HomeMy WebLinkAbout29935-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29992 Date= 02/.03/04
THIS CERTIFIES that the building ADDITION
Location of Property. 125 BOW RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 87 Block 2 Lot 33
Subdivision Filed Nap No. Lot No.
conforms substantially to the Application for Building Permit: heretofore .
fined in this. office dated DECEMBER 11, 2003 pursuant to which
Building Permit No_ 29935-Z dated DECEMBER 11, 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 DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR & AS
PER. CERTIFICATION OF LAWRENCE M. TUTHILL, P.E. DATED 1/13/04.
The certificate is issued to ANTHONY & BARBARA F. LEWANDOWSKI
(OWNER)
of the aforesaid building.
SUFFOLK. COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
,T�.ut Zrid Signature
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)
PERIKIT`14 29,935 Z Date DECEMBER 11, 2003
Permission is hereby granted to:
ANTHONY & WF LEWANDOWSKI
PO BOX 448
SOUTHOLD,NY 11971
for
CONSTRUCT A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR. THIS PERMIT REPLACES BP#22344 .
at premises located at 125 BOW RD SOUTHOLD
County Tax Map No. 473889 Section OB7 Block 0002 Lot No. 033
pursuant to application dated DECEMBER 11, 2003 and approved by the
Building Inspector to expire on JUNE 11, 2005 .
Fee $ 150 . 00
A oozed Signature
COPY
Rev. 5/'8/02
FORMNO.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 AUTH IZED)
� X2344 Z Date .— ......... ...................... 19.
.
'i
Permission Is hereby grant to,
. N �......... .. `
..,���..........................................................
....... ..fie. ......... y.....�
to ..... 1h�5. �- U ...t ........�rL�.�/�J...... 64 . 1, /..7%.a.l? ... a
.... vxs ` ........ '- ...2../.�... :.., ,:.f .....�� s�=
. :..... 1/0 / .
............... .......
........................ /................ ................. ...
at premises located at. ....1. ... 0� ..,...................................................
.... ................................................................................
- �` .�OL ...... . .....3�..............
County Tax Map No. 1000 Section ........ Block.......................... Lot No. ............................
pursuant to application dated .... ,;,,,.,.,,............... 19..... and approved bythe
Building--Inspector.
Fee$..l.. .... .....
Irl ,
.. ......:..... ................
Building Ins pector
Rev. 6/30/80
U =mil, . ;FonnNo.6
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TOWN OF 50UTHOLD
BUILDING DEPARTMENT
TOWN[TALL
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:
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. Approvai 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.
B. For existing buildings(prior to April 95 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 tb dwelling$25.00,
Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.60,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 /
Date. Rf 1�10
New Construction: Old or Pre-existing Building: (check one) (�
Location of Property: /02 r U0c7 &q� l ,T/�ao/d
House No. Street Hamlet
Owner or Owners of Property: 80frhQYA is "kr
Suffolk County Tax Map No 1000, Section 2.7 Block Lot .3_z
Subdivision /Uk4.t4ka"9 1t)a°WC Filed Map. //_510 (l Lot: /5'
Permit No. a�q 3� Date of Permit. 1411103 Applicant: &44,V4 F te'W a"k— /,lJ 4
Health Dept. Approval: N/�} Underwriters Approval: e—R
Planning Board Approval: /U�l
Request for: Temporary Certificate Final Certificate: f (check one)
Fee Submitted: $
L/ Applic t Signature
�
C 0 -,it7
LAWRENCE M. TUTHILL
PROFESSIONAL ENGINEER
P.O. BOX 162 '
GREENPORT, N.Y. 11944
(631)477-1652
Southold Town Building Department
Southold Town Hall
MaintRoad'
Southold, 'N.Y. 11971
To whom it may concern,
I have inspected the construction of a deck and screened
porch at Bow 12oadi ,Southold belonging to Mrs. Barbara Lewandowski.
It is my professional judgement, and opinion that the constructs-n
Of these projiects meet the building codes for +Which., they were
permitted.
