HomeMy WebLinkAbout29054-ZFORM NO. 4
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
Office of the Building Inspecnor
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30034 Date: 02/20~ 04
T~IS ~RTIFIES that the building ALTERATIONS
Location of Prope~ty: 2355 BEEBE DR
(HOUSE NO. (STREET)
County Tax Map No. 473889 Section 103 Block
Subdivision
aka 70 FAWN LA. CUTCEOGUE
Filed Map No. Lot No. --
Lot 25
(PIAMLET)
conforms substantially go the Application for Building Permit heretofore
filed in this office dated DECEMBER 26, 2002 pursuant to which
Building Permit No. 29054-Z dated JANUARY 2, 2003
was issued, and conforms uo all of the requlremenus of the applicable
provisions of the law. The occupancy for which 5his certificate zs issued
is WINDOW REPLACEMENT TO EXISTING SINGLE FAMILY DWELLING AS APPLIHD FOR.
~ne certificate is issued to CECILIA AN~ KRUPSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTYDEPARTMENT OF~EALTlt APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N/A
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
(THIS
BUIDING PEPd~IT
PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED
p~T~NO'.
29054 Z Date JAI~IARY 2, 2003
Permission ms
hereby granted co:
CECILIA ANN KRUPSKI
70 FAWN LA
CUTCHOGUE,NY 11935
for :
ALTERATIONS (WINDOW REPLACEMENT TO AN EXISTING SINGLE FAMILY
DWELLING TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at 2355
County Tax Map No. 473889 Section 103
pursuant to application dated DECEMBER
Building Inspector to expmre on JULY
BEEBE DR
CUTCHOGUE
Block 0004 Lot NC. 025
26, 2002 and approved by the
Fee $ 150.00
~ature
Rev. 5/s/02
ORIGINAL
TOWN OF SOUTHOLD
TO~ H~L
APPLICAIlON FOR ¢ERT~ICATE OF OCCUPANCY
.........
,This apphcahon must be filt~ m by t~ewnter or ~ ~d sub~tted to the Buff&ag
For new building or new use:
1. Final surve~ ofproper~y 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 tess than 2/10 of 1% lead,
C~orrm~rcial building, industrial building, multiple residences and similar buildings and installations, a eerdficate
of Code Compliance from architect or engineer responsible for the building.
6 Sttb~r2t 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 anusua~t natural' or topographic
features.
2. A properly completed application ard consent ro inspect signed by the app]icaut. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing ro the applicant
C. Fees
Certificate of Occupancy - New dwelling $25.00. Additions to dwelling $25.00. Alterations to dwelling $25.00,
Swnnming pool $25.00. Accessory building S25.00. Additions to accessory building $25.00. Businesses 550.00.
Certificate of Occupancy on Pre-ex,sting Building - $100.00
3 Copy of Certificate of'Occupancy - $.25
a Updated Ce?tificate ofOccupanc~ - $50.00
5 Temporary Certificate of Occupanc5 - Residential $15.00. Commercial $
Oat e__ 3
Subdivlsmn
Permit N57 ~7_
Health Dept. Approval:
New Construction: Old or Pre-existing Building: / check one-
House Nc Street
Owner or Owners ofPrc perty: 0,¢~.~m, /~AY_/t,' ~)Ru.4~_5/~_~
Suffolk County Tax Map No 1000. Section /0 ~ ~ O ~/-' ~ ~ Block Lot
Lot:
Filed Map.
Date of Permit.
~//2-/6 .~ Applicant: 0~,[)~ Underwriters Approval
Planning Board Approval
Request for: Temporary Certificate
Fee Submitted: $ '2, ~', ~
Final Certificate:
~'- (check one ~
Applicant Signature
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152
E~uca~on Law.
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] ~/~TION
F~MING ~iNAL
FIREPLACE & CHIMNEY
,,.,,,,KS,. ~.A_~..__~
INSPECTOR ~
BUILDING DEPAtlTMENT
TOWN HALL
SOUTItOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
ww,v. nor thfork.net/S outhold/
Examined
Approved
Disapproved a/c
Expiration
,20 -~
,20 ~
PERMIT NO~-q~(~-~"~
BUILDING PERMIT APPLICATION CI-IECKLIST
Do you have or need the foll{ywing, before,appJs-Su]§?
Bogrd of Health
'~3 sets of Bm'ld/ng Plans ~.,~X,e, lk-cx..a 5:~ Cc>
Planning Board approval
~ Survey_
Check __
Septic Form
N.Y.S.D.E.C:
Trustees
Contact:
Mail to:
~PPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
Deeen4,em ,20
a. This application MUST be completely tilled in by typewriter or in ink and subm/tted 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 pren~ises, relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be comcmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will iasue a Building Permit to the applicant. Such a penmt
shall be kept on'the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in parr for any purpose what so ever until the Building Inspector
issues a Cert/ficate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced with/n 12 months after the date of
issuance orhas not been complefed within 18 montha from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the inter/m, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. ThereaFtei:. a new perm2t shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purstmnt to the
Building Zone Ordinance o£the ]'own of Sonthold, 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
appticant agrees to comply with all applicable laws. ordinances, building code, housing code, and regulations, andto admit
authorized inspectors on premises and in building for necessary inspectiono.
(Signature of'applicant or name. if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises ~ e O // R ~ n r~ ]4~,e %~_~.,'
(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.
Location of land on which proposed work will be done:
House Number Street
Han~et
County Tax Map No. 1000 Section/O~-Oq- Z ¢' oBlock
Subdivismn Filed Map No.
(Name)
2. '~tlife~xi~tihg U~e:~d ocenip~cy 6fpremises and intended use and occupancy of proposed Construction:
a. Existing use and occupancy
b. Intended use and occupancy_
3. Nature of work (check whiqh applicable): N~w Building Addition
Repair RemovaI Demolition Other Work
4. Estimated Cost Fee
5. If dwelling, number of dwelling units Number of dwell'm8 units on each floor
If garage, number of cars
6. Ifbus'mess~ commercial or mixed occupancy, specify nature and extent of each typeofuse.
7. Dimensions of existing structures, if any: Fron~ Rear _Depth
Height Nu'mbigr of Stodes
9imensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear _Depth
Height Number of Stories
9. Size of lot: Front Rear 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
Alteration
c~a c~ e d
(Description)
Address Phone No.
Address Phone No
Address Phone No.
15 a. Is this property within 100 feet of a tidal wettand 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.
(To be paid on filing this application)
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEV~ YORK)
SS:
COUNTY OF )
/~c~/o.5/q ~ be'mg duly sworn, deposes and says that rs)he is the applicant
(Name of individual signing contract) above name&
rS)He is the ~LtJ)7 c~tz_
(Contractor, Agorot, Corporate Officer, etc.)
of said owner or owners, and is duly author/zed to perform or have performed the said work and to make and ftc this application;
that all statements contained iu 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 apphcation filed therewith.
Sworn to before me this
&y of/'9 a _-.
J 'I~lo~'ary Public -
ELIZABETH A STATH1S
NOTARY PUBLIC, State of New¥ork
No, 01ST6008173, Suffolk Cou~nty
Term Exp{res June 8,
Signature of Applicant