HomeMy WebLinkAbout30429-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30401 Date: 09/02/04
THIS CERTIFIES that the building ADDITION
Location of Property: 2200 HARBOR LA CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 103 Block 1 Lot 27
Subdivision Filed Map No_ Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 16, 2004 pursuant to which
Building Permit No. 30429-Z dated JUNE 23, 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" DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR-
, The certificate is issued to ROBERT C WHITE
(OWNER)
of the aforesaid building.
i
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A_
PLUMBERS CERTIFICATION DATED N/A
'
7/orted 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 N0. 30429 Z Date JUNE 23 , 2004
Permission is hereby granted to :
ROBERT C WHITE
HARBOR LANE
CUTCHOGUE,NY 11935
for
CONSTRUCTION OF AN "AS BUILT" DECK ADDITION AS APPLIED FOR.
ADDITIONAL CERTIFICATION WILL BE REQUIRED
at premises located at 2200 HARBOR LA CUTCHOGUE
County Tax Map No. 473889 Section 103 Block 0001 Lot No. 027
pursuant to application dated JUNE 16 , 2004 and approved by the
Building Inspector to expire on DECEMBER 23 , 2005 .
Fee $ 300 . 00
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ORIGINAL
Rev. 5/8/02
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTNIENT
TORN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Budding 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. V
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 tens than 2;10 of I'Vo 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 Platming 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 convent 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,
Swimmingpoot$25.00,Accessory building$25.00, Additions to accessory building$25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildine- $100.00
3. Copy of Certificate of Occupancy-$.23
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date. 57— O l-f—
New Construction: Old or`Pre-existing Building: (check one)
Location of Property: 2C 0 t_ 17�WO&CI E_ /V
House No. '� Street Hamlet
Owner or Owners of Property: C62&,C/2-
Suffolk County Tax Map No 1000, Section /r� 3 Block 0 O0 / Lot G Z 7
Subdivision Filed Map.t Lott:A
PenNo. 3 0 4 r5 Z Date of Permit. 7' / —O Applicant: 12615 � (.cam/t/i E
Health Dept_Approval: __Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate_ Final Certificate: _t� (check one)
— Flo
Fee Submitted: $ Z J
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Lr7C�� Applicant Sigxiature
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DATE RE UYVED: j�-/x:'04
APPLICANT: CAMT � _" `I_y _ DATE SUBMITTED: &,'-/ 04
SCT11I9DISTRICT 1.000; SECTION: 103 , BLOCK: , LOT: 42� SLB)NISION: ` - . -_
ADDRESS: CITY: t: uc3�O 7_ON1NG DISTRICT: __ CONFORMING^
_— ,
BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N
BP----Z.1 C10 Z- INFO -Z i C/0 Z- INFO--
13P -Z/C/0 Z- , INFO ✓/BP -Z/C/0 Z- _, INFO
1 SINGLE & SEPARATE CERTIFICATION-REQLIIRED_ NOTES:—
] LOTS a0,000SF-1002og
4.Lot reenitlon.(CREATED beforeER5
lune 30, 1983),UND17.P0 LATS FROM JAN.1997100-Z5.Nferger.(A nonronforminga[any time afle
REQ. LOT SIZE —ACT. LOT SIZE: NO2-CREQ. LKCOV.s,2�ACT. LOT COQ'.
REQ. FRONT_ T PROP.FRONT—R .
_ e f s ACT. SIDE
REQ. REAR -_1z S' PROP. REAR— -/ REQ. HEIGHT PROP- HEIGHT--
PROJECT
ROP. HEIGHT _PROJECT DESCRIPTION:
ESTMATED PROJECT COST: ARCHITECTdRtMZ=>
WATERFRONT? Zt DESCWTION: L #, t�FLOOD ZONX
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DF T: YES or 60>ED #):_DTE:__i__! PEPAflT#: _
TO WN SEPTIC RECEIPT: Y or
NEVA'YORK STATE DEC: PRr-DbC 9rtr75 YES ori _DTE: –/ PERMIT #:
SOUTHOLD TOWN TRUSTEES: YFS ordM DTE. PERMIT #:
TOWN ZONING BOARirs APPROVAL: YES o DTE: PERMIT#:
TOWNPLSu1. BOARD'APPROVAL: YES or _–_DTE__/ _/ – 'PEnIIT #: —
TOWN HISTORICAL!PRE (SPLIA): YES —
NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): YES or NO
NOTES: --- � �'' ce�n` ----
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: _ _SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: _ °=)fes SF FEE FEE FEE
1. (—SF)- (_SF)= -_SFX
2. ( SF)- L SF)=---SFX
3. (
---SF)- (_—_SF)= SFX $--
FINAL TOTAL: S
yo
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
j [ ] FOUNDATION 2ND [ ] 1 ULATION
'
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE p. INSPECTOR /✓�
�/ 1
FIELD INSPECTION REPORT - DATE COMMENTS
� ro
FOUNDATION(1ST)
�- at
--------------------
FOUNDATION(2ND)
----------FOUNDATION(2ND) .
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ROUGH FRAMING& y
PLUMBING f
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INSULATION PER N.Y. 3
STATE ENERGY CODE
iQclo
FINAL
ADDITIONAL COMMENTS '
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SURVEY OF PROPERTIES
5ITU,4TE: GUTGHOGUE
TOWN: 50THOLD N
SUFFOLK COUNTY, NY
�I
5URVEYED 0-1-11-02
SUFFOLK COUNTY TAX u `
1000-103-1-21
1000-103-1-20
GElft'TMW TO:
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Land N°�� or Fornerly of
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5 C.
