HomeMy WebLinkAbout30544-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30360 Date: 08/16/04
THIS CERTIFIES that the building ADDITION "
Location of Property: 6955 SKUNK LA CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No_ 473889 Section 104 Block 4 Lot 33 .2
Subdivision Filed Map No_ Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 2, 2004 pursuant to which
Building Permit No- 30544-Z dated AUGUST 5, 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 WITH ARBOR ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR "AS BUILT" .
The certificate is issued to EDGAR A. & DONYA VANBUREN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO- N/A
PLUMBERS CERTIFICATION DATED N/A
uthorized 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. 30544 Z Date AUGUST 5, 2004
Permission is hereby granted to :
EDGA A & DONYA VANBUREN
6955 BAY AVENUE
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF A DECK WITH ARBOR ADDITION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR "AS BUILT"
at premises located at 6955 SKUNK LA CUTCHOGUE
County Tax Map No. 473889 Section 104 Block 0004 Lot No. 033 . 002
pursuant to application dated AUGUST 2 , 2004 and approved by the
Building Inspector to expire on FEBRUARY 5, 2006 .
Fee $ 300 . 00
Authorized Signature
ORIGINAL
Rev. 5/8/02
055 3 .
Form No.6
{' TO`V1N OF SOUTHOLD
BUILDING DEP.XRTNIENT
i TORN H_AI.L
i ------_----n 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 Code Compliance from 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:
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.
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. ov y
New Construction:_ Old or Pre-existing Building: ^(check one)
Location of Property: �9A r./� C� k o
House No. I Street _Hamlet
Owner or Owners of Property: 1� 0. Eekr V4 #L 4 ✓C <"
4738q
Suffolk Countv Tax Map c .000, Section 1 0 4 Block O O O y Lot 033 007-
Subdivision Nit 5 5 a0, f a v w. 5 Filed blap. (� 9 _Lot: 2
Permit No. 'j0 5 4 •Z Date of Permit. CJ r 0 - 0 / Applicant:_ � �Iti 4✓ Q k
Health Dept. _Approval: Underwriters Approval: J-
Planning Board:approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
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`__ ROBERT O'BRIEN P.E. CONSULTING ENGINEERING SERVICES
2074 MAIN ROAD, P.O. BOX 456, LAUREL, NY 11948 - 631-298-5252
July 28, 2004
Southold Building Department
Town Hall
Southold, New York
VanBuren Residence
Certffioate of Occupancy for Rear Deck Addition and Arbor (As-built)
6955 Bay Avenue, Cutchogue, New York
Gentlemen:
I hereby certify that the rear 8' x 24' deck addition and arbor (as-built) at the
above-captioned property appears to be structurally sound. Further, that it was con-
structed in accordance with the building codes in effect in 1988, when the deck was
constructed, and in 1996 when the arbor was constructed.
Very truly yours,
'`PSS OF NEW lO9
I F. 0,6 ¢
`(1 W
Qr
Os2"IN 20� Robert O'Brien P. E.
pROfE'SSIOW,
I � —TOWN OF SOUTHOLD PROPERTY RECORD CARD
VILLAGE DIST. SUB. LOT
OWNER 1 STREET / ` e y •� p/ . Past- A �� 14
V' \ Cf U` I J MI �d1 t�j1a6\f ,,.� c k1 t I V1 ZaCCG-1 1'CtY`4tr1
FORMtR OWNER N E rr "ACR. - -- - .
� �1VW 'ree La�
S W TYPE'OF BUILDING
I�- I dA-I d,. P v
RES. SEAS. VL. FARM COMM, CB, MICS,,, > 'Mkt, Value
LAND IMP. TOTAL DATE REMARKS
(xA GSI '"'! a;J.r..:: ,.Y"a� w•.> ..:�'�. !J ±`3."� �'r;:�. �;- - --I.� ^ '.�, �( , lTM'.f�rt hl�l l r�"�z AC:ac, —'-
/..:i /'' 69 C A?P r�W a ��.�C7d•):.;�5'n 4"a! - .t'pre d6. • &•@ el b i Ci ) 477661--
/7G U - / ". �Y's3� - ar 111.013
Tillable FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD •^a 'F,a i
Meadowland DEPTH
House Plot BULKHEAD
Total
11 1
.7.��. s... ...�..
u
4
;. ,_ . . _
1� 8
'A 11141 Foundation f'a ( , Bath
xtension to X �, . _ r7 �Z Basement )C'u // Floors
Walls Interior, Finish Ext.
=xtep�s„�. .. ! ,- tet• (� <?"--" (,, r11'• �.
Extension Fire Place Heat 6,
je
)' q 2, /vG,
3orch ,.' 0
Pool Attic
)eck Patio Rooms 1st Floor
3reezeway Driveway Rooms 2nd Floor
�,
B.
-� Applieanti Date.
Owners Name:.. . .1 _ — -- Reviewed:
Architect/ Date
CagiReer: B C�i �d �^� _ Submitted:
SCTM #:
Diorki: l 000 Scction: ���/ Mock: Lot:
I'1'ajccl p _yg Subdivision
Name:------
Singlc S separate Required
cent cation (Yes(Nal
Req. �p rG Rrq. ),(
Toning Dislria:�" tial sin: Z.L_�IV �3 Acrual.__��_(LI Ilrt ruvcrngc p� _I'ropusc�
Req. Req. S Req
. ` -
Yard Protwsed- 11 —J—(Side Yard Pretwsed: �_J (Rear Yud � Professed- d—
Project Description:
NA
AGEN
C s Permit
RR'OUIRED FOR RE,VICW N_A. ISO YES Number
Suffolk County Health Dept
New York State. D. E.C. l
Town Trustees _
Town Zoning Board approval:
Town Planning Board approval:
1.
