HomeMy WebLinkAbout30223-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30299 Date: 07/14/04
THIS CERTIFIES that the building ADDITION
Location of Property: 565 BAILEY AVE GREENPORT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 34 Block 4 Lot 9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 7, 2004 pursuant to which
Building Permit No. 30223-Z dated APRIL 7, 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 DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIEDFOR.
The certificate is issued to JAMES T GLOVER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Aut r3�z ed ignatIIure
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. 30223 Z Date APRIL 7 , 2004
Permission is hereby granted to:
JAMES T GLOVER
522 BAILEY AVE
GREENPORT,NY 11944
for
CONSTRUCTION OF A DECK ADDITION TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR
at premises located at 565 BAILEY AVE GREENPORT
County Tax Map No. 473889 Section 034 Block 0004 Lot No. 009
pursuant to application dated APRIL 7, 2004 and approved by the
Building Inspector to expire on OCTOBER 7, 2005 .
Fee $ 150 . 00 �-
Authorized Signature
ORIGINAL
Rev. 5/8/02
F�
Form No.6 � ,;
TOWN OF SOUTHOLD
BUILDING DEPARTNIENT g f Q
TOWN HALL K
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. Approval 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 Coxae Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B, -For tysting-bu€ldings-(Itr-iorto April-9,1957)-non-confermlt e-tses�-or-haUdings and' pre-ex-isting"Ianduses-.
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.
1 C. Fees
1- Certificate of Occupancy-New dwelling$25-00,Additions to dwelling$25.00,Alterations to dwelling$25-00,
Swimming 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. .47' b—o
New Construction_ Old or Pre-existing Building: l/ (check one)
nn
Location of Property: ZZ $ A vi_ r
House No. (7lf Street et
JOwner or Owners of Property: t T 4- J(a(/)n I a,el'-
Suffolk County Tax Map No 1000, Section 0 Block cW H Lot 0o�f
Subdivision Filed Map. ``-- Lot:
Permit No. �o 2Z5 - Z Date of Permit. �-� Applicant: T. G /LA/A/
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ Z.5-CA-)
ApplicantSignature
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5 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
NEW YORK BOARD OF FIRE UNDERWRITERS 5
S
BUREAU40 FULTTON STREET F C
NEW YORK,K , NY 10038 rS
CERTIFIES THAT
5 Upon the application of upon premises owned by e51
5 C-CAT CO. JAMES GLOVER 5
S 9280 SOUND AVE. 725 STERLING LANE r5
C5 MATTITUCK, NY 11952, CUTCHOGUE, NY 11935 5
c� Located at 725 STERLING LANE CUTCHOGUE, NY 11935 5
Application Number: 2048068 Certificate Number: 2048068 5
c 5
Section: Block: Lot: Building Permit: BDC: ns11
5 Described as a Commercial occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: IN
5 Outside,
5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5
herein, was conducted in accordance with the requirements of the applicable code and/or standard
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
5555 authority having jurisdiction, and found to be frit6mpliance thekwip8R5the Day of 5
Name 4TY Rate Rating Circuit Type 5
5 Service 5
5 1 Phase 3W Service Rating 400 Amperes 5
5 Miscellaneous 5
5 Commercial Inspection Fee 5
5 Service 5
5 Service Disconnect: 2 200 cb 5
Meters: 1
5
5 5
S 5
5 5
5 5
5 Sea/ 5
5 1 of I e
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. S
5 5
TOWN OF SOUTHOLD PROPERTY RECORD CARD
CFW—NER ---- STREET i VILLAGE DIST. SUB.
nus T vejc
FORMER OWNERN E,-, ACR.
Ie-
MnLr is Lsaa .__ tf an() /
S, W TYPE OF BUILDING
T7, pjjl�4�
RESrU SEAS. VL,
iLFARM COMM. C B. MICS. Mkt..Value
LAND IMP. TOTAL DATE REMARKS
L 4 B ..`1
L 2 7( --n-(6n f-i't (f F!-x 4
w,
a31ol-L (2-11 '134- aae- ho r�lnve'f-'Al �,
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
—FARM Acre Value Per Value
Acre
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD 00
Meadowland DEPTH
z
House Plot BULKHEAD
Total DOCK
COLOR > TRIAA�i PLL 71 .
h
T
MEIN - P
tii�"" Vic• L }
1
a Ir
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M. Bldg. y
IT
�r
Extension _ -
Extension
Extension
Foundatior Bath Dinette
Porch _ ... Basement 9 Floors. ..-. ) K.
— /- •a 2. .G ,
PorchIExt. Walls 5 t Interioi Finish �.>�.c+w�� LP,.
—_
A - ..
Breezeway Fire Place Heat ?' D R.
Garage Type Roof Rooms 1sT Floor BR.
Patio Recreation Room Rooms 2nd Floor FIN. B
T —
O. B. Dormer " Driveway
Total —
MAP OP-PROVrIf W,
1 P�IJf2,12ia 15AAC
140,0
651
4011
pr, c'LY "NA.'uOry L{ �i�F�+i'+r''l'7!ZI�. � I: •'
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1
Applicant/ Dale .
