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HomeMy WebLinkAbout27901-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28072 THIS CERTIFIES that the building ADDITION Location of Property: 370 VILLAGE LA (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 114 Block 6 Subdivision Date: 11/15/01 MATTITUCK (HAMLET) Lot 20 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 15, 2001 pursuant to which Building Permit No. 27901-Z dated NOVEMBER 15, 2001 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 PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HELEN A SLEDJESKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Signature Rev. 1/81 1010=061M 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. 27901 Z Date NOVEMBER 15, 2001 Permission is hereby granted to: HELEN A SLEDJESKI PO BOX 1183 MATTITUCK,NY 11952 for . CONSTRUCTION OF A PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BO#9297. at premises located at 370 VILLAGE LA MATTITUCK County Tax Map No. 473889 Section 114 Block 0006 Lot No. 020 pursuant to application dated NOVEMBER 15, 2001 and approved by the Building Inspector. Fee $ 150.00 AutJhJbriped Signature ORIGINAL Rev. 2/19/98 a79o/ M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE A CHIMNEY REMARKS: [ ] ROUGH PLBG. [ ] INSU ON [ FINAL L DATE INSPECTOR ��''� Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT ��1 J 2001 TOWN HALL J 765-1802 BLDG. r : ' DEPT. D APPLICATION FOR. CERTIFICATE OF OCCUPAN 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. r 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - _ -2► 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date....11/15/01............................. New Construction.?......... Old Or Pre-existing Building ................. Location of Property... PP. VWOW.I-Ke..MattituC k .......................................... House No. Street Hamlet Onwer or Owners of Property ..... H den. A..Sledjeski........................................... r. County Tax Map No 1000, Section.,,114........ Block ..... 6 .......... Lot .... 20 ................ Subdivision ...�.,,...�..................................Filed Map ............ Lot ...................... Permit No. .::..�.-.�� ,.....Date Of Permit...L Applicant .................... ....... Health Dept. Approval..........................Underwriters Approval......................... Planning Board Approval ........................ Request for: Temporary Certificate........... Final Certicate.x.f(?r.pgrch w/ roof Fee Submitted:FF $.........25.0 D ............... �C)� • • . APPLI• CANT . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Examined , 20 Approved , 20 Disapproved a/c Q L ,4 �r 1.440 BUILDING PERMIT APPLICATION CHECKLIST PERMIT NO. Building Inspector Do you have or need the following, before applying ? Board of Health n/a 3 sets of Building Plans see letter Survey Yes Checkyes Septic Form N.Y.S.D.E.C. Trustees n /a Contact: Mail to: Deb crah ibty, , Esq. PO Box 1181, Cutchogue Phone: 7-34-6648 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date 11/15 , 2001 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 waterways. 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 a 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 what -so -ever until a Certificate of Occupancy is issued 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. (SfQnature of applicant or name, if a c/o Doty, PO Box 1181 Cutc hDgu e (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or.builder attorney for own er Name of owner of premises Helen A. Slecjeski (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 done: 370 V it lage La m, Mattituck House Number Street Hamlet County Tax Map No. 1000 Section Subdivision (Name) 114 Block 6 Lot 20 Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy one -family dwelling b. Intended use and occupancy ane—fami 1 V dwe11;ng wi th *5W_amca R may f Nature of work (check which applicable): New Building Addition y Alteration_ Repair Removal Demolition Other Work (Description) Estimated Cost $1,800 Fee (to be paid on filing this application) If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth . Dimensions of same structure with alterations or additions: FrontEel I Depth Height Number of Stori Dimensions of entire new construction: Front Rear Depth Height Number of Stories Size of lot: Front Rear Depth 10. Date of Purchase 19 67 Name of Former Owner MBrid e 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: Will lot be re -graded. Will excess fill be removed from premises: YES NO 14. Names of Owner of premises same Address sane Phone No. n/a Name of Architect Address Phone No Name of Contractor Address Phone No. 15. Is this property within 100 feet of a tidal wetland? *YES NO x • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF Sjfolk DEBORAH m`Y being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the attorney (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 tg,bvfore me this ay ofNoN r_ 20 Not Public CLAIRE L GLEW Notary No O1 GState LL"79505 York Qualified in Suffolk Cou Commission Expires Dec. 8, Wo" NO. Y TOWN Of SOUTHOLD WILDiNG DRPARTMRNT TOWN DLIRWI OFFICI SOUTHOLD, N, Y. Examined ..,..!'.A ........, 19.7./ Approved ... �.;....,• .... ...., 19,....... Permit NA....l..rl.....1........ Disapproved a/c ...... ................ ....................... ........................... . . . .................. . ...... .... Building Inspector) Application No. ./.?.,7 .............. APPLiCATION ICOR WILDiNG 1'9RMIT �-- v Date ........................ 9 ........, 19...7.