I t�rl d IIVIfIIt . + I `rtJ L if - V1f I .M t hlk " x4 a�me +�tti tlt.Jlt ✓"\ri fll 41 is�re xlvlA.7iIK IV \ � ,r r o de 'J' v r + r xl � f "In r[t 44ii `#V ��r � olh id`J,i fA'H 1jF F -.X�kk I✓ e L!I\ �a . � � � V � � � `1 -, I ° r �r i A�,_ 11 • a F a't 1 a+ I ! 1 �� I I- - �I I In }1. r ✓+ } 1 + a yn p� 1' r + " �. k `''a ,1,' t <, . � '". ' -: . . f� � IF\ �✓- �n�y '`\�\� 1` M f e;,i - I ?, , e 7 I 1: r .�.'✓J. Y4 <' V v ll , 4 � .y \ V1\# 1Vt,1� 1�V{\ � � n_„�jv r u 11 1 �_ 'r'yh r{ ' I! f I V" ' _ .n�opl� 1 I I y,ll?�'`. 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