HomeMy WebLinkAbout27822-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28183 Date: 01/25/02
THIS CERTIFIES that the building ADDITION
Location of Property: 2700 BRIDGE LA CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 85 Block 2 Lot 4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 23, 2001 pursuant to which
Building Permit No. 27822-Z dated OCTOBER 23, 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 DORMER ADDITION OVER AN EXISTING GARAGE ON AN EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to JOHN & AMY S BAGLIVI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. H 052645 11/06/96
PLUMBERS CERTIFICATION DATED 01/24/02 JOHN BAGLIVI
). 44<
//,Iktl/rized gnature
Rev. 1/81
f
l
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. 27822 Z Date OCTOBER 23 , 2001
Permission is hereby granted to:
JOHN & AMY S BAGLIVI
PO BOX 1020
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF A DORMER ABOVE GARAGE OF AN EXISTING SINGLE
FAMILY DWELLING (FOR STORAGE) AS APPLIED FOR
at premises located at 2700 BRIDGE LA CUTCHOGUE
County Tax Map No. 473889 Section 085 Block 0002 Lot No. 004
pursuant to application dated OCTOBER 23 , 2001 and approved by the
Building Inspector.
Fee $ 150 . 00
Authorized Signature
ORIGINAL
Rev. 2/19/98
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)
0 a Date..?. . .................................................. 19.��l'�.
N_ 22041 Z
Permission is hereby granted to:
......................
s
....... . oo... ... V. A, 4......�............
�Ov- �
to ....1m -�.... .... ... . 4r{.. .....a?r'e
....... .......... I ............
r.............................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
at premises located at.....PZPo....... .......................................................
................................................... . . ..................................................................
County Tax Map No. 1000 Section .........4�........ Block.........ate............. Lot No. ........7`...............
pursuant to application dated ..........7'/�....................................1 19...?f... and approved by the
Building Inspector.
Fee$.....��.......
Builds g Inspector
Rev. 6/30/80
Form No.6
TOWN OF SOUTHOLD ��
BUILDING DEPARTMENT
TOWN HALL i t F 1
765-18022 to 4
APPLICATION FOR CERTIFICATE OF OCCUP C ' UDG.DEPT,.
,..7
This application must 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.New Construction: @hear Pre-existing Building: (check one)
Location of Property: 7J J /� D�e 6,+ C u-rr f/ O 5y Q
House No. Street Hamlet
Owner or Owners of Property:���((G. V
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision l f/` 41( 4fe,J Filed Map. Lot:
Permit No. 0Date of Permit. Applicant:
Health Dept. Approval. Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check e)
Fee Submit ed: $ 02 S�
Ci'11J _a_ a.li� )�3 3
�C.SZ. Applican gnat e
THE. NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
8062990 BUREAU OF ELECTRICITY
F 85 JOHN STREET, NEW YORK, NY 10038
Date NOVEMBER 06,1996 Application No.on file 12746496/96 H 052645
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
JOHN A. BAGLM, 2700 BRIDGE LANE, CUTCHOGUE, N.Y.
in the following location; ❑ Basement ❑ Im Fl. ER Ynd Fl. Section Block Lot
was examined on NOVEMBER 01,1996 and found to be in compliance with the Nationwl Electrical Code.
HXTUREACLEf SWITCHESFIX UREIC
S RANGES COOKING DICKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS NCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT.LK.W. AMT. H.P.
3 15 7 3 1 F
DRYERS FURNACE MOTORS FUTURE AFMANCE FEEDERS SPECIAL RECPT TIME CLOCKS MLI UNIT IUAIMS "TI-OUTLET DIMMERS
AMT. K.W. OIL N.P. GAS M.P. AMT. NO. A.W.G. AMT. AMP. AML Amps. TRANS. AMT. H.P. SYSTEMS.Oi FEET AMT. WATTS
NO
SERVICE DISCONNECT NO.OF S E R V I C E Lll
AMT. AMP. TYPE 1 X 2W 1 R 3W 3/3W 3/4W NO-OF CC-GOND.R INOF CG G.
NO .OF 141-LEG I 0p•N�• NO. NEUTRALSOF NEUTR
Al
OTNER APPARATUS:
PADDLE FANS-2
MOTORSs2—F H.P.
G.F.C.Is-1
SMO$E DETECTOR:-1
JOHN A. BAGLIVI L L
F. 0. BOX 1020
CUTCHOGUE, NY, 11935 GOOM (MANAGER
11
Per
This certificate must not be.ghered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
%3FFot,��o
Town Hall;53095 Main Road Fax(631)765-1823
P.O.Box 1179 ,ji �� Telephone(631)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date:
Building Permit No.