%., 0 INSTRUCTIONS c r. a. This QppliWion rmust be Completely filled in bar typewr;ter or in ink and submitted in triplicate to the Building r Inspector, with 9 gets of plgrs, accurate plot Pion t9 mole. Pee QcePrding to schedule. b. Plot plan 4howing jgc.gtior► of lot qnd of buildings an premises, relationship to adjoining premises or public streets of areas, and giving a C10011100 description of layout of property must be drawn on the diagram which is part of this application. �1 C. The work covered by this Application moy not be commenced before issuance of Building Permit. d. Upon approval of this gpplicgtipn, the 11wilding Inspector will issue a Building Permit to the applicant. Such permit' shall be Dept on the premises available for inspectiisn throughout the work. ZS e. No building shall be occupied Ar used in whole or in port 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 altercations, 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 ptemlm and in buildings for necessary inspections. ti .......,.. (Sign. -store of applicant, or name, iffa corporation) ...................... e ........ .... 4 *-k. (Address of oppicant) State whether opplicont Is owner, leasee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................................................,......................,...................................................................................................... Nameof owner of promises ............... l.:i' r. ...V..., ........................................................................... If applicant is a corporate, signature of duly authorized officer. ......... (Name and title of corporate officer)f r Lf- G1 o _ Builder's License No . ..............�rT... l�f:':.................... Plumber's License No . ............................................... Electrician's License No . ........... ............................... Other Trade's License No ............................................... 36 9 1. Location of land on which proposed work will be done. Mop No.: 41//1-,.4dA.<1ot No. ..?.3 Street and Number ......,�r..7.0.......+(/.i(!,f,~i ...4,4,Vim.............:....................::..................... ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propafed construction: a. Exisiting use and occupancy ...........(,�...l�%.r!/.,�, �,%/J�l..�} ............... b. Intended use and occupancy ............ 5/.Qe'1. ....;ltl. l.. e'�1�,.(j /j?,Rc. . ...,,,���, �O 3. Nature of work (check which applicable): New Building• .................. Addition .................. Alteration ................ . Repair .................. Remoilz l ................ Demolition.........: Other or ................................................ .... 4?0 d «w (Description) 4. Estimated Cost......................./................................... fee.......................................................................... .......... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ Ifgarage, number of cars............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height........................ Number of Stories................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ......................•• Height.................... Number of Stories...................................................................................................... L............... Rear ................................... 9. Size of lot: Front ...........�/ © /.......�}Depth ... OG �.l..4t.. .Name of Fg/ r Owner . [.:..C.? ................. 10. Date of Purchase.................7....................... 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 ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone, No....................... Nameof Architect.............................................................. Address ................................ Phone No....................... Nome 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 lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. z� N S 11A.+ "7cr 2 f," LILL—AQG L_A1-4A= STATE OF NEW YQ7 I S S COUNTY OF .... .,.�/,.,G,l•••• being duly sworn, deposes and says that he is the applicant ............. ` fh]5me of in ivid signing contract) ' above named. Heis the ................................. ......... ..................:...........................................................................................I............... (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 than the work will be performed in the manner set forth in the application filed therewith. SwornA before me this 7"A..... day of ........ 19.7. . ............... . Notary Public .. ...... County .....� (Sig Lure of applicant) ELIZABETH ANN NEVILLE IWftARY PUBLIC, State of New York No. 52.8125850, Suffolk Counh, Term I'mree March 3n 1 7eY t iJgrl:: t_sr NidMRi�RS SNOw�v REFER TO "MAP VP Y/LLASE µ MAPWOR,n FaBD I N S!./ ICFCI-K lodt mlev - c s*xr ovAtt r• As } MSP CLlAAANrY CO. AND AANX.AVYffn JAtJUA"-f r -S, orTa w, vAN -ruYL � SaN �` Lfe-XNSii[7 LAMO -SLJ RVGYVRS GksHNppRcr; N"Evr YoOiK r t PROFESSIONAL ENGINEER 1725 HOBART ROAD / PO Box 616, SOUTHOLD, NEW YORK 11971 TEL 631-765-2954 • FAX 631-614-3516 • e-mail: joseph@fischetti.com Date: November 9, 2001 Reference: 370 Village Lane Southold Building Department Main Road Southold, NY 11971 Dear Sir, I have inspected and evaluated the masonry porch and frame roof structure constructed in 1977 at the above referenced dwelling for Ms. Helen Sledjeski. The structure has safely supported the loads and is currently in sound condition. With p.Mper maintenance they should continue to support the expected loads. „rNr� Joseph Fischetti, PE 9 97 Permission is hereby granted to: FOKI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. et premises et BUILDING PERMIT pursuant to application dated Building Inspector. Fee $..Z.~ ...... .~ ................... 19.7~..., and approved by the_ · ~:)R~i'_ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No...Z~....~...2 .......... J97....? Approved ............. ~..