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Home My WebLink About29896-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29880 Date: 12/03/03 T~IS CERTIFIES that the building ALTERATION Location of Property: 1805 PARK WAY SOUTMOLD (HOUSE NO.) (STREET) (HAMLET) County Tax ~lap No. 473889 Section 70 Block 11 Lot 21 Sulxlivision Filed Map No. -- Lot NO. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 3, 2003 pursuant to which Building pez~nit NO. 29896-Z dated DECEMBER 3, 2003 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 "AS BUILT" INSTALL~kTION OF CENTRAL AIR CONDITIONING IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT & VIRGINIA LUDWIG (OWNER) of the aforesaid building. SUFFOLK COUNTer DEPARTMENT OF I~L~_LT~ ~_PPROVAL ELECTRICAL CERTIFICATE NO. PLI~BERS CERTIFICATION Di~l'~o Rev. 1/81 N/A 1178071 11/14/03 N/A 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. 29896 Z Date DECEMBER 3, 2003 Permission is hereby granted to: ROBERT & VIRGINIA LUDWIG 125 BEACBWOOD LANE SOUTHOLD,NY 11971 for : "AS BUILT" INSTALLATION OF CENTRAL AIR CONDITIONING IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. at premises located at 1805 PARK WAY SOUTHOLD County Tax Map No. 473889 Section 070 Block 0011 Lot No. 021 pursuant to application dated DECEMBER 3, 2003 and approved by the Building Inspector to expire on JUNE 3, 2005/~ Fee S 150.00 .~ ~.~ !1 I_ * ~ fCAut~or~ ze Si~q~a~ure ORIGINAL Rev. 5/8/02 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 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. 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. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pooi $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 k~ Old or Pre-existing Building: House No. Street ~a New Construction: Location of Property: Owner or Owners of Property: ~-x.A ~,,.x.,,5~\ (~.~ Suffolk County Tax Map No 1000, Section "q~ (check one) Hamlet Block Lot ~' I Subdivision Permit No. ~c~ Health Dept. Approval: Filed Map. Date of Permit. I ~'~-~-K3~ Applicant: Underwriters Approval: Lot: Planning Board Approval: Request for: Temporary Certificate __ Fee Submitted: $ ~ ''~ . C5 ~ Final Certificate: ~ (check one) Applicant Signature BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORk BOARD Of FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON StReet - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by ROBERT LUDWIG 125 BEACHWOOD LN SOUTHOLD NY 11971 ROBERT LUDWIG 125 BEACHWOOD LN SOUTHOLD, NY 11971 Located at 125 BEACHWOOD LN SOUTHOLD, NY 11971 Application Number: 1178071 Certificate Number: 1178071 Section: Block: Lot: Building Permit: BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, Outside, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found to be in compliance therewith on the 14th Name QTY Rate Appliances and Accessories Air Conditioner 1 0 Wiring and Devices Disconnect 1 0 Day of November, 2003. Rating Circuit Type 24.000 BTU 30 amp Appliance A visual inspection, of the delineated electrical installation, determined that an obvious hazard is not present end the installation is believed to be in comformence with the applicable reference standard for the estimated period of construction of the premises wiring system. sea; 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined ,20___ Approved ,20___ Disapproved aJc Expiration ,20__ PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Plarming Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date 20 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 Pemfit 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 may purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not conunenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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, ifa corporation) (Mailing address ofapplican0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~)/'~']ZT ~4-~l~l/t//~ ~.~{x./{C (As on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders LicenseNo. Plumbers License No. Electricians License No. Other Trade'sLicenseNo. / Location of ,ant~(~o~non which pr~p s~edt4w~o?~4wfll be don~: House Number Street Hamlet County Tax Map No. 1000 Section Subdivision (Name) Block [ [ Filed Map No. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intendeduseand occupancy Nature of work (check which applicable): New Building_ Repair Removal Demolition Estimated Cost ,,~"-O2P ~ ~ ~ OO If dwelling, number of dwelling units If garage, number of cars Fee Addition /'~-~ Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Rear _Depth Dimensions of same structure with alterations or additions: Front Depth. Height_ Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories 9. Size of lot: Front Rear Rear .Depth 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? YES NO__ 13. Will lot be re-graded? YES__ NO__Will excess fill be removed from premises? YES NO 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES __ NO__ * IF YES, D.E.C. 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) COUNTY OF~S: ~/~ ~-~W'3~ '-[, L-~ d o3'~ o being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing(~ontract) above named, (S~s the_ ~/~ tL~ [q_~ g'~ (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 tiffs 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 before me this '2.- day of ~tq'e~.k.~-' 20~._~ Lorraine LaRosa NOTARY PUBLIC, State of ~ No. 01LA6059;~57 Qualified In Buffolk County Commission Expire~ May 2g. 20~_...~ - 'gnature of Applicant/