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HomeMy WebLinkAbout30254-ZFORM NO. 4 TOWI~ OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-30350 Date: 08/11/04 T~IS CERTIFIES that the huild~ng ABOVE GROUND POOL Location of Property: 1275 NOKOMIS RD SOUTHOLD (HOUSE NO_) (STREET) (PIAMLET) County T~x Map No. 473889 Section 78 Block 3 Lot 30.1 Subdivision Filed Map No. __ Lot No. __ conforms substantially 5o the Application for Building Permit heretofore filed in this office dated APRIL 21, 2004 pursuant to which Building Permit No. 30254-Z dated APRIL 22, 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 ABOVE GROLrND SWIMMING POOL WITH DECK AROUI~D AS APPLIED FOR "AS BUILT". The certificate is issued to DON & LINDA LUBOV (OWNER) of the aforesaid building. SUFFOLK COUNTer DEPARTMENT OF lt~J~THAPPRO~-AL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A ~/r~d S ig~ture Rev. 1/81 FOPdVi NO. 4 TOWIq OF SOUTHOLD BUILDinG DEPARTMENT Office of the Building Inspector Town Hall Southold, CERTIFICATE OF OCCUPANCY No: Z-30351 Date: 08/11/04 THIS CERTIFIES that the building ADDITION Location of Property: 1275 NOKOMIS RD (HOUSE NO.) (STREET) Cotunty Tax Map No. 473889 Section 78 Block 3 Subdivision Filed Map No. -- Lot No. -- SOUTHOLD (HAMLET) Lot 30.1 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 21, 2004 pursuant to which Building Permit No. 30254-Z dated APRIL 22, 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 APPLIED FOR "AS BUILT". The certificate is issued to DON & LINDA LUBOV (O~E~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~EALTH APPRO~-AL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION D~rmu N/A 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. 30254 Z Date APRIL 22, 2004 Permission is hereby granted to: DON LUBOV 1275 NAKOMIS RD SOUTHOLD,NY 11971 for : AS BUILT DECK A_KID AS BUILT ABOVE-GROUND SWIMMING POOL AS APPLIED FOR. 2 COS REQUIRED SIMULTA~IOUSLY AND ADDITIONAL CERTIFICATIONS MAY BE REQUIRE at premises located at 1275 NOKOMIS RD SOUTHOLD County Tax Map No. 473889 Section 078 Block 0003 Lot No. 030.001 pursuant to application dated APRIL 21, 2004 and approved by the Building Inspector to expire on OCTOBER Fee $ 600.00 22__, 2oo__ . ..',.' ,/ I/ Autho~ized'5~f~nature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD DEPARTM~ENT BUILDING TO~2'q HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Tkis 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, sJreets, 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, indnstdal building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engdneer responsible for the building. 6. Submit Planuing Board Approval of completed site plan requirements. B.. ~or e~xi~-mg building: (prior to4~pril 9r&9~7) non-conforming~uses~ orbuildings- and-"pre-exisfingv- land uses:. l. Accurate survey of property showing all property lines, slreets, building and unusual natural or topographic features. 2. A properly completed apphcation 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 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 Oecupaney - $.25 4. Updated Certificate of Occapancy- $50.00 5. Temporary Certificate o f Occupancy - Residential $15_00, Commercial $15_00 Old or Pre-existing Building: New Construction: Location of Property: {,D~? ~-- House No. Street Suffolk County Tax Map No 1000, Section ~) 7t~o' Block Date. ~)~/~ ¢ (cheek one) Hamlet Subdivision ermit No. 9--9 Health Dept, Approval: Date of Permit. Filed Map. Lot: Underwrit~r~ Approval: planning Board Approval: Request for: Temporary Certificate Sub-,itted: $oo Final Certificate: (cheek one) Form TOWN OF 8OUTItOLD · '~ BUILDING DEPARTMENT · -, TOWN HALL :'~ 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: For new building or new use: 1. Final survey of property with a~curate location of all buildings, property lines, streets, and unnsual natural or topograpkic features. 2. Final Approval from Hcalth Dept. 0fwater supply and sewerage-disposal (S-9 form). 3. Approval of eleclrical installation fi:om Board of Fire Underwriters. 4. Sworn statement fi:om plumber certif55ug that the solder used in system contains less than 2/I0 of 1% lead. 5. Commercial building, indnstrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from m:ehitcct or engineer responsible for the building. 6_ Submit Plannin g Board Approval of completed site plan requirements_ For.e~isling~uildings.(prior to April 9, t957) non-eonformin~-uses~r-buildings and "preexisting-" land uses: 1. Accurate sur~ey ofproperty showing all property lines, streets, building and unusual natural or topographic features. 2_ A properly completed application and consent io inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in aa/ting to the applicant. 