HomeMy WebLinkAbout27546-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28365 Date: 04/24/02
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property: 150 TERRY LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 65 Block 1 Lot 4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 23, 2001 pursuant to which
Building Permit No. 27546-Z dated AUGUST 16, 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 ALTERATIONS & SCREENED PORCH ADDITION TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to FRANCIS & SUSAN STEPHAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N564125 01/31/02
PLUMBERS CERTIFICATION DATED N/A
thor zed Signature
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. 27546 Z Date AUGUST 16, 2001
Permission is hereby granted to:
FRANCIS & SUSAN STEPHAN
4301 169TH STREET
FLUSHING,NY 11358
for
ALTERATIONS AND SCREENED PORCH ADDITION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR
at premises located at 150 TERRY LA SOUTHOLD
County Tax Map No. 473889 Section 065 Block 0001 Lot No. 004
pursuant to application dated MAY 23 , 2001 and approved by the
Building Inspector.
Fee $ 150 . 00
Authorized Signature
COPY
Rev. 2/19/98
• Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802 C,
APPLICATION FOR CERTIFICATE OF OCCUPANC -�
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 I% 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.T 9r10 2--
New Construction: Old or Pre-existing Building: V-- (check one)
Location of Property: /5-0 r-v LQ"e-
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section p�.� Block o 0 0/ Lot 00 Y
Subdivision Filed Map. Lot:
Permit No. 2-7-5-116 z Date of Permit. ff� zz , zo of Applicant: fe,„ /V
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $ 2 S o0
Applicant Signature
Coit,0835
f
- -----------------
THE NEW YORK BOARD OF FIRE UNDERWRITERSt= 1
1001093 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK, NY 10038
Date JANUARY 31,2002 Application No. on file 13238901/01 N 5541.25
THIS CERTIFIES THAT PERMIT NO. 275462
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
FRANK STEPHANS, 150 TERRY LANE, SOUTHOLD, NY
in the following location; ❑ Basement ® 1st Fl. ❑ 2nd Fl. OUT Section Block Lot
was examined on JANUARY 24,2002 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCE FLUORESCENT OTHER AMT. K.W. AMT. I K.W. I AMT. I K.W. AMT. K.W. AMT. H.P.
2 5 2 2
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC-PT.1 TIME CLOCKS BELL UNIT HEATERS M SYSTEMS ET DIMMERS
AMT. K.W. OIL X.P. GAS M.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. X.P. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
METER NO.OF CC GOND. A.W.G. A.W.G. A.W.G.
AMT. AMP. TYPE EQUIP. ZW JW 3W •4W PER OF CC.COND. NO.OF NI-LEG OF HI-LEG NO.OF HE OF NEUTRAL
OTHER A ARATUS:
DOROSKI ELEC. INC. LIC.#2941 k L L
425 MONSELL LANE
CUTCHOGUE, NY, 11935 GENERAL MANAGER
1t
Per
This cerlif-ate must not be alNrat!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.
BUILDING PERMIT VIEW CHECK LlSrj`
Applicant/ i Date
Owners Name: � !• tc S. Reviewed:
Architect/ Date
Engineer: f�u �Q f� Submitted: . " v
SCTM #:
District: 1,000 Section: 65— 131ock: Lot: _
Project Subdivision
Location: 15V EJUI
__— _ Name:
i
Sin&le R separate Required /l,0
certifica(ion: Yes/No) _
Rcy. 1 Rcq. ell
Zoning District (lot siu: O U U Actua S� _J (Loccuvcragc Prolxscd _I
Rcq. / Rcq. ,j Req. r r
jFront Pard Proj�osed: (Side.Yard) Proposed: J [Rear Yard Proposed'— x.577 J
7y
3�
Project Description:
AGENC=ERMITS Permit
REQUIRED FOR RE,VIEWImo.A. NO YES Number
Suffolk County Health Dept. f
New York State D. E. C.
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation???
