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Home My WebLink About27471-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29526 Date: 06/17/03 THIS CERTIFIES that the building ADDITION Location of Property: 440 GRANGE RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) Couxlty Tax Map No. 473889 Section 78 Block 1 Lot 1 Su]~division Filed ~{ap No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated MAy 24, 2001 pursuant to which Building Pe~nlt No. 27471-Z dated JULy 11, 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 SCREENED PORCH ANDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD D & PATRICIA RICHARDS ( OWNER ) of the aforesaid building. SUFFOLK COUI~TY DEPART~4ENT OF HEALTH APPROVAL ELEC~"RICAL CERTIFICATE NO. PLUMBERS CF~qTIFICATION DA~D Rev. 1/81 N/A N/A N/A Authorized S~ature 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. 27471 Z Date JULY 11, 2001 Permission is hereby granted to: EDWARD D RICHARDS 440 GRlkNGE ROAD SOUTHOLD,NY 11971 for : NEW CONSTRUCTION OF A SCREENED PORCH ADDITION AS APPLIED FOR. at premises located at 440 County Tax Map No. 473889 Section 078 pursuant to application dated MAY Building Inspector. GRANGE RD SOUTHOLD Block 0001 Lot No. 001 24, 2001 and approved by the Fee $ 150.00 ~~Auth~ignature COPY Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department With f,he following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and mausual natural or topographic features. 2. Final Approval fi.om Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement fi.om 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 ca'tificatc of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 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. Co 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. Copy of Certificate of Occupancy - $25,00 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: Suffolk County Tax Map No 1000, Section Subdivision Pen'~tNo. ~"](-~-'] I'~ Health Dept. Approval: Planning Board Approval~ Request for: Temporary Certificate Fee Submitted: $ Old or Pre-existing Building: ~'~2'~ ~treet Date of Permit. (check one), Hamlet Filed Map. _ Lot: Underwriters Approval: Final Certificate: ~ (cheek one) Applicant Signature BUILDING PERMIT REVIEW CHECK LIST APPLICANT NAME: / tc~/~ . SCTM#--- DISTRICT: 1,000 SECTION: ~'- BLOCK: [ LOT: DATE REVIEWED: "2 /// DATE SUBMITTED: ~ / PROJECT LOCATION STREET: ARCHITECT / ENGiNEER: CITY:~ SINGLE & SEPARATE CERTWICATION-REQUIRED: YES OR ~qOTES: FAST TRACK: YES o~ ZONING: PERMIT~'~ATE AMOUNT: $ ~ ~ ~- .00 C(SNFORM1NG: REQUIRED LOT ~o~: _SQ: ZONING DISTRICT~80, AC, - Y.ESo~ SIZE: WHERE ACTUAL LOT SIZE FROM?~"6~ ACTUAL LOT SIZE: ./8'SZ°,..ff SQ REQUIRED FRONT:~.~' PROPOSED:_~ SIDE YD: /O '/~' PROPOSED:,/"t~t~'/ ~ KEAR:..,~_~ PROPOSED:~~-' LOT COVERAGE: ALLOWED:.9--O % EXISTING: sf % NEW: sf % TOTAL:/¢,t.o_sf_~ii~ CORNER? YES o~Q~ WAT ER FRONT? YES o~_.~ DESCRIPTION: 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 July 1, 1983.) PROJECT DESCRIt)TION:O~Acc oR N/D: AGENCY PERMITS REQUIRED FOR REVIEW TOWN SPETIC PERMIT: YES o~,~ SUFFOLK COUNTY HEALTH DEPT: YES {~___.~(BED #): MW YO~ STATE DE~.I'RE-DECg/1/75 YES or~ SOUTHOLD TOWN TRUSTEES: YES TOWN ZONING BOARD APPROVAL: YES o~ TOWN PLAN. BOARD APPROVAL: YES FLOOD COMPLIANCE ZONE: vR~-v~mu 3as/so PANEL #:_/~-.- DTE: / / PERMIT #:RI 0- FLOOD ZONE: '~ , NYS ENERGY: YES OR NO : EGRESS: VENT: LIGHT: NOTES: ,~g't~'. / FEE STRUCTURE: FOUNDATION: ~ SF FIRST FLOOR : .g,Z-o SF SECONrD FLR : '~ SF TOTAL: -~,2-~ SF TOT( SF)- ( .SF)= SF X $ =$ INIT OTHER TOTAL FEE FEE FEE 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING [ ]FINAL [ ] FIREPLACE.&.~CHIMNEY .~ DATE INSPE ~~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FO~LJNDATION 2ND [ FRAMING [ [ ] FIREPLACE & CHIMNEY REMARKS: ] ROUGH PLBG. ] INSULATION ] FINAL DATE INSPECTOR BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PL~ [ ] [ ] FOUNDATION 2ND [/~~ON [ ] FRAMING ~ FINAL [ ] FIREPLACE~ CHIMNF.~ ~ DAT FIELD INSPECTION R~PORT ' DATE __, ~ ~, CO~4ENTS FOUNDATION FOUNDATION ........................ ~=_-_-~=_-~=_-~--~ ........... [~=--=~--~ ....... ?~-~=--~ INSULATION PER N. Y. STA~E ENER~ CODE ADDITIONAL COI~IEI~S: BUILDING DEPARTMENT TOWN HALL $OUTHOLD, NY 11971 TEL: 765-1802 Exam/ned ~//4 ' Approved ~//Z , Disapproved age 20 ~/ 20~._)/ PERMIT NO. ', ~'~'2/~ I~UI.L,L)IiNt5 FP~F,.NIII API°LI(.iA'I'I~N C'~t. ECK.LIS Do you have or need the following, before applying ,Board of Health 3 sets of Building Plans Survey Check Seplic Form.