HomeMy WebLinkAbout30453-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N_Y.
CERTIFICATE OF OCCUPANCY
No: Z-30291 Date: 07/08/04
THIS CERTIFIES that the building ADDITION
(aka 905 Fourth St)
Location of Property: 16615 NEW SUFFOLK AVE NEW SUFFOLK _
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 117 Block 8 Lot 2
Subdivision Filcd Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated ,TUNE 15, 2004 pursuant to which
Building Permit No. 30453-Z dated JUNE 2B, 2004
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" DECIC ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR. CONSTRUCTION CERTIFIED BY FRANK NOTARO R.A. ON 6/29/04.
The certificate is issued to LELAND BRA14DES
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
i v
Authorized 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)
PERMIT NO. 30453 Z Date JUNE 28 , 2004
Permission is hereby granted to :
LELAND BRANDES
59 DAWN DRIVE
SOUTH WINDSOR, CT 06074
for .
CONSTRUCTION OF AN AS BUILT DECK ADDITION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR
at premises located at 16615 NEW SUFFOLK AVE NEW SUFFOLK
County Tax Map No. 473889 Section 117 Block 0008 Lot No. 002
pursuant to application dated JUNE 15, 2004 and approved by the
Building Inspector to expire on DECEMBER 28 ,E 2005 .
Fee $ 300 . 00
I Authorized Signature
i
ORIGINAL
Rev. 5/8/02
�I
Form No.6 ^
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
JUN 15
APPLICATION FOR CERTIFICATE OF OCCUPANCt ' -
i — ---This application must be filled in by typewriter or ink and submitted to the Building Departs ent;crith.thS follo',umo
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
tupog aphis features-
1 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. Swom statement from plumber certifying,that the solder used in system contains less than 2;10 of 1% lead-
s. Commercial building, industrial building,multiple residences and similar buildings and installations,a certificate
of Code Compliance front architect or engineer responsible for the building.
6. Submit Planning 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.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 to duelling$25-00,
Swuruning pool$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
Date. JUt:.t; l r{ , ___OO1A
ACX
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 5�?t_'s ecu r.
±—_ iJELt;- cS ii/--PGLlti-
House No. Street Hamlet
Owner or Owners of Property: Lr�P,
i
Suffolk County Tax Map No 1000, Section 17 Block Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit- Applicant:
Health Dept. Approval Underwritells Approval:
Planning Board Approval:
i
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $
i
1� Applicant 5ignature
ITEcNo. .(GIES v
mevlccEs
pgrm�rnrrrma PLANNINGGONSfRiTLTiONS
A3AOS�ImmRoed'M�tiuek New Y-i 1I 42 - ..
,. 63129.81129 'faz:6312M-Mg '
;lurie 29,2004.'
Town of Southold
Buildingpepatnent ��
Towrt ball'-
56u4hold;'N Y
Re LeeBrandes
T M.- # -00Q 11T-8 2 '
To Whorri It"May Concern
We certify that thastructurp of the as-built deck is in full�omplfartce with the New York
State Building Cede. Tho xis ting footings of a e deck are poured ano fess than 36
-below grade_ The footings are 8 diameter sunotubes onp o [ # footingsu`
r Please,call our office if you have any questions: ;
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B-UIIDINA i- 1 LZ`1'`11Y —R � -Y1T�C, r
Applicant/ ^ Date.
Owners Name: _6h L— Reviewed: -6/Q
Architect/ Date
Engineer: ula„__ Submiued: !
SCTM 4:
District: 1_000 section: `f 17 Block _� Lor
Projectr � r,�� — Subdivision
Location. – --- �''` '"� J• - 91 Name:
Single&separate Required °
certification: (Yes/Nol �
/��(� Req. , - ) Rey. L
%nning Ilisrrie (lur sis: 0 'ual. l' �— I IIAI wrcragc 1're�°5eJ r/ I
Rey ' n ti ZI —
r7�[[17r-N�yard Pralwsrzd` ,ylssid✓e rY;;dd Pmpa.° f Rear Yard rill sscd' f
Project Description: { t � � gGei t� . 1t-&
/
AGENCYRERMITS Permit .
REQ UIRFDFOR RE,VIE W N_A. NO YES Number
Suffolk County Health Dept.