1. Certificate of Oecupancy- New dwelling $25.00, Additions to dwelling $25.00, Alterations to .dwelling $25.00, $Wil~ming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Bnsmesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Oecupancy- $.25 4. Updated Certificate of Occupancy- $50_00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Old or Pre-existing Building: ~ LoeationofProperty: {'&-7~- t~,~CcI<Z~$~-~.S ~-C~' House No. Street 8uffolk County Tax Map No 1000, Section ~) 7~0' Block (check one) Hamlet Lot ~gr tgO I Subdivision Permit No. Health Dept. Approval: pJnnn{ng Board Approval' Requeat for:. Temporary Certificate Date of Permit. Filed Map. Lot: Underwriters Approval: Final Certificate: L~ (check one) Nassau Suffolk Electrical Inspections, Inc. 5A Canal S~eet * Center Moriehes, New Yo~k 11934 * Tel: 631-878-3500 * Fax: 631-ti78-3764 Application: 2204 Date:7-26-04 Issued to: Lubov Address: 1275 Nalcomis Dr Village:Southold Introduced By:FL/O License #:N/A was examined mud approx ed up to the abe; e date arid was in compliance with the NEC Attic 1 st Rmr Residential[] Pool [] Det Garage Basement 2nd floor Cemm~rdal ' Hot Tub gdditJon Switches Receptacles Fixtures ' G.F.h Range Hood Whirlpool 2 2 Oven Carbo~ Fans Dishwasher Washer/Amps Dryer/Amps Range/Amps Monoxide I Sr~oke Bell Furnace Oil Gas Heat Zones I Detectors Transformers I I Meter I Amps Phase Motors Other Equipment: i I Sero i-lnground P~ol Out,Res I 'This certifi6at~x~ust n0~ be altered in any maturer O~ <0 OTM 0 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ~ FINAL [ ] FIREPLA~,E & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARK S..~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]ROUGH~ [ ]FOUNDATION 2N~ [ ]_~ATION [ ] FRAMING . [~"FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE ~ INSPE~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUL/A-~I~i~ [ ]FRAMING [,---~A~// [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ~/~~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH PLBG. [ ] I~ATION [ r~' FINAL ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION DATE INSPECTOR DATE COMMENTS FOUNDATION (IST) ~'~1 --~ FOUNDATION (2ND) ---- ', ~ ~S~A~ON PER N.Y. M STATE E~RGY CODE , ~ TOV~SN OF SOUTHOT ,D BUILDINC~ DEP.~TMENT TOgVN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ww~v. northfork.net/S outhold] PERMTr NO. Examined Approved Disapproved a'c Expiration ql,h ,2o q BUILDING PERMIT APPLICATIO}q CHECKLIST Do you have or need the following, befc~.-e appbsng? Board of Health ~sets of Building Plans p]annlng Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: .,20 - · · INSTRUCTIONS a~T.~,~plitatinn IvlUST be completely filled in by typewriter or in ink and subrrdtted 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 premises, relationship to adjoqnqng 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 m parr for any purpose wt~at so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not comm~mced within 12 months after the date of issuance or has not been completed within 18 months fi-om 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 slx months. Thereafter, a new permit shall be required. .APPLICATION IS HEREBY MADE to the Building Department for the issuance of a BuilcFmg Permit pursuant to ;he Building Zone Ordinance of the Town of Southold, Suffolk Coumy, New York, and other applicable Laws, Ordinances or Regulations, for the construction o£buildings, additions, or akerations or for removal or demolition as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to admit amhonzed inspectors on premises and in building for necessary inspections. "-+~gnature of applicant or nme, if a corporation) .~,.,-... ' (Mailing addres/s of applicant) ; /{g .~ / State whether applicant is owner, lessee, agent, ar~fitt~t_.., engineer, general contractor, electrician, plumber or builder Name of owner of premises q'~O~ ~ ~? ,~© 0 (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: T i _'br o 7"4o / House Number Street Hamlet County Tax Map No. 1000 Section (~)"?~" Block O '3 Subdivision Filed Map No_ (Name) Lot Lot 30, State existing use and occupancy of premises and inte~_~ded use and oc~cupancy of proposed co~t~%~ruction: ~ a. Existing use and occupancy ,l~oO~_- ~ ~-0~ ~Oot.~ b. Intended use and occupancy ~F--C~ r~,O~ Nature of work (check wkich applicable): New Bt:ii,ding /_j Addition Repair Removal Demolition"---.: Other Work Estimated Cost Fee If dwelling, number of dwelling units if garage, number of cars Alteration (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth Height 8. Dimensions of entire new construction: Front Rear Height Number of Stories 9. Size oflot: Front //C~ / Rear ~ ~-, ~- / Depth Rear -...Number of Storie§" ~,~ Depth 10. Date of Purchase__ ,/¢77 Name of Former O~vner 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 firom prennses? YES NO l 4. Names of Owner of premises ~)o~-, ~, ~a ~'. L~ ~.~ddress I~ 't~t* ~-4~a~ ~ ~ ~ Phone No. ~ Name of Architecll2-~ ~,~l ~o Address '~ ~ -sb" ~ t (- ~ ~ Phone No 7 te~ Name of Contractor ,~aaress t-none 15 a_ Is this property within 100 feet of a tidal wetl~d o~[ra fxeshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE R~QUI~ED. 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 an5' point on property is at 10 feet or below, must provide topographical data on s.urvey. STATE OF IXrE\V YORK) SS: COUNT'/' OF ) / '~ ~} ~'). ~X~.'~'~..'/~Q ~ being dOy swo~ deposes ~d says ~t (s,he is the apptican[ ~a~e of ~di~id~l sJ~ing contract) above name, (S)He is the {~~ (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 fde this apptic~ that all statements contained in th/s application axe true to :he best ofkis knowledge and belief; and that the work will be performed hi the manner set forth in the application filed theY"er w~th. JOYCE M. WILKINS Notary Public Stat~ of N=w York No. 4952?.46, Suffolk County Term Expires June 12, ~ O0