HomeMy WebLinkAbout29011-ZFORM
TOWN OF SOUTHOLD
BUILDING DEPART~iENT
Office of the Building inspector
Town Hall
Southold, N_Y.
CERTIFICATE OF OCCUPanCY
No: Z-B0288
Date: 07/06/04
'£uiS C~HTIFIES that t~ ~ild/ng ACCESSORY
Location of Property: 2000 WILLOW DR EAST MARION
(HOUSE NO.) (STREET) (F~AMLET)
County T~xF~ap No. 473889 Section 22 Block 5 I~t 22
subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in tb/s office dated DECEMBER 16, 2002 pursu~nnt to wb_%ch
Building Per~{t No_ 29011-Z dated DECEMBER 16, 2002
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 ACCESSORY TWO CAR G~AGE AS ~PLIED FOR.
The certificate is issued to ALBERT W & CAROL G ALBERTSON JR
of the aforesaid building_
N/A
N/A
Ahoriture
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town HallI
Southold, N.Y.
BUI[,DING PERMIT
(THIS PERMIT N23ST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF TME WORK. AUTHORIZED)
PERMIT NO. 29011 Z Date DECEMBER 16, 2002
Permission is hereby granted to:
ALBERT W JR ALBERTSON
PO BOX 644
EAST BLA~iON,NY 11939
for :
CONSTRUCTION OF A~ ACCESSORY GARAGE IN THE REQUIRED REAR Y~dD AS
APPLIED FOR
at premises located ah 2000 WILLOW DR
EAST ~RION
Co~ty Tax Map No. 473889 Section 022 Block 0005
Lot No. 022
pursuant to application dated DECEMBER
Building Inspector to expire on ,Z/NE
Fee $ 166.20
16, 2002 and approved by the
ORIGINAL
Rev. D/8/02
Form No. 6
TOX,~N OF SOUTHOI,D
BLqLDING DEPARTMENT
TOWN I~kLL
765-1802
APPLICATION FOR CERq[IFICATE OF OCCUPANCY
This application must be filled in by typexxqSter 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 Appro vol from Health Dept. of water supply and sewerage-disposal (S-9 Ibm).
3. Approval of electrical installatron fi~om Board of Fire Underwritars.
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 sinfilar buildings and installations, a certificate
of Code Compliance fi'om architect or engh~eer responsib!e for the building.
6. Submit Planning Board Approval of completed site plan requirements_
-For-e-x~s?.'eg Imildings4~prior4oAptStg, t9-57)aoa-co~fo~ming-ases~or baildln~ and "preexisting" land uses:
~. Accurate survey of properB, showing all properly 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 x~,ritiag to the applicant.
l. Certificate of Occupancy - New dwelhng $25.00, Additions to dwelling $25.00, Alteration~ to dwelling $25.00,
swlmming pool $25.00, Accessory buildJng $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Certificate of Ocanpancy on Pre-existing Building - $100.00
3. Copy of Cerltficate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50_00
5. Temporary Certificate of Occupancy - Residential $15 00, Commercial $15.00
Date. ~7
New Construction: ~ Old or Pre-existing Building:
l-Iouse No. Street :
Ow'neror Owners oferoperty: '~ [ '[:De~-~- ~v~tJ~50x"/A
Suffolk County Tax Map No 1000, Section ~)--22:3-- Block
Date of Permit. ~2- l~- 02_
(check one)
Hamlet
Subdivision
Permit No. ~l,~ 0 [ ~
F[ealth Dept. Approval:
planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~- . ~'0
: Filed Map.
Applicant:
Undervaiters Approval:
Final Certificate:
Lot
Lot:
?r.,,._ (check one)
epp' 'gna
LAWRENCE M. TUTHILL
PROFESSIONAL ENGINEER
P.O. SOX 162
GREENPORT. N.Y. 11944
June 30, 2004
Mr. Michael J. Verity, ~epartment Head
Southold Town Building Department
Main Road
Southold, NY 11971
Permib ~ 29011Z
Carol Albertson
2000 Willow Drive
East Marion, NY 11939
To Whom It May Concern:
On July 25, 2003, I inspected the forms and r~a-~orcing
bars prior to the pouring of a monolithic concrete garage
floor at the above mentioned sire. I observed the pouring
of the concrete on the same date. An inspection of the
framing it was noted that there were some discrepencies
in the plans and deficiencies in the framing. Subsequently
revised plans were filed with the Southo3d Town Building
Department. An inspection there after, it was noted all wore
had been done in accordance with the revised plans on file
and meeb the New York 8tare BuS%ding Code and the Town of
Southold Building Code.
Sincerely,
Lawrence H. Tuthill, P.E.
