HomeMy WebLinkAbout27904-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEP~RTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28917
Date: 10/07/02
T~IS CERTIFIES that the building FIRE REPAIRS
Location of Property: 1355 SMITH RD
(HOUSE NO.)
County Ta~ Map No. 473889 Section 98
PECONIC
(STREET) (H~24LET)
Block 4 Lot 14
Sulx~ivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 2, 2001 pursuant to which
Building Permit No. 27904-Z dated NOVEMBER 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 FIRE REPAIRS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JOSEPH SMITH
of the aforesaid building.
( OWNER )
SUFFOLK COUq~TY DEPARTMENT OF HEALT~ APPRO~-AL
ELEt-,'~ICAL C~TIFICATE NO.
PLUMBERS CERTIFICATION DA'rmu
Rev. 1/81
N/A
PENDING 03/18/02
N/A
+/~nature
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUIT~ING PEPd~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 27904 Z Date NOVEMBER 16, 2001
Permission is hereby granted to:
JOSEPH SMITH
1285 SMITH RD
PECONIC,NY 11958
for :
FIRE REPAIRS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at
1355 SMITH RD PECONIC
County Tax Map No. 473889 Section 098 Block 0004
Lot No. 014
pursuant to application dated NOVEMBER 2, 2001 and approved by the
Building Inspector.
Fee $ 413.10
Authorized Signature
Rev. 2/19/98
ORIGINAL
Form No. 6
TOWN OF SOUTHOLD
BUI~LDING DEPARTMENT
TOWN HALt,
765-1802
APPIACATION FOR CERTIFICATE OF OCCUPANCY
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. Approx~al 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 building(s (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. Ifa Certificate of Occupancy
is denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. ~ertifieate 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, Conuncrcial $15.00
New Construction:
Location of Property:
Date.
Old or Pre-existing Building: x/ (check one)
House No.
Owner or Owners of Property: ~2f--~l~x
Suffolk County Tax Map No 1000, Section
Subdivision ~ c~cl r~t4
PermitNo. ~"~qO~ 7__
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Street
Hamlet
Date of Permit.\\ - \~:~ -0 \
Block q Lot
Filed Map. Lot:
Applicant:
Underwriters Appro.val:
Final Certificate: ,// (check one)
Fe~ Submitted: $ oq [5,
MaP
01:24p
Haas
47:::' - 746B
New York Board cf Fire Underv~iters
Bureau of Electrlclty
is in the process oi issuln§ a certificate
compliance for the' electrical installation
as provided for ~ the application for
inspection
#
New York Board of I~ke Underwriters
Bureau of ~ectridty Inspection activity
jpursua~t to Appllcallon '
has been complel~l mid a certlflcate of
compliance seRing forth the detail of the
fi'inspectOr Date
Form
BUILDING PERMIT EXAMINER CHECK LIgT
APPLICANT NAME: ~ r,~ i~-~
DATE REVIEWED: tt 'q/01
.DATE SUBMITTED: It .2. /01
SCTM# DISTRICT: 1,000 SECTION:
STREET: /2~". 5m/r~
PROJECT DESCRIPTION:
BLOCK: .7/ LOT:
CITY: ~'c~/~_ SUBDIV. NAME:
FAST TRACK?
SINGLE & SEPARATE CERTIFICATION,REQUIRED? AFO NOTES: ~
LOTS 40,000SF -100-24. Lot recognition.(CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN. 1997 100-25. Merger.(A nonconforming at any time after 7/1/8~
ZONING DISTRICT: ,~'- qo CONFORMING? /'
REQ. LOT SIZE:
REQ. FRONT
REQ. REAR.
WATER FRONT?
PANEL #:
ACT. LOT SIZE:__ REQ. LOT COV. ACT. LOT COV.
PROP. FRONT REQ SIDE ACT. SIDE
PROP. REAR
DESCRIPTION:
FLOOD ZONE: ,X' .
AGENCY PERMITS REQUIRED FOR REVIEW
.APPll-O-V,,ALS REQUIRED:
SUFFOLK COUNTY HEALTH DEPT: YES o N0~.~, ED #): DTE:__ __ __
NEW YORK STATE DEC: Plm~)ec ~a/Ts YES orl~ )
$OUTHOLD TOWN TRUSTEES: YES
TOWN ZONING BOARD APPROVAL: YES
· OWN L .