Permit numbers 29935-Z, and 29933-Z.
i
� i Lawrence M. Tuthill
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JAS t 3 200
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parte.fr�.✓�'�0>✓99�
PROPERTY RECORD CARD
OWNER T STREET VILLAGE DIST. 5UB. LST ' "* '
'l�fON gy, � LW44VQ11
FOM,.R OWNR N " E
ACR,
,E
TYPE OF_BUILDfNG1
RES.9 O SEAS: VL FARM COMM. CB. MICS AAkt,Value
LAND IMP. TOTAL DATE REMARKS -
h (o n
13x4 _.:�
mom,.'-•�:--
®
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AGE BUILDING CONDITION
NEW NORMAL BELOW ,. ABOVE
FARM Aur ' VI;uc• Per Vclue
Acre
Tillal;la
FRONTAGE ON WATER ;
Woodland FRONTAGE ON ROAD'
Meadowland
Hausa Plot BULKHEAD .
Total - „t I ---�.. —r CK
-- ;J — /ADO I _ :q
�• r t x w r«y1 t t tt N? a _ 5 't x! x c}C
�� pit
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14
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CALOR r((�Tr✓ - 1.. TR tis'
Aq.x r
.off
A6. Bldg. a i
PV 3 D
AExtension /i zea l54,
Extension
av tieHiv c: ,
Extension 2 5 /
FoundationGu o Tt' Bath Dinette
porch .E.; Basement /=u L doors p K.
P r _ Ext Walls Z �tr�or FYi�sh,� Sl-/��r 'v'C! 'LR:.'
Breezeway . Fire Place , 's Heat DR.
(,r rae' '" o •' - T e Rood - Ra ms'1•t F oo BR,
3Z
3 u �7.T.C� $ t
Patio ; Recredloh Room oisrialCbp FIN. 13 s
O. B. Donner Drlvoivay,"t
Total '
lo6
r a > v
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765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] 1 CATION
] FRAMING [ FINAL
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[ ] FIREPLACE & CHIMNEY
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REMARKS: C'
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DATE / INSPECTOR
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JTTDATIOY
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(2nd )
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FLUMBI,
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's 17LATI02T PER N. Y.
STATE ENERGY II
CODE
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FINAL --
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ADDITIONAL COMMENTS:
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FORM NO. 1` DE PLAN'S . . . .
TOWN OF SOUTHOLD /ySDAVEY . .... . . . . . . . . . . . .
$ 4
BUILDING DEPARTMENT CIIECk
BUILD . . . . . . . . . . . . . . .
TOWN HALL 'SEPTIC FORH _ - . _ . . . . . . . .
gSOUTHOLD, N.Y. 11971 ,
�. t h TEL.: 765-la02 NO
TRY
c
'Examined . . ., 19 . —I BJ ITO
Approved' . . . ., I9 . .Permit No. > 1 . 1: ;
Disapproved a/c . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . ..
•
isv
(Building Inspector)
P IOATION,FORBUILDINGPERM IT
Date
INSTRUCTIONS
a_- This application must be completely filled in by.typewriter or in ink and submitted to the Building Inspector,with 3
:et's of plans,accurate plot plan to scale. Fee'according to schedule.
b. Plot plan showing location of Iot and of buildings on premises, relationship to adjoining premises or public streets
Dr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this,appli-
ation.
c, The work coveredby this application may not be commenced>before issuance of Building Permit.
d`.'Upon''approval of this application,the Building Inspector will issued a Building Permit to the applicant. Such 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 whatever until a Celtificate of Occupancy
;hail have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the.Building Department for the issuance of a Building Permit pursuant to the
3uilding 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.
File applicant agrees to comply with all applicable laws, ordinances, bu' g code, housingcode, and regulations, and to
:dmitauthorized inspectors on premises and in building for necessary in a tons
. . . . . . .
(Signat ire of pplicant, or name,if a corporation)
(Mailing address of a�pIicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .
\arae of owner of premises .. . . . . . . . . . . . . . . . _ .
(as on the tax roll or latest deed)
'If applicant is a corporation,signature of duly authorized officer.
.
(Name and title of corporate officer)
Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . .
Plumber's License No. . . . . . . . .. . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No.
Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . .
/mss:. . : . . . : : . . . . . . . . . . . . . :. �w :'. . . . . : :. . . . . . . ;5��4Z 1. . . . . . . . .. . . . . . . . ...