TOWN OF SOUTHOLD PROPERTY J~GORD CARD
~R~N~ ~^1 A'li~.t-¥sen~'rd~ral(~sTREE'r P-O d) o VIL~GE DIST. SUB. LOT ~;, -:
"~'~ '~ ~ ~l '
. trk, 0,%~
[2. [ (~6,~.{~ ~ff ~)~ S W ~PE OF BUILDING
RES. ,:~) / 0 SFAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
o~-& t~a
· lllobl~ FRONTAGE ON WATER
~1o~ FRONTAGE ON ROAD
M~dow~d DEPTH
~ ~lol ~'~ ,,~? ..... ,, :,, '::~ ~ BULKH~D
T~ol
M.~"~'g. I 2~' ~( .~ :",/~0~- ~,-/,~''F ~Z~y, Foundation p~ Bath /~:.
Extension Ext. Walls ~ ~ Interior Finish
Extension Fire Place ~ &~., ~_ Heat ~,
Porch ~. Pool Attic
Deck Patio Rooms 1st Floor
Breezeway Driveway Rooms 2nd Floor
Garage
O.B.
"~16 745 6642
HOL LEU SOL RO
002
v
BUILDING PERMIT EXAMINER CHECK LEST
DATE SUBMITTED:_jZ../I~ ~02
SCTM# DISTRICT: 1,000, SECTION: .~ , BLOCK: ~ LOT:
PROJECT DESCRIPTION: j~r .... ~~- __
ESTm[q'rED PROJECT COST: r rm CK¢.
S~GLE & SEParATE CERT~ICAT[ON-~Q~D? ~o NOTES:
LOTS 40.000SF ~100-24 I r,t reca~itiou.(C~A~D before Jane 30. 1983), ~DDR~ED LOT8 ~OM JAN. 1997 00 25. b erger.,A nancon ann ng *t an} time ~er 71
ZONING DISTRICT: "~ ~ ~O CONFOP,5,IING?
REQ. LOT SIZE: t./o,oo= ACT. LOT S~E:~fl~6 REQ. LOT COV.~ ACT. lOT COV.
~Q. FRO~ /$ PROP. FRONT
~Q. RE~ /o PROP. ~ / REQ ~[OHT- PRS~
WATER FRO~: ?
PANEL #: 07
r'~/~ DESCRIPFION: -
FLOOD ZONE: ~ , __ -
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH D. fi4ZT~'~TS o[~',~.B ED
#):__
TOWN SEPTIC RECEIPT: Y o~gFj') ~
NEW YORK STATE DEC: e~-"6~cvmTs YES ot ~
SOUTHOLD TOWN TRUSTEES: YES o{ ~[
TOWN ZONING BOARD APPROVAL: YES o/ ~
TOWN PLAN. BOARD APPROVAL: YES & ~l~
TOWN HISTORICAL PRE . (SPLIA): YES c kiD '~
EGRESS (18 H mm.? 4 sq 'C6~al) ' VENT (SQ. FT. x 4%)
BUILDING PERMITS OPEN/EXPIRED: BP
HAVE PRE CO'S: Y OR N BP
NOTES:
DTE: / ,," PERiV[[T #:RI0-
-Z / C/O Z-
-Z / C/0 Z-
LIGHT (SQ. FT. x 8%)
FEE STRUCTURE: FOUNDATION:
12. ( SF)- (
SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF D,IIT OTHER
TOTAL: ,~""~'22'-' ' SF FEE FEE
TOTAL
FEE
SF)= SF X $ =$ +$ +$ = $
765-1802
BUILDING DEPT.
INSPECTION
[ ~UNDATION 1ST
[ ] FOUNDATION 2ND
[ ~'~RAMING
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FIREPLACE & CHIMNEY
DATE ~. // ,,2~ INSPECTOR
FOU'NDAT~ON (IST)
STA~ E~ CODE I
TO~,g~4 OF SOUTHOLD
BUIL~ING DEPARTMENT
TOW~ HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FA~X: (631) 765-9502 · o
vpanv, northfolk, net/~dthold/ PER'lIT NO; ~ L ~ ~
Dinappzoved ~ c
Btfild~g ~spector
:: · ~, ~PLICATION FOR B~ D~G PERNHT
BUILDING PEP,~,gr APPIIC_&TION CHECKLIST
Do you have or need the following before app135ng?
Board of Heal~
3 scm of Building Plans
Planning Board approval
Check
Sepnc Form
N.Y.S.D.E.C.