Owners Name: Re
Reviewed:
Architect/ ) Date
Engineer: _ Submitted:
SCTM M
a
District 1,000 Seclimti3�_ 131oct:: �_ Lai:
Project f �. Subdivision
Location: �t'� r�na 0=1 u -- � _ Name:
J
Single & separate Required
ccrltGcation: (Yes1No _ ,�
Req. �nn `� ecr R�J / r� �
7_miine Uislricl: [IAl size —�V� u'� _Aqual: d [Lal coverage Proposcd ' - �T
Req. Req. ( / Req. .
[l=roo(Yard _Proposed: [Side Yar Proposed- J [Rear Yard-=_ Proposed'
Project Description: �
AGENCY Erb RMITS Permit
REQUIRED FOR REVIEW N_& NO YES Number
Suffolk County Health Dept.
New York State D_ E. C.
Town Trustees
Town Zoning Board approval: i
Town Planning Board approval:
Flood Plane Elevation M
Flood Zone: ��
Notes.:
lr
765-1802
BUILDING DEPT.
I PECTION
[ FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMA KS- l
DATE + INSPECT
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOU DATION 1ST [ ] ROUGH PLBG.
[ F NDATION 2ND [ ] INSULATION
[ RAMING [ ] FINAL
[ ] FIREPLACE & C, 1 NEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE INSPECTO 4"'2
1
765-1802
BUILDING DEPT.
INSP96TION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ 1 FOUNDATION 2ND [ ] 1 ULATION
[ 1 FRAMING [ FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
rr
P
DATE
"} f P INSPECTOR
t
FIELD LNSPECTION REPORT DA / FONEVIENTS
- Cao
FOUNDATION ( — 30 �]
---------------------------------------
FOUNDATION(2ND) .m
_ t �
m
ROUGH FRAMING&
PLUMBING -- -
� f
INSULATION PER N.Y.
STATE ENERGY CODE ---�- --
FINAL
ADDITIONAL CONUgFNTTS [�
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7
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: (63 1L)-76571802 Planning Board approval
FAX.- (631) 765-9502 Survey
A-ww. northfork.net/Southold/ PERMIT NO. 3��� 3 Check
Septic Form
N.Y-S.D.E-C-
.`/ Trustees
Examined 4y 2 2010 � Contact_
Approved,200�/ Mail to:
Disapproved a,c
Phone:
Expiration D '7
uilding Inspector
R — APPLICATION FOR BUILDING PERMIT , I
_ Date 3 20 Oy
INSTRL CTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building hupector 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 premises, relationship to adjoining premises or public streets or
areas, and•watenvays.
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 permit for 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, Suffoll;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 o applicant or name,if a corporation)
J Z Z ; ,C J /.(6
ailing address of app cant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Owaf t1"
Name of owner of premises s �/37P,� T J[yo7
(_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:,?
Z
House Number ( Street Hamlet
County Tax Map No_ 1000 Section Block Lot
—r
Subdi-,2sion Filed Map No. lhdt
(Name)
2. State existing use and occupancy of premisespd intended use and occupancy of proposed construction:
a_ Existing use and occupancy
b. Intended use and occupancy S61YT e-
3. Nature of work(check which applicable): New Building Addition Alteration
Repair_t/ Removal Demolition Other Work �PC.�
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
i
7. Dimensions of existing structures, if any: Front `il Rear 246 Depth 4/y
Height Number of Stories Z
I
Dimensions of same structure with alterations or additions: Front SomQ- "'" Rear
Depth Height n Number of Stories
S. Dimensions of entire new construction: Front �!N Rear Depth
Height Number of Stories ��yy
9. Size of lot: Front coo + Rear 00( )' Depth /TO
3 10. Date of Purchase ZDO1 Name of Former Owner Ml)//t s J-
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-funioved from premises? YES_NO
14. Names of Owner of premises Address Phone No.
Name of ArchitectAddress Phone No
Name of Contractor Addizss Phone No.
15 a_ Is this property within 100 feet of a tidal wetland 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_LZ
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide sun•ey, 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.
STATE OF NENA'YORK)
SS:
COUNTY OF )
C/�— being duly sworn, deposes and says that(s)he is the applicant
(Name of indi�adualT signing contract) above named,
(S)He is the 01"V/
(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.
Swo {l'before me this r
day Qf i I 206_
No Public Signature of Applicant
BONNIEJ.DOROSKI
Notary Public,State Of New York
No.01DO6095328,Suffolk t
Term Expires July 7,20
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ALL CONSTRUCTION SHALL
MEET THE REQUIREMENTS OF THE
- - - - �IT
CODES OF NEW YORK STATETi .
' I
APPRO ED Ai NOT
!I •,i1,� ';ittP - i lr ME lo I DATE: B.P.IX
.� FEE: /� BY:
NOTIFY BUILDING DEPARTMENQ AT
765-1802 8 AIM TO ! M FOR
�RFc
LLOWING I N0 N Y FQU�b'�R
TI N AYE IR
LAWF
O / U 'FC � � .- el�EssWITHOUT CERFICATE . eE c N K c.o MBING
3. FINAL - r ,71;tCI ION MUST S
OF OCCUPANCY � .
�'�t! 1 ALL CONS'�J, ION SHALL MEET THE �{
✓'G+L�F• ` �ItiI ,�yy � 1 p REQUIREMENTS OF THE CODES OF NEW Y�
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