HomeMy WebLinkAbout27296-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27668 Date: 05/11/01
THIS CERTIFIES that the building ADDITION
Location of Property: 12910 MAIN RD EAST MARION
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 31 Block 14 Lot 14
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 4, 2001 pursuant to which
Building Permit No. 27296-Z dated MAY 8, 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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to NORMA MILLER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Authorized Sip
i ture
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. 27296 Z Date MAY 8, 2001
Permission is hereby granted to:
NORMA MILLER
BOX 13
EAST MARION,NY 11939
for
CONSTRUCTION OF A DECK ADDITION TO A SINGLE FAMILY DWELLING AS
APPLIED FOR.
at premises located at 12910 MAIN RD EAST MARION
County Tax Map No. 473889 Section 031 Block 0014 Lot No. 014
pursuant to application dated MAY 4 , 2001 and approved by the
Building Inspector.
Fee $ 75 . 00 !
Authorized Si ature
I
ORIGINAL
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR.CERTIFICATE OF OCCUPANCY
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.
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 Occgpancy 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 Buildinc - $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 . . . . . � ��. . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Buildi//n � J1lf
. . .v�:
Location of Property. . . . �.�:�.�a . . . . .. . . . - � rF . , , , , , , , • • �. ;, !�:'
. . . . . . t�`?t,r. . . . . .
House No. // Stre�etJ Hamlet
Onwer or Owners of Property.. . . . G �.�n:"�:. , , , , , , , , , , , , , , . . . . . . . . . .
. . . . . . .
County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . .". .y . . , , , , .Lot. . . . . 7. . . . . . . . . . . . .
Subdivision. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . Fi ed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . .:2..�Z. . .Date Of Permit. . . Sf ��. .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. . �:�, . . . . . . . . . . . . . . . . .
C O a . . . .APPLICANT. . . . . . . . . . . . . . . . . . . . . . . .
78 °-1802
BUILDING DEPT.
INSPECTION
[ ` ) FOUNDATION IST [ ) ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ l FRAMING [ ) FINAL
[ ] FIREPLACE & CHIMNEY
REMARKSol
:
>;
J
,DATE c INSPECT
L
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND /FINAL ULATION
FRAMING 0
[ ] FIREPL � CHIMNEY
REMARKS:
y
,DATE .�/9 � IN8PE
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 NO. 7 6 Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 20 Contact:
Approved 6' '200 t Mail to:
Disapproved a/c
Phone
Building sector
APPLICATION FOR BUILDING PERMIT
Date 1'-� 12061
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.
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.
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
owNLA%=
Name of owner of premises
(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:
/(UI✓ J09aQ
House Number Street Hamlet
County Tax Map No. 1000 Section 131 Block 11CV/ Lot
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 " , ��i T j?rd A ed&ffl
b. Intended use and occupancy ):jjFn &,ga[LF 77
3. Nature of work(check which applicable): New Building Additio Alteration
Repair Removal Demolition Othe ork
(D scription)
4. Estimated Cost 30 °0 C—
Fee
(to be paid on mgt is application)
5. If dwelling, number of dwelling unitsZ -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
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
i de
8. Dimensions of entire new construction: Front 0;a3 -f — Rear « f— Depth 4
Height Number of Stories
9. Size of lot: Front Rear 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: NO
13. Will lot be re-graded /1r/o Will excess fill be removed from premises: YES NO
14. Names of Owner of premises Address Phone No.
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
• 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 )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is theJ�
(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 me this
`hof j)y elk- 20D/
Notary Public \ Signature of Applicant
HELENE D.HOIRNE
Notary Public,State of New York
No.4951364
Qualified in Suffolk County
commission Expires May 22, 02 G o
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-TOWN ov Sou rkoL o ~' N Y
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UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
40/•� //' SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW,
lY
ES
THIS SURV
- •S ., Q PtYOrt�rTt�-'K'f' THEPILANDFSURVE SURVEYOR'S,
NOT NS
IN!,ED DP SEAL"OR
t.
EMBOSSED SEAL SHALL NOT 6E CONSIDERED,
TO BE A VALID TRUE COSY.
", :-,„? • - GUARANTEES INDICATED HE2EON SHALL -.UN 1 .r..
r ONLY TO THE PERSON FOR V!'.-j`.1 THS SURVEY
IS PREPARED, AND ON {.S C! -LF TO THE
TITLE COMPANY,GOV".:;,t,Nl'AL AGENCY AND
r
�. . LENDING INSTITUTION L:ST:D IiEREON, AND
" �,- ,;o _ TO-THE ASSIGNEES OF THE LENDING INSTI-
'
W-, - ,
Y � "' 'x" y� !- TUTION.GUARANTEES ARE NOf ihA\S::f AALE
TO ADDITIONAL INSTITUTIONS OR.SUMk4UCNT
OWNERS! -
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existing upper deck
existing house U)
stairs to upper deck
10' +-
6'+-
X X X X
Specs: existing steps
box will be 2x8 cca treated lumber
2X8 BEAMS 16"O/C with tecos
4X4 post marked with an x are to be replaced
with cca treated lumber on cemeAV Weep
IST � r B.P
decking will be 2x6 cca treafed�fum�'e �� -
FEE: 7 BY:
N0TiFY BUILDING Q PA ENT AT
r � Ta 9 ASI TO 4 PM FOR T1,,?E
Cry u`?NG 1N1^,PLCTIONS:
O RCQ4..EIRC-1?.
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