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Home My WebLink About29885-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29882 Date: 12/04/03 · ~{IS C~TIFIBS that the building Location of Property: 505 RUCN LA (HOUSE NO.) County Tax Map No. 473889 Section 52 ADDITION GREENPORT (STREET) (HAMLET) Block 3 Lot 4 Su~ivision Filed Map NO. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 17, 2003 p%krsua~mt to which Building Pe~rait No. 29885-Z dated NOVEMBER 21, 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" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. ENGINEER CERTIFIED CONSTRUCTION OF FOOTINGS. The certificate is issued to ANN DOBSON CLEMENTS (OWNER) of the aforesaid building. SUFFOLK CO~IN~YDEPAR~ENT OF~{EAL~{~_PPROV~%L EI~EC'~RICAL CERTIFICATE NO. PLIN~BERS CERTIFICATION DA'r~3 Rev. 1/81 N/A N/A N/A - ~uthorized ~nature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southotd, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29885 Z Date NOVEMBER 21, 2003 Permission is hereby granted to: for : DOBSON CLEMENTS 345 WEST 13TH ST #3A NEW YORK,NY 10014 AS BUILT DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. ADDITIONAL CERTIFICATION WILL BE REQUIRED. at premises located at 505 RUCH LA County Tax Map No. 473889 Section 052 pursuant to application dated NOVEMBER Building Inspector to expire on MAY Fee $ 300.00 GREENPORT Block 0003 Lot No. 004 17, 2003 and approYed by the 21, 2005. COPY Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~ HALL 765-1802 · .3 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled iu by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final sup.,ey of property with accurate location of all buildings, property lines, streets, and unusual oatural 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 Uuderwriters. 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 dud similar buildings and installations, a certificate of Code Compliauce from architect or engineer responsible for the building. 6. Submit Plmmiug 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: l. 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. [fa Certificate of Occupancy is denied, the Building Inspector shall state the reasous therefor io writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinmaing pool $25.00, Accessory. building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupaucy on Pre-existiug 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 Constructioo: Old or Pre-existing Building: L~ (check one) Locationo Prope.y: 'OS- House No. Street OwnerorOwuersofProperty: A~,t,n,- "~. Cteqs,~.~5 Suffolk County Tax Map So l000, Section q-/3 q ¥ ock 600 Subdivision &~'S~&~O tApewOrm7__ C-,e~t~L~..~'~ Filed Map. Pemfit No. DatYof Permit. ~} Applicant: Hamlet Ooq Lot: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request tbr: Temporary Certificate Fee Submitted: $ ~ ~""~"~ Final Certificate: (check one) Applicant Signature PROFESSIONAL ENGINEER 1725 HOBART ROAD I PO Box 616, SOUTHOLD, NEW YORK 11971 TEL631-?65-2954 , FAX631-614-3516 · e-maik joseph@tischetti.com Date: Reference: November 18, 2003 505 Ruch Lane / Clements Southold Building Department Main Road Southold, NY 11971 Dear Sir, The footings for the existing deck at the above referenced home have been inspected and are installed in accordance with the previously submitted plans. If you have any questions regarding this matter, please do not hesitate to call. 'o ?M#~584, ?ILED APF:'IL LOT S 46'09'00"E ~.~N~C[ C,F FC~C~ LOT 14 FD CM 24.0-- ONE STORY RESIDENC£ FIFST FL EL=24.29 N 46'09'00"W ? 00.00' D..f# 1000-052-03 004 SURVEY OF D~SCR/SED PP, OPE~,TY SITUATE ARSHAMOMOOU£, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. su~.,E¥cc.. 04 ~U'~E 2'2'r~1 ,ZUARANTEED TO aNN CLEMENTS FIDELITY NATIONAL TITLE iNS. CO. 92ALE I'~- 20' SURVEYED FOR: ANN CLEMENTS 0.