Flood Plane Elevation
Flood Zone:
No
4 , .
-i_ROBERT O'BR1E1Y P.E. CONSULTING ENGINEERING SERVICES
2074 MAIN ROAD, P.O. BOX 456, LAUREL, NY 11946 631-29B-5252
July 28, 2004
Southold Building Department
Town Hall
Southold, New York
VanBuren Residence
Certificate of Occupancy for Rear Deck Addition and Arbor (As-built)
6955 Bay Avenue, Cutchogue, New York
Gentlemen:
I hereby certify that the rear 8' x 24' deck addition and arbor (as-built) at the
above-captioned property appears to be structurally sound. Further, that it was con-
structed in accordance with the building codes in effect in 1988, when the deck was
constructed, and in 1996 when the arbor was constructed.
Very truly yours,
CPS OF NEW YO
I F. O•B 9•f
? 2
Yn W
\Z�Fe N°• 052
11 �'O$� Robert O'Brien P. E.
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [,--f'FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
11i �� s
DATE 6 S c INSPECTOR
FIELD INSPECTION REPORT DATE COMNIENTS
•e
r=
FOUNDATION(1ST) -- ---- '�
L�
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FOUNDATION(2ND)
O
ROUGH FRAMING& r
PLUMBING
V1
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9
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iNsULATION PER N.Y. —
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
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TORN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTXIENT Do you have or need the following,before applying?
TOWN HALL, Board of Health
SOUTHOLD,NY 111171 )(sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 �/ dSurvey
vrww. northforILnet/Southold/ PERIIIIT NO. 02 -&i Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 20_D q Contact:
Approved
Mail to: h elVGr—
$�� , -OD L
Disapproveda/c `ADZ SlX-�t S •r�V-�,.p
Phone:y77^ d �/,Aj
Expiration_ a' 5',200� of
/ ( �
r—
t� V`4hi4r-e�—
uilding Inspector 4 "z R o - (P 2-
�` r. "
AUG APPLICATION FOR BUILDING PERLVIIT 7 'iy — -7b 1
i Date 20
MO INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 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 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 IvLADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, 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
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 of applicant or name,if a corporation)
(Mailing address of a cant
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises Z /,/ rIJ// 4--Xz
(Aso a 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.
I. Location of land Nvhic proposed work will be done._,
House Number Street f1Hamlet 2 2
County Tax Map No. 1000 Section 109 Block " I Lot'F3 .
Subdivision W 5 S t ::Fd V 1% 5 Filed Map No. 11 -79. Lot
(Name)
2_ State existing use and occupancy of premises and intended use and�oo cupancy of proposed construction:
a. Existing use and occupancy 6TG' lzs��/ll/ /TOiIL�
b. Intended use and occupancy
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal` Demolition Other Work
(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.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Fronte. Rear
Depth Height Number of Stories I"Ot
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
S Depth / if o I
9. Size of lot: Front .�((''12- 5 , Rear � 2 �
10. Date of Purchase Slrh, 19 9 5 Name of Former Owner ✓I e-
4 f
11. Zone or use district in which premises are situated A
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 'V"'
f J C-Z . Aa{c„p
14. Names of Owner of premises Gd r/✓ ddress 6 iP���! 12 JPhone No. 7 3 �� 7912-
Name
812-
Name of Architect Address Phone No
Name of Contractor % � c� Address �/;`IIav Fk Id� Phone No. 7&S— / y l?
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO i"
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_
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF
�
,P N A_ U.4 N 33 47-E�/
t-E�j/ "being duly sworn, depose_ and says that(s)he is the applicant
(Name of individual stgnmg contract) above named,
(S)He is the
(Contracto gent, 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.
Swom to begemethis
2..-e ^_0
Notary Public Signa e of App cant
/ R RT 1.SCOTT.JR.
Notary ublic,State of New York
O 1 led in Suffolk County
AN0.01SC4725089
To Expires May 31,
SUPFpLK C&J HLTH DEPT APPFROVIh
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DATE: B.P.#
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w� -- ✓ NOTIFY BUILDING dEPARTMENT AT----- - - -
-
765-1802 8 AM TO 4 PM FOR THE
R
w 'K s — -- FOLLOWING INSPECTIONS:
1. FOUNDATION - Two REQUIRED Q CUPANCY OR
�r iF FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING —� IS UNLAWFUL
'.I `�� �•�P¢.Mcs f�,J��.� �, >,",� �, ��,� �,,� 3. INSULATION
t6 OF NEK 4, FINAL - CO STRUC.TION MUST WITHOUT CERTIFICATE
y1P t F. , BE C
0Y�RF ETE FOR C.O.
NSTRUCTION SHALL MEET THE OF OCCUPANCY
y QUIREMENTS OF THE CODES OF NEW
Y RK STATE. NOT.IIESPONI FORf - -- -
`I SIGN OR CONSTRUCTION
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5 ��Td� c tf iza�f/ ZN CQN TION SHALL ?AF Apry , e..' Nc �'1.Ar. r'. iCI- _ell td3tai[T,�_
REMENTS OF THE
1a f-Y '=a. ' �-5 •_} ° ` WYOWSTATE. m ROBERT O'BRIEN P.E.
CO.N.SULTINC3 ENGINEERING SERVICES
OF nneRoad, l
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N.Y. 94e
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CERTIFICATION �L_F✓_ � ___ _ _/_i/'r .
p� NAILING 81 CONNECTIONS DWN LJ I
SCAL: DRAWING NO.
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