Owner: OL�(ti �A7cr✓�V�
(please print)
Plumber:
(please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
( s Signature)
Sworn to before me this a
day of 20�9—
k
LYNDA M.BOHN
NOTARY PUBLIC,State of New Yb*
No.01606020932
OUallfied in Suffolk TOM Expires,March 8,20�?
Notary Public, County
r"
JOHN A. BAGLIVI
2700 Bridge Lane
Post Office Box 1020
Cutchogue, NY 11935
516/734-5431
September 30., 1994
Southold Town Building Department
Town Hall
Southold, New York, 11971
Dear Sir,
I have spoken to Mr. Fisher about my construction
project and as per his instructions have enclosed a
sketch on the interior plans for my dormer.
Kindly amend my building permit (#22041 Z) to
include the changes illustrated.
Thank You,
BLDG.DEPT,
r TOWN OF SOUTHOLD
PerM�T Zz ��� Z
BAGLIVI 2 too artdq e f,c-
P.O.B..1020 f i
CUTCHOGUE, NY 11935
v 1
1 r�
r i t
z
i
n,� I
h ¢!�
,
I
i
, I
bgt,ANtt if AU4Ivcr<- "1171wt PO-4(
I,
r
t f u d� rr
/-7(' �� � 4��b�� t�✓�n/oow //u�o~ �Nr�✓!C/CAL �S/�r.i:��lr 'v bi(/�) �9Jt; ®i.�r�ll�'io N �,��y��
70-lM
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [4J ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS:
DATE 1 L PIN INSPECTOR
a��
ra-u�
BUILDING oar.
INSPECTION
[ ] FOUNDATION 18T [ ] ROU H PLBG.
J FOUNDATION 2ND [ INSULATION
[ l
FRAMING [ J FINAL
REMARKS: �-
z, )
DATE 1. INSPECTOR �i�
M-102
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] RO H PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: �,4�•��...�
�I
DATE � �/ INSPECTOR
ass-iso:
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ 4---FIN�AL
INSTION
FRAMING [
[ ] FIREPLACE 8 CFIIMNEY
REMARKS: d
DATE ` a� �� INSPECTOR A",,
LD i;:E: E.:: L N T f
OUNDATION ( 1st)
cn
OUNDATI0N (2nd )
4- < L
. z �
0
.OUCH FRAME & I d
• I O
•PLUMBING (�
m
n
:NSULATIOIN PER N . Y. • • '�
STATE ENERGY -•
CODE
FINAL I
Io
ADDITIONAL COMMENTS :
' c
O V�
y `�J
m .
H
FORM NO. 1 BOARD OF HEALTH . . •
3 SETS OF PLANS
TOWN OF SOUTHOLDSURVEY . . . . . . . . . . . .
' '
SURVEY • . . • . . _
BUILDING DEPARTMENT CIIECK _ . . . .
� ' ' ' ' '
TOWN HALL SEPTIC FoRtl � •
SOUTHOLD, N.Y. 11971 . " ' •
/ TEL.: 765-1802 NGT I FY
Examined .�,5 19���..' CALL •�3�; t���•
Approved . . . L, .V. . . . a7 jW__e� MAIL TO:
• . . . . . .
19,��Permit No. . . . . . . . . . . . . . . . . . . . .
.
Disapproved a/c . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . .
LS Q (Bu' ding ector)
br APPLICATION FOR BUILDING PERMIT2 0Date . . . . . . . . . . . . . . . . . .. 19 . . .
INSTRUCTIONS
a. This application mustpletely filled in b
=ts of plans,accurate plot plan to scale. Fee according to typewriter hedule or in ink and submitted to the Building Inspector, with 3
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining r
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is
;tion. g p emises or public streets
c. !The work covered by this application may not be commenced before issuance of BuildingPart of this appli-
d. ; Upon approval of this application, the Building Inspector will issued a BuildingPermit
all be kept on the premises available for inspection throughout the work. Permit.
e• No building shall be occupied or used in whole or in art for an to the applicant. Such permit
all have been granted by the Building Inspector. P Y Purpose whatever until a Certificate of Occupancy
APPLICATION IS HEREBY MADE to the Building Department for the issuance ofa Building
ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and cher applicable
gulations, for the construction of buildings, additions or alterations, or for removal'
Permit pursuant to the
e applicant agrees to comply with all applicable laws, ordinances, buildin PP able Laws, Ordinances or
d.
nit authorized inspectors on premises and in building for necessary inspec or.Siemolition, as herein described.
de,
g code, and regulations, and to
S..nature ature of ppljor name, ifa corporation)
Po 1020Cptgue,.ailing ess of applicant)
to whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician Plumber OwnOr d 4 , p mber or builder.