TOWN HISTORICAL PRE (SPLIA): YES
NYS ENERGY: YES OR NO : ,.-.-L
EGRESS (18 H min.? 4 sq total) _~.~ VENT (SQ. FT. x 4%)
BUll.DING PERMITS OPEN/EXPIRED: BP'~/~'~
HAVE PRE CO'S: Y OR N BP t~,nboq
NOTES-: q 6~-~
/ /"/~PERMIT #:R1 O-
-Z / C/0 Z- 66iq
-Z / C/0 Z- qtq ~
- /e/o Z-- 'f092
LIGHT (SQ. FT. x 8%) _.~'_
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR : .(. 7.2:7 SF
SECOND FLR: SF INIT
TOTAL: SF FEE
e,D,&B. IO
SF)- ( ~'2:~ SF)= ~99 SF X $ .c.~O =$ +$ [ ~-O
OTHER
FEE
+$ = $
TOTAL
FEE
q 5.10
INSPECTION
~~OUNDATION~ 2ND ' [ ~SULATION
~RAMING '"~ []FINAL
R EM"-~ ] ['RR~AC~H ' M~ ~
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[[ ] .~~,,~ FRAMiDNA~ION 2ND [[ ]]IF~NSAULLATION
FIREPLACE & CHIM~NEY _
765-180;2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] ROUGH PLBG.
[ ~/1NSULATION
[ ] FRAMING
[ ] FINAL
REMARKS:
[ ] FIREPLACE & CHIMNEY
~~/~:~ ~..
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [~
FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:~
DA'I;E ~ ~_~~/~ 2._.. INSPEL'~I'OR ~/,~h
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
RE:MARKS: .~-~//.~P ~*~__
[ ] ROUGH PLBG.
[ ] IN/SUL~0N
[ ,/~INAL
DATE r*~/o~//0~'~ INSPECTOR /~ ~~Z~
rr~ 'r~sp~c¥~os. ~PORT '-
~ &
· PLUH~ING
CODE-
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: 765-1802
Approved [I [ [ & ,20 O {
Disapproved aJc
PERMIT NO.
BUILDING PERMIT APPLICATION' CHECKLIST
Do you have or need the following, before applying ?
Board of Health
3 sets of Building Plans /
Survey.
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
Phone:
Building lv, spemvr
APPLICATION FOR BUrl,DING PERMIT
INSTRUCTIONS
Date ,20
, 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
Buitdmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Reguiatiqns, for the construction of buildings, additions,, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all apphcable 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 con/ractor, electrician, plumber or builder
Name of owner of premises
(as on the tax roll or latest deed)
o,
(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:
/~g'T- 6",'~t/z-6· ,E¢9.
House Number Street Hamlet
CountyTax Map No. 1000 Section
Subdivision
(Name)
Block ),r
Filed Map No.
2. State existing use and occupancy of premises and intended use and occupancy of proposed constru~ion: '
a. Existing use and oCCUpancy PZ'! rd,4 7-£ fl~.rtt>~.oC£
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
Repair ~ Removal Demolition Other Work
Estimated Cost /o~/ooo. t~o Fee
If dwelling, number of dwelling units
If garage, number of cars 2~c-~-,.4eat~
(Description)
(to be paid on filing this application)
Number of dwelling units on each floor /
If business, commercial or mixed occupancy, specify nature and extent of each
Dnnens~ons of ex~stmg structures, ff any: Front. ~ y' /o -. Rear &,/
Height__________Number of Stories_____ _/__ --.
Dimensions of same structure with alterations or additions: Front J',~-l"
Depth £~*ti · Height J',.~.-~- Number of
8. Dimensions of entire new construction: Front Rear
Height Number of Stories
Depth
9. Size of lot: Front Rear Depth
10. Date of Purchase ffi~ q? 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:
13. Will lot be re-graded
!4. Names of Owner of premises
fl~?,4/~ o,v~p- Will excess fill be removed fi:om premises:
Add-ess *~tq ~-~- Phone No.
N~e of~c~tect ~ ~ Ad,ess
N~e ofCon~a~or ~t~/~ Address
,~.~_,.,.~. ~3~ rhone ~o.
15. Is ~s prop~ Mthln 100 fe~ of a fidfl wetl~d? *~S NO
· W ~S, SO--OLD TO~ TRUSTEES PE~S ~Y BE ~Q~D
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:
COLrNTY OF Stt~ecl~)
ffo/..c~,~o ,46,q,,,/~j being duly sworn, deposes and says that (s)he is the applicant
(Name of individual siLmlng contract) above named,
(S)He is the
(Contractor, Agent, Corporate Officer, etc.)
Sworn to before me this
~ ! day of /~) 0_~, ' 20 Of
Nj{ary Public
Notary Pub~lo, ~tale of New YOlt
r;o. 01MA6020279
Quatli'Isd In Suffolk County
Con'anl~on Expl~e~ ~,-1-200~
~ ignature °f ApPlicant
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 maimer set forth in the application filed therewith.