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HomeMy WebLinkAbout26818-ZFORM NO. 4 TOM OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29387 Date: 04/24/03 THIS CERTIFIES that the building ADDITION Location of Property: 1355 KENNYS RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 59 Block 7 Lot 18 Su]0division Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 26, 2000 pursuant to which Building Permit No. 26818-Z dated OCTOBER 4, 2000 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 ADDITION WITH REAR STOOP TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to PAMELA A ALLEN of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF H]L%LTH APPROVAL ELBC~IaICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'£~U3 Rev. 1/81 N/A H 074406 02/15/02 N/A Authorized Signat~e -- FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMI? (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26818 Z Date OCTOBER 4, 2000 Permission is hereby granted to: PAMELA A ALLEN 1355 KENNEYS ROAD SOUTHOLD~NY 11971 for : CONSTRUCTION OF AN ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 1355 County Tax Map No. 473889 Section 059 pursuant to application dated JULY Building Inspector. KENNYS RD SOUTHOLD Block 0007 Lot No. 018 26~ 2000 and approved by the Fee $ 75.00 Authori~Z'ed Signature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCC[ 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 syste~n 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: Old or Pre-existing Building: Location of Property: [ "~ ~'5 ' House No. ['~. f3 F)Det~ {Sd. Owner or Owners of Property: ?F~ tY/~L/3 ~2} LL ~ KJ Suffolk County Tax Map No 1000, Section 5c~ Subdivision Permit No2~/~8 ~ g ' Health Dept. Approval: Date of Permit. rE>--q -L~ (check one) Hamlet Block'-~2~ Filed Map. Applicant: Underwriters Approval: Lot Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~'.ff'~' Final Certificate: (check one) Appli~q~g~ature BUILDING PERMIT REVIEW CHECK LIST Applicant/ ~. } lO.,v,. ,.{9~1C.t_ Owners Name: Architect/ Engineer: '[,x). ~ SCTM #: District: 1,000 Section: ~---e~ Block: "7 Date Reviewed: Date Submitted: Project Sx~ Subdivision Location: _! 3 ~ ~7 ~'~ , Name: Single & separate Required ~- certffication: .(Yes / No) {Fronl yard ~ ProposedY'-/ ~ [Side Yard~.~ Proposed: / ~ [Re.ar Yard _~.~ Proposed: ~ 70 ] Project Description: t~ · · AGENCY PERMITS REOUIRED FOR REVIEW jN.A. Suffolk County Health Dept. New York State D.E.C. Town Trustees 7j -- Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flbod Zone: Permit NO YES Number Notes: 765-1802 BUILDING DEPT. INSPECTION [~//FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~~, BUILDING DEPT. !NSPECTION [ F~~OUNDATION 1ST f~ [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: 765-1802 BUILDING DEPT. INSPECTION [~"] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMA~' DATE INSPECTOR ~__~z~' '~'~'~/ 765-1802 BUILDING DEPT. I SPECTION .] F/QI:JNDATION/ 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY/~-~ REMARKS: ~ - 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] F/OUNDATION 2ND [ ] INSULATION ./ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY ,DATE ~/~/~// / / INSPECT(] 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ . ]~~41~LBG, [/-..~F1NSULATION [ ] FO/UNDATION 2ND //~[ /.~}/F~MING [ ] FINAL [ ] FIREP~AC~HIMNE/Y.~ REMARKS. INSPECTION [ ] FOUNDATION I ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND I ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROU~J.B~. [ ] FOUNDATION 2ND [ ] ~,OLATION [ ] FRAMING [~]/FINAL [ ] FIREPLACE &~CHIMNEY REMARKS: ~ DATE~~/~/ INSPECT~ 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH~P~.BG, [ ] FOUNDATION2ND [ ] I~ULATION [ ] FRAMING ~ ~FINAL [ ] FIREPLACE & CHIMNEY . FINAL ADDITIONAL COMHENTS: BLDG. D EP'r, ~ ~ TOWN OF ~OUTHOLD · FORM NO. TO~N OF SOUTHOLD BUILDING DEPARTMENT TONN HALL SOUTHOLD, N.Y. ll971 TEL: 765-1802 Pettai t N0 ................. Disapproved a/c .................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 3 SETS OF PLANS .... : .......... SURVEY ........................ CHECK ......................... SEPTIC FORH ................... DEC ........................... TRUSTEES ...................... NOTIFY: CALL .7~.~:~-d~?. ...... FLAIL TO: ................... Date ................ ,20 .... a. 