HomeMy WebLinkAbout29752-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y_
CERTIFICATE OF OCCUPANCY
NO: Z-30464 Date: 10/04/04
THIS CERTIFIES that the building ACCESSORY
Location of Property: 2835 PLATT RD ORIENT
(HOUSE NO.) (STREET) (HASQLET)
County Tax Map No_ 473889 Section 27 Block 2 Lot 2.2
Subdivision Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 22, 2003 pursuant to which
Building Permit No. 29752-Z dated SEPTEMBER 22, 2003
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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to BRI-AN HAz1GIWARz1
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 2024041 09/23/04
PLUMBERS CERTIFICATION DATED N/A
e
ized Signature
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
f
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 29752 Z Date SEPTEMBER 22 , 2003
Permission is hereby granted to :
BRIAN HAGIWARA
PO BOX 434
ORIENT,NY 11957
for
CONSTRUCTION OF AN IN-GROUND SWIMMING POOL AS APPLIED FOR
I
at premises located at 2835 PLATT RD ORIENT
County Tax Map No. 473889 Section 027 Block 0002 Lot No. 002 . 002
pursuant to application dated SEPTEMBER 22 , 2003 and approved by the
Building Inspector to expire on MARCH , 2005 .
Fee $ 150 . 00
A hor ed Si re
i
I
ORIGINAL
Rev. 5/8/02
Form No.6
TOWN OF SOUTHOLD
BUH DINGDEPARTMENT
TOWN HALL
765-1802
-- --_r APPLICATION FOR CERTIFICATE OF OCCUPANCY
p'i2t Fi vi ..
Cts appTtcafiori 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 Undenwiters.
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. Submir PlainihigiBoard 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 sighed 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,
Swimrning 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.
New Construction:V/Old or Pre-existing Building: (check one)
Location of Property: ZZ35 PL4,1-'C 9-0AD 0P'lE4f
House No. Street Hamlet
Owner or Owners of Property: T)t 1A,i PA&W A fZ A
Suffolk County Tax Map No 1000, Section 21 Block %> Lot
Subdivision 5PTTCgRs Co OYSTer- Po-JPS Filed Map. 7724 Lot: Z
Permit No. 2915 L- z Date of Permit. 03 Applicant: 13 14A-(7u..1 A a-A
Health Dept_Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ ZS- oc
-330
II
( C✓�YJ �� App ' ant ignature
I
BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY 5
40 FULTON STREET — NEW YORK, NY 10038
CERTIFIES THAT
5 Upon the application of upon premises owned by
5 BRIAN BROOKS ELEC. INC. BRIAN HAGIWARA
BOX 1001,455 BEEBE DR. 2835 PLATT RD
CUTCHOGUE, NY 11935, ORIENT, NY 11957
rj Located at 2835 PLATT RD ORIENT, NY 11957
Application Number: 2024041 Certificate Number: 2024041
Section: Block: Lot: Building Permit: BDC: ns11
Described as a Residential0-599square h. occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Outside,PorchDeck,
5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard 5
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 23.rdDay of September, 2004.
Name OTY Rate Rating Circuit Type 5
5 Miscellaneous
2 Lights in rear deck steps
Wiring and Devices
57�57�57� Fixture 2 0 Incandescent
� 5
5
seal
1 of 1
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
rJ arJ�rJ?PcPcPcPrJ�rJ@PrJ�rJ�r21222�rJ acPrJ 1 al irJ�rJ a2 51arJ�rJ�rJ�rJ�rJ arlurJ�cfacJ ar�rSurJ�i Pr�rJ�rJ�rJ�rJ�rJ�rJrJ�rJ�rl�r�c farJ�rJ�rJ�rJ�rSrJ�rJ�rJ�rJrJrr. ar PRPE
o ��sssLnns��r�r2r1r��r�sr:r:sss���sr�r�9�ss�����rs����n�n�n�n��n�n1 21 2nPLIOnR11RO n� o
5 i BY THIS CERTIFICATE OF COMPLIANCE THE 5
S NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 n BUREAU OF ELECTRICITY 5
5 j 40 FULTON STREET — NEW YORK, NY 10038 5
CERTIFIES THAT
Upon the application of upon premises owned by
5 BRIAN BROOKS ELEC. INC. BRIAN HAGIWARA 5
5 BOX 1001, 455 BEEBE DR. 2835 PLATT RD 5
CC5 CUTCHOGUE, NY 11935, ORIENT, NY 11957 5
Located at 2835 PLATT RD ORIENT, NY 11957 5
e5 Application Number: 2026518 Certificate Number: 2026518 5
Section: Block: Lot: Building Permit: BDC: ns11
5 5 Described as a Residential occupancy, wherein the premises electrical system consisting of 5
electrical devices and wiring, described below, located in/on the premises at: 5
5 Outside, 5
5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5
5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 5
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5
5 5 authority having jurisdiction, and found to be in compliance therewith on the Day of 5
I0th November,2005. 5
5 5 Name 4TY Rate Rating Circuit Type e5
Service 5
5 1 Phase 3 W Service Rating 200 Amperes 5
rj Service Disconnect: 1 200 cb 5
Meters: I
5
5 5
5 5
5 5Nu
5 5
5 5
seal
I of I JM
N
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5 s���L3PL[I s ss�sPLII3IIsrn�ssssrnrnLnL�ssssssL���s�L�L��
JOWNOF SOUTH. OLD PROPERT(-�RECORD CARD
OWNER
STREET DIST. SUB. LOT
�JJ GE _
VILLA
FORME OWNE� N Jx 1 : p.. .a —5e � — r5
g y_ 4 'Y GV
I /�- c: r 7'1 � .-._ �1 V'1 7'C• -' E ACR.