Flood Zone: , 1
Notes.:
1,q IA .-
_! A Was /0 Jre ..rte AXT_e, 'kti..i{
/-1c --1-ttcr- w 111 s r C h �. rAJ
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S ✓ Sa a rf /�/ a y.C / S S Xc P"o S
5—/6 - hoz - F-Y9z-
STATE OF NEW YORK )
ss:
COUNTY OF SUFFOLK )
being duly sworn, deposes and says:
That/deponent is ver the a e of 18 years and resides at
�C�l �
That on the25 day of ��7 , 2001 deponenjA ct/engineer,
licensed by the State of New York, hereby states-that//he accepts full
responsibility for the accompanying plans compliance with the New York State
Fire Prevention and Building Code (9 NYCRR); said plans pertain to property
located at SCTM# 1000- ` 73 8`Y 5--
street
street address sb %e;Ty La
ect/Engineer
Sworn to before me this
day of s. o
Y PUiUc,State of Now York
Ne.304916018
Qualified in No—
mldon Exptros �,�,.
Notary Public
cc: Applicant
T65-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOU ATION 2ND [ NSULATION
[ FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: 0 /6U -ra)n Nt�
bp-
� ` s
DATE IQ I � I INSPECTOR
suauiNc DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
DATE
FIELD INSPECTION REPORT-- bATE ..: . . COMLENTS
H
FOUNDATION ( 1ST)
FOIINDATION (2ND)
.t.
l o�
ROUGH FRAME 91
.S' C
PLUMBING
AL
INSULATION PER N. Y. t{
STATE ENERGY
CODE
H
FINAL
--�_----- - - _�-----ate=-� -
ADDITIONAL COMMENTS:
ITO
n
H�
T
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802 Survey
PERMIT NOG 75 6 Chec 7 R/S0.CIA
Septic Form
N.Y.S.D.E.C.
�
Trustees
Examined 9- /6 '20 0/ L'� " t5 i i Contact:
Approved 8�6 20� Mail to:
MAY 2 3 2001 a
Disapproved a/c �
BLDG. Phone:5)`- Iiia— 9 If f
TOWN 0 THOLD
Z e��
uild ng h pector
APPLICATION FOR BUILDING PERMIT
Date ZZ-2 3 9200/
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 waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
f 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. yy� c
,7d4„,,///� / / c
(Signature of applicant or name,if a corporation)
/Z W���w✓r e w C-� Z�ar+e”Ie
(Mailing address of applicant)
ti
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises _Sv54. 4uee Fl�c i s 5-�e4g it
(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. 2 /3ff h/—d S WV//C CCU.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done: S `� Id
JS-0 ��.er4 y L.c ou o
House Number Street Hamlet
County Tax Map No. 1000 Section q7 3 8'8 c Block 65, Lot /—y
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed consimctien:
a.. Existing use and occupancy L /
b. Intended use and occupancy
3. Nature of work(check which applicable): New Building Addition Alteration ✓
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost /5- os� .ov Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units 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 existing structures, if any: Front Rear Depth
Height Number of Stories / '/T-
Dimensions of same structure with alterations or additions: Front 50= Rear
Depth SW c Height Number of Stories S�.w
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
i
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 re-graded /V D Will excess fill be removed from premises: YES NO
N3-o/
14. Names of Owner of premises 4 e- .s Address /� 9 f s s 4,'r //3SFl Phone No.71f1-35W--Z 7 ZC
Name of Architect AddressPhone No
Name of Contractor C/eAddress iz e-f Phone No. 6/6 -702 - 9r5/9 z_
r3o Cw,a , a/• ,iii/c
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 )
G le K /Li being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the C o 7�i�4 c 7V f-
(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
o23A,y, dayof/n —200/
otary Public Signature of Applicant
LINDA J.COOPER
Natoy
pim 4>k22663 Suffioollk Cou York Y
Terns Expires December 91,
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OCCUPANCY OR
rte- -- - - -- - - -----------
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USE USE IS UNLAWFUL
Ilk WITHOUT CERTIFICATE
OF OCCUPANCY
DATE: A;aPgDBP pNOTED
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FEE:
I- -_ NOTIFY BUILDING DEPARTMENT AT
---_-J —II ❑ L li I LIV
-- 765-1802 9 AM TO 4 PM FOR THE P h-.-
LOWING
FO FOUNDATION TOO REQUIRED
FOR DCONETE_-______ —_ --032254-1
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I I 2. ROUGH - FRAMING & PLUMBING
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4. FINAL - CONSTRUCTION MUST /
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ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
�'] i2 SL-f��.B•17 o1-I STATE CONSTRUCTION & ENERGY
---- , CODES. NOT RESPONSIBLE FOR UNDERWRITERS CERTIFICATE 0L)
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