'Ibis application must be c~upletely filled in by typewriter or in i~k and sul~nitted to the Building Inspector 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of b~ildings on premises, relationship to adjoining pr~ulses or public streets or areas, and giving a detailed description of layout of property u~st be drm~n on the di~gran ~hich is part of this applicatioa. c. 3he work covered by this application may not be ccrmnenced before is~ance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Sud~ permit shall be kept on the premises available for inspection throughout the work. e. No l~ilding ~hall be occupied or used in ~t~ole or in part for amy purpose ~daatever until a Certificate of Occupa~y shall have been granted by the bailding Inspector. APFLICA~CI~ IS ~t ~ ro the Building Department for the issuance of a Building Pemit pursuant to the Building Zoce Ordinance of the To~n of Southaid, Suffolk County, New York, and other applicable L~s, Ordinances or Regulations, for the construction of buildings, addition~ or alterations, or for re,oval or demolitic~n, as herein &scribed. lhe applicant agrees to ~,-ply with all applicable laus, ordinances, building code, honking code, and (Signature of applicant, or na~, if a corporation) ..... ..... (Mailing address of app~ant) State ~betber applicant is o. mer, lessee, agent, architect, engineer, general c~trsctor, electrician, plumber or Imild{ Nane of owner pr~mises ..~..~. ....................................................................................... (as on the tax roll or latest deed) If 'aMflic~t is a corporation, signatm-e of d~ly authorized officer. and title of corporate officer) Builders License No ..... Pl~nbers License No ............. Electriciams License No ...................... OCher Trade's License No ..................... ..... .0..~......~.~ .... .o.r ..~..~...%~_ o. ow~_ ~ House N~ber Street ~let £1on .... ..... Blo ................ ..... [ ........ S~livision ...................................... Piled ~p ~ ................ ~t ............. . . (~) 3. P.~tn[e. of ~rk (check ~hid~ applicable): Ne~ Building .......... Addition ... teration .......... Repair ............ l~aval ............. Demolition ............ Other Work (Descr]ption) 4. Esti~mted tost ......................... fee .............................................. (to be paid on filing this spplicatloo) 5. If ck~elllng, ,t~er of ~lling mits ............ tl~ber of ck~elling mits tya escb floor ................ If garage, mmber of Cars ...................................... 6. If business, cu,,ernial or mlz~d occupancy, specify nature and extent of each type of use ...................... ?. Dinenaions of existing structures, if any: Fro~t ................ P~ar ............... Depth ................. lielght ......................... ]xlm~er of Stories ...................... Dimensions of s~me structure with alterations or additions: Front ............... Rear ............... Depth .................... Beight .................... limber of Stories ............... 8. Di~rensioos of entire ee~ c~mstn~ction: l~x~t ................ Rear ............... Depth .............. [leight ......................... N~ber of Stories ..................... 9. Size of lot: I~x~t .................... Rear .................... Depth .................... I0. Date of Putrdmse ..................... Nam of Former O~r ........................................ I I. Zone or use district in ~aich V~,,iees am si~mted .............................................................. 12. Dces proposed constroctlon violste any zoning lma, ordinance or regulation: ........................ 13. Will lot be r,~graded .................... Will exness fill be removed ~ron premises: YES NO I/~. N~r~s of O~er of vf~dees ........................... ,~]dress .............................. l~one No ..... '.: ...... ~ of Ard~itect .................................... A~dress .............................. ~ I~o ............. ~ of Co~tr~ctor ................................... A~dress ............................... P~ ~ ............. ../.. 15. Is this property within 300 feet of a tidal wetland? * ~ .......... NO ......... · IF YBS, SCUTFf~D ~ Tl~i.~,q ~ ~ BE lqEC~tt~O. PLOT DIAGRAH l~cate clearly and distinctly all buildings, ~bether existing or proposed, and indicate all set-back dlmsnsions hmm p,operty lines. Gix~ street and block nu~ber or description according to deed, and ~ street r~es and indicate uhether interior or corner lot. ........ ~-~-.~..~ ........................ I~ing duly (Name of individual signing contract) s~orn, clepase~ and says tlmt he ~,q the ~ppl. ic~.t lie is the ................................................................................................... (Contractor, sgent, corparste officer, etc.) of said c~mer or c~ers, and i$ ~ly ~thorlv~ t~ ~rfom or h~ ~rfo~ fl~ mid m~ md to m~ a~ file this a~licati~; that all stat~ts c~ta{~ in ~is ~llcati~ are t~ to ~e ~st of his ~1~ a~ ~liefl a~ that the ~rk will ~ ~r[o~ i. tbe m~r mt forth in ~e a~limtim fild t~. ~m to ~fo~ m .... - .. ~O~STffi~.S~lk~_~ (Si~mre of A~lic~t) × 3 -© Ill II · 1 II