~ Trustees Contact: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application MUST be completely filled in b~ ~ypewfiter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to sgl/edule. b. Plot plan showing location of lot and of building* ~n"premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before i~suauce of Building perrmt. d. Upon approval of this application, the Building In~ectOr will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection througho.ut'the work. e. No building shall be occupied or used in whole or ia part for any purpose what-so-ever until~a Certificate of Occupan is issued by the Building Inspector. APPLICATION IS HEREBY MADE to the Building DepaMment for the issuance cfa Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk:.Co~nty, New York, and other applicable Laws, Ordinances or Regulations, for the c'onslruction of buildings, additions, or'alterations or for removal or demolition as herein described. The applicant agrees to coi'aply with all applicable laws, ordinand?s, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nee .e~ry inspections.~ (Signature of applicant or name, ifa corporation) (l~lailing address of applicant) / State whether applicant is owner, lessee, agent, architect, ~ngineer, general contractor, electrician, plumber or builder Name ofownerofp~'emises ~t,7'.~ b: ~ 9~2/~'~)~J ./~[. (as ? the tax roll or latest deed) If applicant is a corporation, signature of duly authoriz.~d officer (Name and title of corporate officer) . . Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed wqrk will b~ do.ne:,_ , D House Number Hamlet County Tax gap No.. 1000 Section , 0~'~ 0~"' Block O/ ' 00 Subdivision ~0~9~..5'oO-~ Pl~fk~,/t-~ Filed Map No, ~ ~ (' ame) '. · . , Lot i2( 1,00o Lot 3- .. ,~,.,~ ~.~..g ,,~ ~mu v~;ugat~cy o~ premtses anct intended use and occupancy ofproposol construction: a. '~xisring use and occupancy., ~l,_ox'U ~ , '~, , b. Inteaded we and occupancy ,~ ~/kwOL Nature of work (check which applicable): New Building. Repair Removal Demolition Estimated Cost if dwelling, number of dwelling units If garage, number of cars Addition Other Work Alteration (Description) Fee 1'5'0, (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 type of use. Dimensions.of existing structures, if any: Front ~' Rear Height_~. Number of Stories Dimensions of same structure w~th alterations or add't'ons Front Depth ,tTt~ ' Height /O Number of Stodes D~mensJons of entire new construction Front ~1~ 0.,t,~ Re~ ~ O Height 10 Size of lot: Front 0. Date of Purchase Depth Rea~ Depth__ Number of Stories .~ Rear Name of Former Owner 1. Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation: 3. Wilt lot be re-graded FL~ Will excess fill be removed from premises: YES NO 4. Names of Owner ofpremis~.s ¢:za~ ~ ~(,Jt~d" Address ..9~) (rrz~ff-~ Phone No. 7(~'--~/%/'~ . . Name of Architect ~ o Address . . } Phone No '5 .. Name of Contractor "1. '~ Address "t * .Phone No. ~ t 5. Is this property within 100 feet cfa tidal wetland? *YES . . NO · I~' YES, $OUTHOLD TOWN TRUSTEES PERM/Ts MAY BE RI~QLTIRED Provide survey, to scale, with accurate foundation plan and distances to property lines. z. If elevation at any point on property is at I0 feet or below, must provide topographical data on survey. ?ATE OF NEW YORK) SS: )UNTY OF .) ('Name of indiv/dual signing contract) above named, ~He is the {~/~)~ (Contractor, Agent, Corporate Officer, etc.) said owner or owners, and is duly authorized to perform or have performcd the said work and to make and file this application; t all statements contained in this application are true to the best of his knowledge and belief; and that the work will be 'formed in the manner set forth in the application filed thcrewlth. om to before me this "~ ~ Signat~'c of Applicant LEHR DATE ~l'he sewage dlspo~ll and water, Supply, facilities l'ov thi~ location have been inspected b~; thls departu~ent and '~o be satls[aetovy. ~'<'.Chief. Of C~neral Englnee~,in~' Services · __ N, 85'~ LOT 5 555. 0° .---' " ' ',~"' REFERENCE~ ',':~,:... ' ') ",',','~.."., - ~ . ~,..~,,.~.:,.:. .~ .,, .. JUA~. '~ · ",,. . ~. '.. ', ;'.' ' . ~ r t..~, ;'.-~ ..',.:. ~ [. . OCCUPANCY OR PROVED AS NOTED DEPARTMENT AT AM TO 4 PM FOR THE INSPECTIONS: - TWO REQUIRED - FRAMING & PLUMBING CONS'rRUCTION MUS'7 SHALL MEET JIREMENTS OF THE NY. NSTRUCTION & ENERGY JOT RESPONSIBLE FOR CONSTRUCTION ERRORS