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Home My WebLink About27620-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-29517 Date: 06/13/03 THIS C~RTIFIES that the building ADDITIONS & ALTERATIONS Location of Property: 1125 MASON DR (HOUSE NO.} (STREET} (HAMLET) County Tax Map No. 473889 Section 104 Block 5 Lot 35 CUTCHOGUE S~ivision Filed ~{ap No. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 2001 pursuant to which Building per~uit No. 27620-Z dated SEPTEMBER 4, 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 SLrNROOM ADDITION, ADDITION AND ALTERATIONS TO kN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to LEDA C BRUNDAGE ( OWNER ) of the aforesaid building. SUFFOLK COU1FrY DEPARTMENT OF HEALTH A~PRO%r~J~ EL~C'fRICAL CERTIFICATE NO. PLL~4BERS CERTIFICATION DA'i'm N/A PENDING 03/28/03 06/03/03 HENRy SMITH +/o~gnat ure 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. 27620 Z Date SEPTEMBER 4, 2001 Permission is hereby granted to: LEDA C BRUNDAGE 122 WILLOW STREET GARDEN CITY,NY 11530 for : ALTERATIONS AND ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 1125 County Tax Map No. 473889 Section 104 pursuant to application dated JUNE Building Inspector. MASON DR CUTCHOGUE Block 0005 Lot No. 035 22, 2001 and approved by the Fee $ 150.00 Authori~'d Sign~ure ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCU~AN~ This application must be filled in by typewriter or ink and submitted to the Building Department with the follow~l~: 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 sinfilar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6~ Submit Plmming Board Approval of completed site plan requirements. Bo 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 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, Swimrmng 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. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: ~, ~- House No. Owner or Owners of Property: L Suffolk County Tax Map No 1000, Section Subdivision Old or Pre-existing Building: Street Permit No. o~-/~ ~ 0-:1~_. Date of Permit.. ~- ~ -~ ~O [ Health Dept. Approval: Planning Board Approval: Request for: Tempora~ Certificate Fee Submitted: $ ~. ~, 00 Date. 3'"vc~e ;~ t 0 003 (check one) Hamlet Block "~ Lot~ FiledMap. ~"/3~__Lot:~ ~ Applicant:~ ~C~d~ % Unde~riters Approval: Final Certificate: / (check one) Applicant Signature Town Hall, 53095 Main Road P O, Box 1179 SouIhold, New York 11971 Fax {516) 765 1823 Telephone(516) 765 !8C2 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION DATE: Building Permit No. Owner: ~ECF4 (please print) Plumber: [-~ ~,~%,~-~4 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ( P 1 um~fer s~S ignatu r e ) Sworn to before me this day of ~/~7, ~ , Notary -Public, ~ ~~ County ~ pu~iC, Stme o{ New y~k BUILDING PERMIT EXAMINER CHECK LIST APPLtCANTNAM : ,L SCTM# DISTRICT: 1..,000 SECTION: [Of BLOCK: ,.~ LOT: ~ ~CmECT / ENG~ER:~OE'O/ S~G~ & SEP~TE CERT~ICATION-~Q~D? /~O NOTES: DATE REVIEWED: ~' ///01 .DATE SUBMH~ED: 6' /2.~/01 SUBDIV. NAME: FASTTRACK? ~/~ LOTS 40,000SF -100-24. Lot recognition.(CREATED before June 30, 1983), UNDERSIZED LOTS FROM JAN.1997 100-25. Merger.(A nonconforming at any ti/ne after 7/1/83) ZONING DISTRICT: /~- ~ CONFORMING? ~,/o 16o* REQ. LOT COV. ACT. LOT COY, ACT. REQ. LOT SIZE: P~r" ° 0 KEQ. FRONT _~- WATERFRONT? PANEL SIZE /2,9a~ ACT. LOT : PROP. FRONT&-~--,~ REQ StOE PROP. REAR --" .7 ~ DESCRIPTION: FLOOD ZONE: X /, AGENCY PERMITS REQUIRED FOR REVIEW APPR, tZyALS REQUIRED: SUFFOLK COUNTY HEALTH DEPT: YES o~_,)(BED #): DTE: / / PERMIT #:RI 0- NEW YORK STATE DEC: FRe-~c 9a/~s YES or~ SOUTHOLD TOWN TRUSTEES: YES TOWN ZONING BOARD APPROVAL: YES or{~ TOWN PLAN. BOARD APPROVAL: YES o~ ms m Ro¥: YEs ORNO: EGRESS (18 H min.? 4 sq total) VENT (SQ. FT. x 4%)_~ .LIGHT (SQ. FT. x 8%) BUmDtNG ?ERMrrs OPENmXPmED: BPo"-S HAVE PRE CO'S: Y OR N BP -Z / C/0 Z- NOTES': FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR : ~fi ~ SF SECOND FLR: SF INIT OTHER TOTAL: SF FEE FEE TOTAL FEE aT(~q sF)-( ~ SF)= r-- SFX$ .~-$ ~+$ /f',~ +$ =$ IfC STATE OF NEW YORK ) ) SS: COUNTY OF SUFFOLK ) /, -~ .~./¢,~-~r~. ~:~,..~/'~(~ , being duly sworn, deposes and says: That deponent is over the age of 18 years and resides at ¢2 That on the ~ [~ay of ~¢ ~, , 2001 deponent architecCengineer, licensed by the State of New York, hereby states that s/he accepts full responsibility for the accompanying plans compliance with the New York State Fire Prevention and Building Code (9 NYCRR); said plans peAain to properly ~located at SCTM~ 1000- street address ~'hit ff~eer .S/worn to bef0.re me this ~',~ day of/~/~y,~/,,g~.