~. ........................ . 19 ........ Permit No....~I~....~....Z ............ Disapproved a/c ............................................................................................ ............................................ ................ , ......... .............. .... APPLICATION FOR BUILDING PERMIT Date ............ ............ , ,9...Z.;. INSTRUCTIONS o. This applicatzon must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildit Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premises, relationship to adjo,ning premises or public streets areas, and g,wng a detailed description of layout ofproperty must be drawn on the diagram which is port of this applicatio 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 wdI issue o Budding Permit to the applicant. Such pert, 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 Occupan, 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 tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessary inspections. ,¢.. ....... ........................... (Signature of applicant, or name, if a corporation) ........................ .................. State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or budd( Name of owner of premises .............. ~...¢ .~z.~r/...c(.......~...~.~.~...~.......-/...~../ ...................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .................~....~..~...~.~... ................... Plumber's License No ................. ./ ............................ / Electrician's License No ........... ./C.. ............................ Other Trade's License No ............................................... f ~/ ..~.~ .~.~..~ 1. Location of land on which proposed work will be done. Map No ......... ./../..~.. ....... at No. Z J~. Street and Number ....... ..~....7...~. ....... ~..~.(../..~..¢7...~.....~.~.-..~.. .............................................................................. Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposbd construchon: a Exm,ting use and occupancy ............ .d..~....~..:....~....//.~.4~.~..~-':....c~'.... /:x/. .................... ~ ....... b Intended use and occupancy .............. ..~....~..~.~ ...... ..~...,~...~...'(-.. . 3 Nature of work (check which applicable). New Building ................ AddJtl ............... Alteration ............. Repair ................. Removal ,. ........... Demoht~or: ...... ~, ....... Other Work ........................................... ~ ~ (Description) 4 EstimatedCOSt ................ ~'' [~'~l' I' ~ ........ Fee ~/....~.........'-/~. ·. ........................................................... (to be paid on flhng th~s applicabon) 5. If dwelling, number of dwelling units .........................Number of dwelhng units on each floor .......................... If garage, number of cars ......................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 D~mens~ons of ex~stmg structures, ,f any Front .................... Rear ............................... Depth ............... Height ........................ Number of Stones ........... D~mens~ons of same structure with alterahons or addmons: Front ................................... Rear ................... Depth ........................ Height ................ Number of Stones ................... 8 D~menslons of enbre new construcbon: Front ................................ Rear ........................... Depth .............. Height ................ Number of Stones .............................................................................. 9. Size of lot Front ........ /..~....O...~_2,,_ ............................... Rear ........ ././..~.....~ ................. Depth I~ ~..~ 10 Date of Purchase ...............~/¢Z'~:~..~. .................. Name of Former Owner ..~.:...~.~.C./~/..,~"'~.. ................ tl. Zone or use d~stnct ~n which premises' -/are s~tuated . '/~1 / 12 Does proposed construcbon wolate any zoning law, ordinance or regulation' ../~.....~.. .......................................... ' 13 WIll lot be regraded .......................... WHI excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises .......................................... Address ................................ Phone No ..................... Name of Architect .......................................... Address ................................ Phone No ..................... Nome of Contractor ....................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distmcdy all buildings, whether ex~stmg or proposed, and red,cate all set-back dimensfons fror property hnes. Gwe street and block number or descnphon according to deed, and show street names and ind~cat whether interior or corner lot 1 STATE C,F NEW Y¢01~<,/! ~, ~/' l '* S COUNTY/.¢~ ." ~'~'//f~/OF ..~f~..¢~~ ~ ........ ~'~....~., .............. . - .~(,..~4¢~[~... being duly sworn, deposes and says that he is the applica (Name of ~nd~wdual s~gnmg contract) above named He is the .................... ~~ .............................................................................. (Contractor, agent, corporate officer, otc ) of said owner or owners, and ~s duly authorized to oerform or have performed the sa~d work and to make and f this applicahon, that all statements contained :n th:s apphcahon are true to the best of his knowledge and behef; a thor the work will be performed m the manner set forth m the apphcat~on filed therewith Sworn to before me th~s ........ ,.~..'~ ...... day of ..... .~.¢¢¢-.¢~ ....... , 19~2',~· //'7~'/7 Notary Pubhc,. ......................... ,~~r~County .. ~ ../~. ·....~'..~'.~ ....... /,~'~ . ~! ~ ':'t..~/// , A (Signature of applicant) ~ ~ ~ EU,ZABETH ANN ~ /+ T'IOTARY PUBLIC, State of New York No 52 8125850. Sultolk Count?