W TYPE OF BUILDING
RES. �I Cy' SEAS. VL. -�
FARMCOMM.'. CB. 105 /v(14to Value
LAND IMP. TOTALD TE u
REMARKS = "
-----------
3C' 00lode
8 B .
zo 9l
- L
I
Tillable
FRONTAGE ON WATER
Woodland FRONTAGE ON ROAD
6 e 06 2 Q 3 Q DEPTH
House Plot c) LnBULKHEAD �
Total
360
3, �■■■■C:fid■ �Id■■■■■ ■■■
. .
.2 0 Foundation
Extension
® Basement
Floors
Extension SO
Interior Finish
Extension
2—' 6 Fire Place Heat
44
Porch Pool Attic
Deck Patio
Rooms Ist Floor
Breezeway
®� DrivewayS -.0oms 2nd Floor
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS
04
!:r
,
DATE INSPECTOR
i
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ] INSULATION
d [ ] FRAMING [ FINAL
FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: f�
I lk,:S
I
DATE 2,6 INSPECTOR—(:
. 1
7654 802
BUILDING DEPT.
INSPECTION
f.
j FOUNDATION I ST ROUGH PLOG.
FOUNDATION 2ND ] IN ATiON
FRAMING FINAL
Ic FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION
REMARKS:
c 7ull�
DATE INSPECTOR
j
L
7654 802
BUILDING DEPT.
F
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ f ULATION
[ ]
FRAMING [,,;/FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
i
f �
DATE f. INSPECTOR o
FIELD INSPECTION iE ORT DATE COIvIlVIENTB
� b
J n
FOUNDATION(IST)
m
FOUNDATION(2ND) 'O
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s
y
ROUGH FR MING&
PLUMBING `3
INSULATION PER N_Y. y
STATE ENERGY CODE '
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ADD 2;L OMMENTS P
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T6A'N'OF'`SOU'T'HOLD BUILDINGPERVIIT APPLICATION CHECKLIST
' BUILDING DEPARTNIENT Do you have or need the following,before-applying?
TOWN HALI: Board of$ealth 1
SOUTHOLD, NY 11971 3 sets of Building Plans
' TEL: (631)765-1802 Planning Board approval
FAX- (631) 765-9502 '1j 2 Survey
va w.northfoik net7South d/ ERAIIT NO. o� Check
septic Form
�z 3 NY.S.D.E.C_
Trustees
Examined ' Contact:
Approved T Ivlail to:
isapproved a/c _
Phone-.
Expiration
'lding inspector -.
'APPLICATION FOR BUILDING PERMIT
4 1 Date . 20
INSTRUCTIONS
a This application MiJSi- e-completely filled in by typewriter or in ink and submitted 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 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.
c.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 vi riting, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPL1C=-)i IGiV IS BE]?EB Y N114-DE 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 inspector on premises and in building for necessary inspections.
1 .
ISignatark of applicant orname, if a corporation)
SS-300 2+ 4& Peconit- NY ii1YF
(Mailing address of applicant)
State whether af(pplicanlrt is otvner,lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
o n4fwv"rof
il-
Name of owner of premises d r;Gv H y1 (/,
V (As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
I
(Name and title of
corporate officer)
Builders License No. /) ?Ss N�
Plumbers License No.
Electricians License No.
Other Trade's License No.
I_ Location of Land on which proposed work will be done:
2 P 3 S � 2�
House Number Street Hamlet
County Tax Map No- 1000 Section 2) Block 7 Lot 2- . a
Subdivision Filed Map No. Lot
(Name)
3
2. 1 State existing use and occupancy of premises and intended use and occupancy of proposed construction_
a. Existing use and occupancy
b. Intended use and occupancy.
3. Nature of work(check which applicable): New Building Addition__,L_Alteration
:Repair Removal Demolition Other Work
(Description)
4. Estimated Cost 9,621000 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
i
13_ Will lot be re-graded?YES_NO_Will excess fill be removed from premises? YES NO
14. Names of Owner of premises Dfi H M Address_a Pas � �//LtT� 41 Phone No.
Name of Architect Address Phone No
Name of Contractor :JrA t n'-Address 35'-300 j& yF Phone No. 73x1- 76 O 0
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 REQUI tED.
b. Is this property within 300 feet of a tidal wetland? * YES NO_X_
* 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
urveySTATE OF NEW YORK)
SS:
COUNTY OF )
]C n being duly sworn, deposes and says that (s)he is the applicant
(Name of individual si6tinggcontract) above named,
(S)He is the Ca ll If /P1
(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 bafore me this
day of 206_�
Not ICK Si of Applicant
Notary PubF State of New York
No.O.tPA6081693
Qualified in Kings County
Commission Expires Oct it 2006
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LOT 2"SETTLERS AT OYSTERPONDS' SEPT 4.1999
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TOWN OF SOUTHOLD SCALE: I'. 100'
SUFFOLK COUNTY, NEW YORK N0. 85-329
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