~'/--, 2001. No{aw P~lic ' .... ['~ / N~afial Seal Ma~ Ann Landis, Notary Public Q~ke~own Boro, Bucks County CC: Applicant My Commission Expires Nov 1, 2001 765-1802 BUILDING DEPT. INSPECTION ~]/~NDATION 15T [ ] ROUGH PLBG. ~ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY Ri.MARKS: 765-~.802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] INSULATION [ ] FIREPLA~.~& CHIMNEY REMARKS:'-~-' /~,~/~ :-//-~_~,~ DATE INSPECTOR 76S-1802 BUIi~DING DEPT. I N [ ] FOUNDATION 1ST [~. [ ] FO/~I~ATION 2ND [ ] INSULATION i ](/~FF i RRAE~NAGcE &/~H iMNEY[ ] FINAL REMARKS: ~ DATE INSPECTOR 765.t802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. ]~)UNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: /~ /~/~ DATE ~//~~ ~ INSPECTOR~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ -/]/ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [/]/FRAMING [ ] FINAL [ ] FIREP~ACE&~IINEY/ REMARKS. ~ DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [[ ]] :OR~UNMiDNA~ION 2ND [[ ] IF~iNALLATION FIREPLACE & CHIMNE~.,~.,~ R~IV~ARKS: ~ .~ / /- DATE INSPECTOR 765-1802 BUILDING DEPT, INSPECTION [ I FOUNDATION 1ST [ LBG. [ ] FOUNDATION2ND [~/] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REI~ARKS: ~.~ ,,,_/ .-- DATE BUILDING DEPT. INSPECTI?N- FOUNDATION 1ST [P~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATIONlST [ ] FOUNDATION 2ND [ ] FRAMING [ ~O~GH PLBG. [//] INSULATION [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE~NSPECTOR FIELD INSPECTION REPORT FOUNDATION (IST) (2ND) ROU~E FP, AI~ & PLUI'IBING n~II~TION PER N. Y. STATE ENERGY CODE Fn,IAL COI. fl~IiTS IFmLD INSPECTION REPORT FOUNDATION (1ST) FOUNDATION (2ND) ROUGIt Fl. C42¢IING & PLU1VI_BIN G INSUq-.,ATION PER N. Y. STATI~ E_NFERG'k' CODE D.4.TE COMlVlIilN~ FINAl, IUW]~ U__e ~UU IJ~EUII,IJ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Ex~,-i-~d . _~_. /-~ ,20 ~),/ Approwd ~. /~ ,20 0 / Disapproved a/c BUILL)LNO k'glCMIT AI~LICATION CHECKLIST Do you have or ne~d the following, before applying ? Board of H~alth % 3 sets of Buildint Plans 'X,qSurvey Septio Form N.Y.$.D.I~.C. Trustees Contact: Building In~ector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,2001 a. This apphcation 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 th/s apphcation 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 Impector. APPLICATION IS HEREBY MADE to the Building Depmtment for the issmmce of a Building Permit pur~,,nt 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, ordi,,,-ees, building code, housing code, and regulations, and to ~utmlt authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or n~lme, ff a cmporalion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eleclri¢ian, plumber or builder Name of owner of premises ~ (as Un 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 prop, osed work will be done: House Number Street County Tax Map No. 1000 Section lot-{ Block ~" Subdivision Filed Map No. C~ame) Lot State existing use and occupancy ;fpremises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ;. Nature of work (cheek which applicable): New Building Repair . Removal Demolition L Estimated'Cost '~ ~'01 0 00 Fee i. If dwelling, number of dwelling units If garage, number of cars Addition Other Work Alteration (Description) (to be paid on filing this application) Number of dwelling units on each floor [ L If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front ~ (a~ ' Rear Height ~, Number of Stories__6 Dimensions of same structure with alterations or additions: Front Depth 3G~T Rear Dimensions of entire new construction: Front - Height ~ Number of Stories Size of lot: Front "7~(-'~ Rear Number of Stodes ~ 5~1 Rear Ilt'*q" Depth ~-'~' ~' 10. DateofPurchase ~{ qq NameofFormerOwner ~)Ol~Jt~e s ~$ ~C~'tJ~cA~/L~fl'~ 5 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: N'O 13. Will lot be re-graded 14. Names of Owner of premises I Name of Architect Name of Contractor 15. Is this property within I00 feet of a tidal wetland? *YES · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS QUIRED Will excess fill be removed from premises: Address ~ e4~. t~ ttc-~ Phone No. Address 565~,~rncr~' fr~a Phone No __ Address ~._. ~._ %.~ ~.~.~:!_Phone No. 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. gTATE OF NEW YORK) SS: 30UNTY OF ) [.~/q' ['2~MD~_. being duly sworn, deposes and says that (s)he is the applicant (Name of individual stg%ing contract) above named, ~S)He is the (Contractor, Agent, Corporate Officer, etc.) >f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; :hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be ~efformed in the manner set forth in the application filed therewith. Sworn to before me this ,/~ dayof ~ t/.~.4 200( '~ ' ~,lota~ Publid- uNDAJ coOPL~ ~,_..~ No. ?em~ ~ir~ ~r 31, '~