New York State D. E. C. _
Town Trustees
Town Zoning Board approval: /✓,/�w _
Town Planning Board approval:
Flood Plane Elevation???
Flood Zone:
VY T�
ry
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�f 3 .141 J
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opo g _ TOWN OF sOUTHOLD P�OPERTY RECORD CARD
OWNER STREET Celt ti VILLAGE DISTRICT SUB. LOT
' tsidYcd �iNet.A tide Ct>e`i � 7 a rhP. a L-(41 J-C,
FORMER OWNER NE �/ - (�^ ACREAGE p�
4-r (,T l".p c.r(Q£k ., ✓ (�G/s�9` i,J ,f e' �o2-UO
S W Fµ, TYPE OFBUiLDING
JI/
tES. C) SEAS. VL. FARM COMM. I IND. I CB. MISC. Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
>Fc� fd 9 iC d t GIler
a U d raC.. N47(.� ti'�'1.�9-- ..,.yi !"I" }* o e 1� .e.,. 7 J-X r o a •C ^lf i"� ./..r�_,.,.� /�-1i..r.
666 2660 Q ? 36 �2 �d �� r: r 9. r
h r7 c'
/ ®(J 2. U a o 2-? U ® 6.(3 G 6 ^ solD A//",04o %S.v� ,3 PA'a) is „3, r. c-.9 RM. 8•,
,7j-l.7 li ?-' /p Q? �.3 ,r` �,'�n nc�e. A ,Liln.h c%S cr-�r a�nrr� e r.7� '^� f,; %-
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AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE FRONTAGE ON WATER �.
Farm Acre Value Per Acre Value FRONTAGE ON ROAD baa 41en ^ n e cc
F�P>.s f�re_r�
fillable 1 BULKHEAD
fillable 2 DOCK
fillable, 3
Noodland
Y,.
I swampland "` -....
Srushland
souse Plot
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M. Bldg. - 3,1-X 2. = - - i L Vndation- .6-n u - - Bath _
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xryeensuon 2 x rS - Basement �I' Floors .
qt
Extension /Z Walls ro!Interior Finish , �
J - 6UNP 9n J,
Extensa n Y ( _
x h Fire Pilate Heat
1 ! dr
6,+fit•4?.
h�a Kang20 Jam_ _ �d '� C Porch 6lo 'o Roof Type
Porch 1600 Rooms lst Floor
Breezeway Patio Rooms 2nd Floor
Garage Driveway Dormer
3
7554 802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ 1 FOUNDATION 2ND [ ] INSULATION
[ l FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE �d`�` INSPECTOR
' Na
SURVEY OF PROPERTY
` I A T NEW SUFFOLK
I
- -- -- - - — - - --- lu- - - N/0/F EDWARD-GROCKE -_J - -
BLpp. - _ - TOWN OF- SO'U•THOLD
lVON. sai 59'40"E SUFFOLK CO UNT�i, NY
r 00.62' 1000-117-08-02
SCALE: 1=20'
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FR. E. vy
co CER77FIED TO.
JOHN A. JEFFREY
pj� B'" MELODY JEFFREY_ 22,5' i OMNI TITLE AGENCY
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WASHINGTON MUTUAL BANK
FIDELITY NATIONAL 7771E INSURANCE COMPANY
ONCRE7E .
C.E.. s.e OF NEW YORK
S°£WALK
NB3 59'40"W -�
{ 100.44'
A[AIN
(NEfY su STREET N. Y.S. LIC. NO. 49618
FF�L$ A VEND ANY ALTERA77ON OR ADDITION TO THIS SURVEY IS A VIOLATION CONICS ORS, P.C.
EJ OF SEC77ON 7209OF THE NEW YORK STATE EDUCATION LAW. (631) 765-5020 FAX (631) 765-1797
EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS P.O. BOX 909
AREA=12,565 SQ. FT. HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET
WHOSE SIGNATURE APPEARS HEREON, SOUTHOLD, N. Y. 11971 F(04-157
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AS REQUIRED TO MAINTAIN
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'RE—GRADE THIS AREA
AS REQUIRED TO MAINTAIN
NO MORE THAN AN 8" STEP OFF DECK
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SCALE:
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