: . . . . . . . . . . . . . . . . . . . . . . . . �' Cl�( /. /. . `. .
ie of owner of premises . . . . . . . . aP•Plicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed).
,plicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. . . . . . . . . . n/a (applicant
. . . . . . . . . . . . . to Preform work)
Plumber's License No. . . . . . • • • n/a
Electrician's License No. . . • • • • n/a
Jther Trade's License No. . . . . . n/a
;cation of land on which proposed work will be done. .
2700 Bridge Lane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
)use Number . . . . . . . . . . . . . . . . .Street• t . . • . . . .. . . . . . . . . . . . . . . . cutcho. . gue.. . . . . . . . . . . . . . . . .
. . . • ' ' ' '
unty Tax Map No. 1000 Section
. . .085. . . . . . . . . . . . Block . . .? Hamlet
. . . . . . Lot . . . . . . . . . . . . . .. . . . .
(Name) ' • • • • Filed Map No. 5 8 7 2 Lot 9.
to existing use and occupancy of premises and intended use and occupancy ofos
ro
xisting use and occupancy Single family dwelling p p ed construction:
;tended use and occupancy • • . • • • • • • • same p nded st . • •
ex a .orage .area above garage • • . .
c
.3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . dorm r. . . . . . .
$5 ,000 .1 0 0 (Description)
4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
S. If dwelling,number of dwelling units . . . .1 . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . .
If garage,number of cars
6. If business, commercial or mixed occupancy, specify_4niture and extent of each type.of use . . n/a_ . ' ' ' ' ' ' '
7. Dimensions of existing structures,if any: Front . . .2 . . . Rear 2 4 1 Depth 2 6 f
Height . . .18.x. . . . . . . . . Number of Stories . . . . . 1. . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front same' ' ' ' . ' Rear .
Depth . . . . . . . . . . . . . . . . . . . . . . Height
8. Dimensions of entire new construction: Front 20 aormer; 2.
Number of Stories .Rear Depth
Height . . . . . . . . .13 . . . Number of Stories . . . . . . . . . . i2'9
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . . . Rear . Depth
10. Date of Purchase 3�8 4 ' ' I sadore Kru ,.
. . . . Name of Former Owner . . . . . —.... '�
11. Zone or use district in which premises are situated . . .residential ' ' ' . . ' ' ' .
12. Does proposed construction violate any zoning law, ordinance or regulation: no' ' : ' '
13. Will lot be regraded nO. . . . • . , • . . . . . . . . . . . . 1.~ ' " . . . . . .
. . . . . . Will excess fill be removed from remises: No
14. Name of Owner of premises applicant Address . . . . . . . . . . . . . . . . . .P
Name of Architect . . . . . n�a . , , . . . • • . . . • . • . . Address . . • ph _
Name of Contractor n a . Address .Phone o.
15. Is this -property within 300 feet of a tidal wetland? *ye xxx � • • � � � � ' ' ' ' ' ' '
s. . . 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 fpom
property lines. Give street and block number or description according to deed, and show street names and indicate whefher
interior or corner lot.
1 Lu
t yl'
QRo�°Ott
D4R
tiL 3�g1�J
STATE OF NEW r�p
COUNTY OF . . . 9". . .�V. . . . . S.S �2l n 4 a
' • • • • • • • • • �� ��w� • • • . . . . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the . . . . . . . . . . . . . . . . . . . . . W. - . . . . . . . . .
(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
2&A-
day of. . . . . . . . . . .1 19
Nota
ry Public, . . County
ROBERT ,JR.
NOTARY State of KY . . . . . . . . . . . . . . . . . .
No.472 ,Suffopc Cou (Signature of applicant)
Term res May 31,19
` UNDERWRITERS CERTIFICATE
REQUIRED
APR 20
NOTED
Y
�T
e ;�rv? POR TF•lsW
�RePbS�D ooRN�e Ao0/TOM
E � -
FkOiJf Of(A)
1 � a
' e2X(a �l Arf�u�
{ + t
EXL
7/A/4 CAL
/nxay P4115 /b"vc £xtlrruc
w
I�
ax�o�f2WR«
1
r
i
y � �,• �5��1�id�. �xrS�+N� r�tn4�, XQ� �R�FZE�a-S l " c.
a � o
i
t cw4
� o '
Vtf
bwA/S{v N
l