HomeMy WebLinkAbout27449-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28129 Date: 12/20/01
THIS CERTIFIES that the building ADDITION
Location of Property: 1085 RAMBLER RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 88 Block 5 Lot 39
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 5, 2001 pursuant to which
Building Permit No. 27449-Z dated JULY 5, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JOHN K COMMONS & WF
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Authorized Sign ure
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. 27449 Z Date JULY 5, 2001
Permission is hereby granted to:
JOHN K & WF COMMONS
1085 RAMBLER RD
SOUTHOLD,NY 11971
for
CONSTRUCTION OF DECK ADDITION TO A SINGLE FAMILY DWELLING AS
APPLIED FOR.
at premises located at 1085 RAMBLER RD SOUTHOLD
County Tax Map No. 473889 Section 088 Block 0005 Lot No. 039
pursuant to application dated JULY 5, 2001 and approved by the
Building Inspector.
Fee $ 150 . 00
Auth r zed Signature
ORIGINAL
Rev. 2/19/98
4
Form No.6
TOWN OF SOUTHOLD �`_Q
Q UILDING DEPARTMENT L ` :
Q TOWN HALL
lie �
-. 765-1802
�Q TIO FOR CERTIFICATE OF OCCUPANCY
This applicatio ust be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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. Photocopy of Certificate of Occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00,Commercial$15.00
Date. 0
New Construction: Old or Pre-existing Building: y (check one)
Location of Property: ���� /e�/yI� E/Z 'PA D 56t--'7"2-216 /V yi l/F 7�
House No. Street Hamlet
Owner or Owners of Property: j4q,</ K• C o Ht My N s-& UJ I h-
Suffolk County Tax Map No 1000, Section X73 X89 Block ego 0 5- Lot O 3 9
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant gnature
FORM NO. a
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)
N? 15127 Z Date .........I-let-$
.. 1. ... 4.............., 192.41
Permission is hereby granted to:
....:�....•............. .. ., �, .................
..� ...c . . .. ....... .ca"""� ....................
..1...........
to . �. ..: ':..�,..... ! ...Q-.d. 444M. . ... .... .... .. ....,cam::...
........:.. ....... ........ .� ... . ................................................................
atpremises located at .... Q...4.... ......n2 0.... . .... .. .......................
G.... ......I!. !.:" ... ^.. :a: ......................................................................................................
County Tax Map No. 1000 Section ..... .g...... Block .....Q1.-V........ Lot No. ....a..l............
pursuant to application dated ......... ..... . . ... .................., 19.. ..%., and approved by the
.
Building Inspector.
Fee $.15D -
...... ................
aC..
.... ................... . .........................
.Building Inspector
Rev. 6/30/80
i
M-1802 15
/ / l BUILDING /
INSPECTION
I
FOUNDATION IST ROUGH
FOUNDATION 2 . INSU TION
FRAMINGiNAL
FIREPLACE & CHIMNEY
REMARKS: .citaa6) •
DATE -
� /
l
7
BUILDING DEPT.
1 ION �I
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU ION
[ J FRAMING NAL
[ ]
FIREPLACE CHIMNEY
REMARKS: \
12
DATE //W&o INBPECTO
FIELD INSPECTION IIDATE ,I C0:•liiEINT S
-o
H
FOUNDATION ( 1st ) = IBJ
c/3
FOUNDATION ( 2nd )
2 .
z —•
0 0
eA
ROUGH FRAME & frj
PLUMBING 7'd
H
3 .
• H 6-•
INSULATION PER N . Y.
STATE ENERGY &9
CODE
x
4 .
a
r
FINAL
o
In
z
ADDITI NAL COMMENTS '
Ldz
z
- 1
- cy
crl
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- - H
' 1
FORM NO. 1 --
TOWN OF SOUTHOLD �` 11 ��� 2 f21986
BUILDING DEPARTMENT 1� :
- TOWN HALL . u
SOUTHOLD, N.Y. 11971 BLDG. DEP(.
TEL.: 765-1802 TOWN OF SOU-1-HOLD
Examined . . ��. . •> 19g•� 7e1GCl Received . . . . . . . . . . . , 19 . . .
Approved . .la,
A-3. .' 1994. Permit No
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Y. ,z`. . . i .!».`n K!�-
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . . . . . . . . . . . . . . . . . .. 19 . . .