Tmswes
Contact:
" } INSTRUCTIONS
a TI'tis application IVlUST be completely fdled hi by D~pewriter 9r In mk and submitted re the Building hmpector with 3
sets of plans, aecurate plot plan to scale. Fcc according to schedule.
b. Plot plan showing location of lot and of buildin~ on premises, relationship to adjoining premises or public streets
c. The work covered by this applicadun ma5- not be commenced :before issuance o£ Building Permit.
d. Upon approvM of tiffs application, the Build'ng Inspector ,x ill,issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available ~or inspection throughout the wo~k.
e. No building shall be occupied or used in whole or in par~ Ibr an5' purpose what so ever until the Bui/dmg Inspector
~ssues a Certificate of Occupancy.
f. Every building pmm/t shall expire it'the work authorized has not commenced within 12 months a~er the date of
issuance or lias not been completed witt~hi 18 months fi-om such date. If ho zoning ameadinents or other regulations affecting thc
propert5 have been etmcted in the interim, the Building Inspector may amhorizc, in *~iting, thc extension of the permit for an
addition slx months. Thereafter, a ~cw pcmfit sh',?d/be required.
,APPLICATION IS HEREBY IVLADE to the Building Dep~.rtment tbr the issuance of a Building Pemfit pursuant to the
Building Zone Ordinance of the Town of Southold, Suftblk Comet), Nexg York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations o~ for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordinances, buildingI code, housing code, a2d re=m.tlations, and to adrmt
aulhorized inspectors on premises and in building for ilccessars' hispections.
r'~Signar~re~f ap~icant or name, ifa cmt,oxation)
(Marling address of apphcant)
State whether applicant is owner~ ]essee~ agent, architect, engineer, general contractor, electrician, plumber or builder
Nazne of owner of premises P~/~I~T-fiTo0 ~rz45.'O
(.~ 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.
Locatiou of lamd on wh/ch proposed work xx-ill be done:
7.000
~Iouse Number S~reet
Hamlet
,C, omttyTaxM~pNo. 1000 Section
Subdivision Mlk~l~01~'~ Fl~gl}t}ld~
(Name)
Block 5- ..
Filcxt Map No.
2. State ex, ting u~e and occupancy of premises and intended use and occupancy of proposed constmcbon:
a. Existing use a~d occupancy
,' b. Intended use and occupancy 04~¢~]~,//0~/~}~C].P~)
3. Nature of work (check which applicable): Ney, Building / Addition Alteration
Repair Removal Demolition Other Work
4. Estimated Cost i~ ]000
5. If dwelling, number of dwelling units
If garage, number of cars
(Description)
Fee
(To be paid on filing this application)
Nnmber of dwelling units on each floor
'6 If business, commercial or mixed occupancy, spec[fy nature and extent of each type of use_
i7. Dimensions of existing structures, if any: Front
: Height. Number of Stories
_Depth__
Dimensions of same structure with alterations or additions: Front
Depth. Height
8_ Dimensions of entire new construction Front ~ ~
Height ]~} ~ Number of Stories
,9. Size oflot: Front iqq Rear
Number or Stories
Rear ~ Depth
I
Rear
10_ Date of Purchase
Name of Former Owner
I 1. Zone or use district in wh/ch premises are situated
12. Does proposed construction '~4olate any zoning law, ordinance or regulation? 'rES__ NO
13. Will lot be re-graded? YES__ NO v/ Will excess fill be remgved from premises'? YES__ NO V
14. Names ofO~mer ofpremises~/.o}~£ ]~h~. ~LqS-0~Address ~l£00 OJIIl/¢ 0g. ~Ef~gd~hone No. q77-,Tf~30
Name of Architect Address Phone No
Name of Contractor~Wrr_.~0~fff... Address ~0 ~ I~ $~v~¢ Phone No_
15 a. Is this property within 100 feet of a tidal wetland or a ffeshwat'er wetland? *YES .NO
* IF YES, SOUTHOED TO~qN- IKUSTEES & D.E_C. PERM1TSiMAY BE REQUIRED.
b. Is this property x~4thin 300 feet of a tidal wetlandO * YES : NO
* ~ YES, D.E.C. PERMITS MAY BE KEQU1RED_
16. Provide sm'vey, to scale, with accurate fourtdation plan and distances to property lines.
17. If elevation at anypomt on property is at 10 feet or below, mustlProvide topoo_j-aphical data on sm-vey.
STATE OF NEW YORK)
COUNTY O~
~"¢YT [ ~C~'~_~ being duly sworr~ deposes and says that (s)he is the applicant
t2q'ame of individnal si~mfing contract) above ~mJzaed, - I
(Contractor. Agent, Corporate Officer, cfc.)
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 al/statements contained in ti:tis application are true to the best ofkis knowledge and belief; and that the work wi/[ be
performed in flxe mangier set forth in the application filed therewith.
Sworn to before me this'-
_ ) ~ -) day of
(J Notary l:hib lic
LYNDA M. BOHN
NOTARY PUBLIC, Btate of New York
No, 01B060209:~2
Qualified in Suffolk Count. y__
Term Expires March 8, 20(..~