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NOTES: �QEy� �0 - .r. -
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MONUMENT FOUND * -
p PIPE FOUND
TOTAL AREA = 20,000 SF OR 0.64 AGRES
-
AREA TAX LOT 2-1 = 140 5 FO -_ ';,: '......
00 FOR 0.32 AGRES 1 , - _
AREA TAX LOT 26 = 14,00 O 5F OR 0.32 AGRE5
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S.LIC.NO. 50202
i.
GRAPHIC SCALE "= 30' RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF-\\Hp server\d\PROS\02-222.pro
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING D9PARTMENT Do you have or need the following,before applying'?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sea of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631)765-9502 Survey
www.northfork.net(Southold/ PERMIT NO. � Check
Septic Form
N.Y.S.D.E.C.
y ` Trustees
Examined a � ,20� Contact:
Approved 20� Mail to:
Disapproved a/c
Phone:
Expiration ,20�_ Q
Buildin etet--
rl PP ICATION FOR BUILDING PERMIT
\Thi��\VOieation
Date 20
INSTRUCTIONS
a. MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plans,ac te`[ilot plan to scale. Fee according to schedule.
b. Plot pl shogc�'rtg location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas,and waterwa .
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, 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.
Leo,lei khtfc-
(Signature of applicant or name,if a corporation)
GGl fG�ilL9C ut /Vy
(Wiling address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer,general contractor, electrician, plumber or builder
Name of owner of premises �u r
(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.
7ther Trade's License No.
1. Location of land on which proposed work will be done:
Z. 3oo H19ROoZ L.Fln/E CUTCIWOGUE /t/ `/
House Number Street Hamlet
County Tax Map No. 1000 Section 10 j O Block O /O D Lot ---Z:W I,
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy fis I'j(;{,L(, l NGP.Ie_--
b. Intended use and occupancy LL& h w--. " C)�Oe-)(--
cCLa�
3. Nature of work(check which applicable): New Building Addition X —Alteration--------
Repair
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: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
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 from premises? YES_NO___
14. Names of Owner of premises _Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address 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
* 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 14
/,e0,4G( W6-1 A— being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the LZ'-k-'
(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.
Sworn to before me this —
/ v _200&
-� �SureVAlancNotary Public
PATRICIA C. MOORE
Notary Public,State of New York
Suffolk County-No. 4861668
Commission Expires June 16,2ou
,�i-kA1>�lolvA-L C�P2�lFlcA�c�c.�S
/^\ APPROVED AS NOTED
---, / DATE: !L^ B.P.# 3040�1-F--
FEE: E)w BY
" �� NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
° FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
�XISTINC� NOUS 2. ROUGH - FRAMING & PLUMBING
r 3. INSULATION
1 4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
_-- ------ -----------
REQUIREMENTS OF THE CODES OF NEW
- - � � - - YORK STATE. NOT RESPONSIBLE FOR
— —
-
`---------------- ------- --- - *--------- ----------------------------------------- OR CONSTRUCTION ERRORS.
1 I, DESIGN
2XB LEDGER BOLTED
TO HOIJ5E a32"OC
COMPLY WITH ALL CODES OF
NEW YORK STATE &TOWN CODES
oAS REOUI ED AND CONDITIONS OF
x SOUTHOLD TOWN ZBA
TrF 4X4P06Tw/ SOUTHOLD TOWN PLANNING BOARD
12"XI2" GONG. FTG.
' 3' Eaow GRADESOUTHOID TOWN TRUSTEES
n_) 2Xe 1 -------------- N.Y.S.DEC
-' Fw(2 GIRDER - - - a
-- FE -
--, 5 ------------------------------ -
�O"
OCCUPANCY OR
USE IS UNLAWFUL
9 WITHOUT CERTIFICATE
OF OCCUPANCY
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540 5O' 5� O ' r O"
ALL r^NSTRUCTION SHALL
(2) 2XB MEET THE HEOUIREMENTS OFTHE
FLusu GIRDERf CODES OF NEW YORK STATE.
-1-Fj
OAA FOUNDATION FLAN FLOOD ZONE N
BUILT PRIOR TO 2003 COMPLY WITH CHAP ER"46"
FLOOD DAMAGE PREVENTION
SOUTHOLO TOWN CODE.
1-1!
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5/4X6 CEDAR DECKING
f'A 2XBDJ alb"OC J
2X8 LEDGER 1 1(2) 2XB FLU6H GIRDER -
4X4 P05T "v bWz
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SECTION A-A
2J�Es, u0
DECK (BUILT PRIOR 2003)
` HARBOR LA., CUTCHOGUE, IJY
P
of 3 June 11, 2004 SCALE 1/4"
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EX16TING
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N
° FLOOD' FLAN
- BUILT PRIOR TO 2003
20'-O"
NEJV
IQ `'F
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DECK (BUILT PRIOR 2003)
HARBOR LA., CUTCHOGUE, NY
Pe. 2 OF 3 June II, 2004 -E 1/4',
i
REAR ELEVATION
_ - _ - - - _ _ _ - - - - - 1 - - - - - - - - - - - LEFT ELEVATION RICHT ELEVATION
LU
NrirP-^a56�1
DECK (BUILT PRIOR 2003)
HARBOR LA., CUTCHOGUE, NY
PG. SCALE
3 of June II, 2004 I/4"