INSTRUCTIONS
a. This application must be completely filled in by ty .Q%k wts
submitted to the Building Inspector,with 3
�ts of plans,accurate plot plan to scale. Fee acco 1 . ec
b. Plot plan showing location of lot an g n i � i Joining premises or public streets
or areas, and giving a detailed description o of pe j -agram which is part of this appli-
cation. GG
c. The work covered by this application m�3Lbec iis uance of Building Permit.
d. Upon approval of this application, the Bilil ' il I s uilding Permit to the applicant. Such permit
shall be kept on the premises available for inspec ' o t
sha fNo building shall be occupied or used in o e n purpose whatever until a Certificate of Occupancy
ave been granted by the Building Inspector. ld�
APPLICATION IS HEREBY MADE to the Bui ing 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 inspection. _
(Signatt re of ap t, or name, if a corporation)
ivi /^.IND�..�i�. : h!Y.EkN/ AD.��/./lyo.� . .
(mailing address of.applicant)
State whether applicant is owner, lessee, agent, architect, engineer, gengal contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises J04Y-4/.df. Q-)C 14-(7r- o /y. aAeS.f. . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latesk VED AS NOTED
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) FEE �� " BY- C' '
40TIFY BUILDING DEPARTM6NT AT
Builder's License No. . . [ 'i 1802 9 AM TO 4 PM FOR THE
OSI OWNG INSPECTIONS:
. 1 f-OUi4OAnt)N TM REQUIRED
Plumber's License No. F'-OF' wUNa C, OONCAE-fE
Electrician's License No. A. ROUGH rkAMING & PLUMBING
iWSIILATIGN ;
4, ;-„N.,, 0 04STRUCTION MUST j
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . Bi ,:(a IF r E FOR C O
MEET
1. Location of land on which proposed work will be done. . . . x�l . .. QV).,,;. N
5 N.Y . . . . . . . .
/ Q Q ) ,Q �o TATE STRij(:TION & ENERGY
[. �. .Q . . . . .!�JAM. . 4� ./.I�. . . .�P. . . . . . . .SO 4 T RESPONSIBLE FUR . . . . . . . . .
House Number Street ��"" �r{�e 'INtyR�TION `RRORS,
County Tax Map No. 1000 Section . . QU. . . . . . . . . . Block �. . . . . . . . . . . . . . Lot . 3.'`.
Subdivision . .,.( PA K Y.W11x7,!R 5.- . . . . . . . . . . . . . Filed Map No.-Z--�G P Z . . . . . . . Lot . . . . . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
.!
a. Existing use and occupancy . . .�. . 4 t7l Y. or. . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and oc, r751 � . / �
1
}
3. Nature of work (check which applicable): New Building . . . . . . . . . . A,.. ..,on . . . . . . . . . . Alteration
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . .�.P- q 4:
Description)
4. Estimated Cost . . . —� . . . . . . . . . . . . . . . . . . (
.. . Fee . . . . . . . . . . . . . . . . . . . . . . . . . .Desai . . . .
(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, specif}' nature and extent off ach type of use . . . . . . .I.
7. Dimensions of existing structures,if any: Front . .Y;/, . . . . . . . . Rear `y. '/ . . . . . . . . . Depth . . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . .(. . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front 9A,.* . . . . . Rear4. ! . .
Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . .
"cibht . Number of Stories . . . . .
9. Size of lot: Front . .//?t� �rt s. . . . . . . . . . . Rear . �1.c . . . . . . . Depth . t' D,."
10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Fernier Owner . . . . . . . . . . . . . . . . . . . . . . . . .
11. "Lone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed construction violate an zonin law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regrade ia � . . . Will excess fill be removed from premises: Yes l
14. Name of Owner of premises Address . . . . . . . . . . . . . . . . . . .Phone No. o . . . . . . . . . . . .
Name of Architect Address . . . . . . . . . . . . . . . . . . .
Phone No.
Name of Contractor Y l ?TH f. . .q.. . Address . . . . . . . . . :'. Phone No.?�?7 j S'4
15. Is this property located within 1.00 feet of. a tidal wetland? * Yes . . . . . No . . . . .
* 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 dimensions frc
property lines. Give street and block number or description according to deed, and show street names and indicate whetl;
interior or corner lot.
/3. 15
1
OCA f
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COUNTY N . . .YORK,
. . N \ p , ,'o ey,
STATE OF NEW YORK, S'S ` �Y'� �a (, 0CcA
. . . . . . . . . . . . . . . . . . . . . being duly sworn, de o'
�. ses and says that he is the applica
(Name of indiv ual signing contract)
above named.
He is the . . . . . . . . . . . . . . . .
(Contracto , went, corporate officer, tc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tf
application; that all statements contained in this application are true to the best of his knowledge and belief;and that tl
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
. . . . . . . . . . . . '1 . . . . . . . .day of. . . . . . . . . .
f. . . . . . . . . . . . . . . 191'
Notary Public, . . . .�. . . . . . .� .Y��' . . County
f
lwttr�SpMd#= (Signature of app' can
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