~44 'a,2h6S I. 21 OCT 05 SHOW wOOD DECK TO~2N OF gOUTHOLD BUILD.lNG I>EPARTMENT T OV~N HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ~-n'. northfork.net/Southold/ Examined Approved Disapproved ac Expiration PER3IIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the tbllowing, betbre applying'? Board of Health 3 sets of Building Plans Planning Board approval Check /.. Septic Form N.Y.S.D.E.C. Trustees It ~ . 20 ~ Contact: ti /"bi ,20 ~ . Mailto: ¢( ,20~~~~ Phone: ~'~ B~ldin~e$tor APPLICATION FOR BUILDING PER31IT '[ '~3 ~ Date ,20 ' l INSTRUCTIONS a. This.a~ppliCa*ion'MlJST e completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets oClS[fi~-s~-'~-ccurate plot plan to scale· Fee according to schedule· b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining prenfises 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 the Building Inspector issues a Certificate of Occupancy. f. Evers' building permit shall expire if the xvork authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 motors from such date. If no zoning amendments or other regulations affecting thc 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 pm'nut shall be required· APPLICATION IS HEREBY MADE to the Building Departmeut for the issuance ora Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk Counw, New York, and other applicable Laws, Ordinances or Regulations, tbr the construction of buildings, additions, or alterations or tbr 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· ~,,w,*,,-~'"~v (Signature of applica~ation) 3 q .0./3 P3/+ x/CC (Mailing address of ap!Mican0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises A~YX '~)~2~,~Ot~''- C~e~,e{A.~ (As on 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 proposed work will be done: House Number Street sCuO~t~.i s~ ;~ M~p, ~.o,. 1 _000 Section ame) 0 Hamlet Lot Block 03 Fil~a'M~p No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy_ b. Intended use and occupancy Repair Removal 4. Estimated 5. If dwelling, number of dwelling units If garage, number of cars / Nature of work (check which applicable): New Building. Demolition Addition V/'t~d/~Alteration Other Work Fee ~30~) ($/,~"'~} I(~"3 (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 ~./' Rear ~3,/tt Depth Height Number of Stories I. ~' Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Rear 9. Sizeoflot: Front 10. Date of Purchase Dimensions of entire new construction: Front Height Number of Stories Rear Depth t/~,..) t Rear /O"D t Depth /~"-0 ' ~--,.,~ t/ Name of Former Owner flOl~ I 1. Zone or use dis~ct in which praises ~e simat~ ~ ~ /~ 12. Does proposed construction violate any zoning laxv, ordinance or radiation? ~S~ NO ~ l 3. Will lot be re-~ad~? YES~ NO ~ Will excess fill be r~oved ~om praises? ~S_ NO ~ 14. Names ofOwnerofpremises~ddress~ ~ Phone No.~~ Name of Architect Address ' ' Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * 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. No X. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at I 0 feet or below, must provide topographical data on survey. STATE OF NEW YORK) COUNTY OF~J~ ~/~--~5S: t~/q ~. ~/e ~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (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 this application; that all statements contained in this application are tree 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 ~re me this /Il l ."7 da3' of /~/~).,C-/' 20~ ~ - Nota~' Public X.f Claire L. Glew Notary Public, 8tara of New No. 01GL4879505 Oualified in Suffolk County Commission Expires Dso, Signature of Applictml~ / I E.X~ST. Tg'E~ UI, JDERWt~ITERS CERTIFICAII: NOTIFY BUlL 765-180~> 8 ~ FOLLOWING INL', 5,EPART~EN'[ kT t TO 4Pf~ FOR THE ISPECTtONS: 4. FO:JNOAT:', N - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4, Fl~. - CONST~UCTm MUS~ ~ C~PLETE FOR C.O. Yo.K STAT~..OT R~SPO"S~aL~ FOR DES~N OR CN~RUCTION ERRORS. ALL MEET THE OF THE i STATE. WITH USE CE.R] 'ANCY COMPLY WITH/ALL CODES OF ~,~T,,',,, ',r /,cnr he,-,, 0 COr,,;~ETE FO,3, ',C, ; DEE~ / / ~~OA% ' - ~'eCHETTI, PE 1725 HOBART R SOUTHOLD, N~ 11971 631-765-29~