House Number Street Hamlet
County Tax Map No. 1000 Section (F?7 . . . . . . . . . Block . . . . . . . . . . . . . . . . . . Lot. . �.. . .'. . . . . . . .'. .
Subdivision .F t .7r q�Gp1?l�. G.LI�1 . . : . . . . . Filed Map No, S% . . . . . . . `Lot . . . . . . . . .
(Nanic)
Stare existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 0 .. . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy • . . . . . . . . • . . • • . •
cure of g work(check whichtapplicable): New Building, . . . . . . . Alteration . . . . . . . . .
3. Na ,, . .. . . . . . Addition
Repair Removal . Demolition . . . . . . . . .. . . . . Other, Vork .., . . . . . . . .
' ' (Description)
4. Estim a tcazcsst,. . . . . .. . . . . . . . ... . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
5. If dwelling, number of dwelling units . -'. , . . . . ... Number of dwelling units on eac") floor. . . .. . ; . . . .
If garage,numberof cars .:. . . . . . . . . . . . . . . :. . .
If business,cGrameezinl or infixed occupancy,specify nature and-extent of each,type of use . - >. . . . .. . . . .. . _...:`
T. Dimensions of existing structures, if any- Front . . .. . . . . . . : . :.. Rear :d ._:, Depth . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . .Number of Stories . . . . . . . . . . . . . . . . . . .I . . . . . . . .. .
Dimensions of same structure with alterations or additions: Front . ... . . . . . .. . .. . . . . Rear . . . . . . . . . . . . . . . . . .
Depth . . . . . . . . . . . . . . . . . . . . . . Height - • . . . . . . . . . .. . . . . ,. . . .'Number of Stories . . . . ... . . . . . . ill . . . . . . . .
8. Dimensions of entire new construction: Front . . . . . ... . . . . : . . .:Rear . . . . .. . . . . . . . . . Depth . . . . . . . . .. . . . . .
Height . . . . . . Number of stories `. .. . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . .
4. Size of lot: F.i nt , V, �2car e th . . . . . . . . . .. . .. . . . . . . . .
t
90. Date ofPurchase . . ./. 6_. . . Name of Former Owner .
11. Zone or use district in wlii . . . . ._y . . .
,r gremises�resrfuafed .,._.x. . . . , . . / . . .
12- hoes proposed construction violate a y zoning law, ordinance or regulation. Ae�. . . . .
. . . .
13. Will lot be regraded . . rte. Will excess fill be removed from premises Yes �No
. . . . . . . . .
14. Name of Owner of premisest}i1la�t�tfPfl ��/. Address X `✓���k° �0�. . . Phone No. s . ..
Name of Architect . . . . eV, . . . . . . . . .. ..`. . . ..Address . .. . . . . . . . . . . . . . . . .Phone No. . . .. . . . .. . . . . . .
Name of Contractor . ZIIZV � . . . . . . . . . .. . :. . . Address . . . . . . . . ... . . . . . . . . .Pho e No ., .. . . . . .. . ,
15. Is this property within 300 feet of .a tidal wetland? *Yes: . . . . . . No.
1f yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from
!{ property lines_ Give street and block number or description according to deed,and show street names and indicate whether.
a interior or corner lot
Oro
X47/ A <
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HSG eng
STATE OF NEW YORK,
MUNTY OF . . . . . . S'S
. . /.7/1.�il:�flf�✓F-= 1,91 ' x,:'!. . . . . . . . . .
. . . . . . . being duly sworn, deposes and.says that he is the applicant
(Name of individual signing contract)
hove named.
ieis 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
pplication; that all statements contained in this application are true io the best of his knowledge and belief;and that the
ork will be performed in the manner set forth in the application filedtherewith.
wom to before me this
l f... . . . . . .'.day of. .,4'4yy4 19
5tary Public . . . . . . . ,ic /r_Yzc-.G.l�_: .\ . . . . . County ,
LINDA J.COOPER . . . . :. . . :. :. . . . . . . .... . .
Notary Public,State of Now York (Signature of applicant)
No.4822563,Suffolk County
f
Tcrm Expires:December 31,19
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CI CKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL t - ,, Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plates
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 c _ Survey
www.northfork.net/Southold/ PERMIT NO., i'�J'J Check
Septic.Form:
N.Y.S.D.E.C.
Trustees
"Examined 20 Contact:
Approved 20 Mail to:
Disapproved a/c
Phone:
Expiration ,20_ J
jl
Building Inspector
APPLICATION FOR BUILDING,PERMIT
1 . 120
Date 2 ( ( 20 03
1 i,l t INSTRUCTIONS
a T'ihis applig ii IuLCT�, -eorvietely filled in by typewriter of in ink and submitted to the Building Inspector with 3
sets of plaxia�urrrtelot 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 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 Every building permit shall expire if the work authorized has not commenced 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 penuirfor 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,if a corporation)
i
i
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of ownerofpremises JJr� YL(3`# yLq LI�wD��+'S1��
(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. A5 6u t Gi-
Plumbers License No. rL rj -tGD ec tc _ L4, Pt u b I -� •K N e�s�'�
Electricians License No, #-J 0n4— '(„t o EL crw.« �
Other Trade's License No.
1. Location of land on which proposed�work will be done:
ZSR JW „o A-a Stl�t-t�-t o�(1 K. V-
House Number Street Hamlet
County Tax Map No. 1000 Section 81 Block Z Lot -3 3
Subdivision► G r•)N m-,Le st A W oofee--G-s Filed Map No. SILL Lot (
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy �j'r i.,f« FA-Ext i t--i J-zr-
b. Intended use and occupancy t` ('s m-LA4 e)
fl t?csc
3. Nature,of work(check which applicable):New Building e n k Alteration
J
Repair Removal Demolition Other Work
--.�—_ (Description)
1 4. Estimated Cost_ Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units / Number of dwelling units on each Boor t
if garage, number of cars t- 15A(51% lslo.
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 Depth Z `/
Height Zv '<G Number of Stories Z
1
Dimensions of same structure with alterations or additions: Front G Rear �►
Depth 7-S`-`t` Height Zri ``-c " Number of Stories Z
8. Dimensions of entire new construction: Front Rear 6G Depth 1-t =�
Height I-r Number of Stories 1�
i
9. Size of lot: Front Rear Depth
i
10. Date of Purchase `� i,9 Name of Former Owner l"f f of 4L'e S lM t rl-
11. Zone or use district in which premises are situatedC S t n c�'aaT t.n
12. Does proposed construction violate any zoning law, ordinance or regulation?YESJ NO
13. Will lot be re-graded? YES NOWill excess fill be removed from premises? YES NO �O
6n-0-6,t-0-0- T-e.ukY - '7r:t- 3( S r
14. Names of Owner of premises Address Phone No.
Name of Architect ( aErtw t [t&,rkt c Address'"tcarr "e 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 NO )Q
* 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.
f
STATE OF NEW YORK)
SS:
COUNTY OF )
tf>re 5& L 1 e-H being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the A^ty kMv-
(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 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
day of b 6em d 6x- 20 ey
zo Ilk &f
Notary Public v Signature of Applicant
KAREN W.SCERGESSCM
NM 01804M YOSd
QW11119d h Suffolk
Cm^Tisx!on Epi-as C=ty
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OCCUPANCY OR
A �"°�° USE IS UNLAWFUL
D Ems'=:8 3
NOTIFY BU DE IN WITHOUT CERTIFICATE
765-1
FOLLOWING
G AM EC I 'FDR THE OF OCCUPANCY
f" 4"�4 foi' FOLLOWING INSPECTIONS:
1. FOUNDATION - TWOREQUIRED
FOR POURED CONCRETE
v ROUGH - FRAMING R PLUMBING
INSULATION
i°L"LIaL CONSTRUCTION MUST
BE`14F ECONSTRUCTlON &
COMPLETE �---
'IY ALL CONSTRUCTION SHALL MEET
IIiF RMUI9 MRENTS OF THE IN`!r,
T
�ENERUff
I y' ! i vv""IOES AlO'f RESPONSIBLE :FCW j 1\611L I I
_ I,c>;It,N OR CONSTROCTkONIERR FhS R
L -- �1� Tv 4tlew Farz ti.P cc.
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