HomeMy WebLinkAbout30505-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30568 Date: 11/19/04
THIS CERTIFIES that the building ADDITION
Location of Property: 1955 A3 CALEB'S WAY GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 40 .1 Block 1 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 20, 2004 pursuant to which
Building Permit No. 30505-Z dated JULY 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 DECK ADDITION TO AN EXISTING CONDOMINIUM (UNIT A3) AS APPLIED FOR.
The certificate is issued to CAROL M GILLOOLY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
/Z'�2"
A ri d 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. 30505 Z Date JULY 23, 2004
Permission is hereby granted to:
CAROL M GILLOOLY
PO BOX 824
GREENPORT,NY 11944
for
CONSTRUCTION OF A DECK ADDITION TO AN EXISTING CONDO UNIT AS
APPLIED FOR
at premises located at 1955 A3 CALEB ' S WAY GREENPORT
County Tax Map No. 473889 Section 040 . 001 Block 0001 Lot No. 003
pursuant to application dated JULY 20, 2004 and approved by the
Building Inspector to expire on JANUARY 23 , 2006 .
Fee $ 200 . 00
c
thor' zed Signature
ORIGINAL
Rev. 5/8/02
FORM NO.6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 — 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted a to the Building Inspec-
tor with the following;for new buildings or new use: t
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal—(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building,
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25 . 00 POOLS $25 . 00 ALTERATION $25 . 00
1. Certificate of occupancy New Dwelling. $25.00, Accessory $ 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50 . 00
3. Copy of certificate of occupancy $ 5 . 00 , over 5 years $ 1 .0 0
4.Vacant Land C.O. $ 20 . 00O .
5.Updated C.O. $ 50 . 00 Date . . . J, a`f. , , , , , , , , ,
NewConstruction. , , , , , Old or Pre-existing Building . . ... . . Vacant Land . . . . . . . . . . . . .
Location of Property
House No. Street lam/et
Owner or Owners of Property . . C . l . . . J.` 0 . . .
47 3$g . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No. 1000 Section N .//\ Block . . . . . . �, . , , , , Lot. . �1.v , , , , , , ,
Subdivision . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No.
Permit No.�3 .Date of Permit ,11� Oq.Applicant • .r� �,�,����s, L)°'1L : . .
Health Dept. Approval -A
A . . . . . . . . . . . .Labor Dept. ApprovalNJ -A . . . . . . . . . . ./ 1
Underwriters Approval . . . . . . . . . . . . .Planning Board Approval
Request for Temporary Certificat . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . .\, . . . . . . . . . , . . .
Fee Submitted $
Construction on above described building and permit meets all ap licable co es and regulations.
Applicant.
Rev.10-10.78
(`�� - 3oS�� . . . . . . . . . . . . . .. . . .
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DATE: Zai SB.P.# o�;,t i��.9» 7 ! ��. �-� �-��Grfii '�.
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NOT BUIL NG r4RTMENT 14CZ��iiR-a�s� O"� c r �> ' �4nt HEyr y0
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FOLLOWING It IONS:
1. FOUNDATIO 4 WO REQUIRED! KOUT # J <<
FOR POURI CRETE
2. ROUGH - F I M ;G & PLUMBING Au
�r
3. INSULATIO4
�-3G�
4. FINAL - CO ti.
BE COMPLETr R C.O.
ALL CONSTRUCTION MEET
REQUIREMENTS OFTHECODE-S'ZYFNI4 �: :
YORK STATE. NOT RESPONSIBLE30 ZN 4RovAlb ter
DESIGN OR CONSTRUCTION ERRORS. Y
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765-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE 8 CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: cr
c
S
DATE 3� INSPECTOR
ass-,sot
BUILDING DEPT. j
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE � � � G INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN CATION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE 11 1 O INSPECTOR
FIELD lKSPECTION REPORT DATE COMMENTS
/ 4 - V.
FOUNDATION(1ST) Z4 I
------------------------------------
- �
FOUNDATION(2ND)
ROUGH FRAMING&
PLUMBING y
INSULATION PER N.Y.
y
STATE ENERGY CODE
co s
FINAL
d
ADDITIONAL COMMENTS
. V
O
^ Z
L• m
a
Q
r
� 0
x
E�
� y
- � x
d
3. Nature o�- _work (check which applicable): New Building . . . . .-. . . . . Addition . . . . . . . . Alteration . . . . . . . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . .
(Descripxion)
4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . .
* " * * * . . *
` kto 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 ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions-of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . .
Depth . . . . . . . . . . . . . . . ... . . . . . Height . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . .
te
-S. Dimensions of entire new construction: Front . . . 0.1.-. ? - . Rear . . . .0!% 9.: . . . . Depth . . .h./ . . . . . . . . .
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: . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
13. Will lot be regraded . . . : . . /V 0. . . . : . . . . . Will excess fill be removed from premises: Yes
14. Name of Owner of premises . .ar°.�. . :(�.o,b,l, . . Address Phone No. 3v) :7
Name of Architect . . . . . . Address . . Phone No. . .
Name of Contractor - -. U�Vk�).�.1��, . . . Address �rs'fi. Phone No. 7.�: .�0. . .
15. Is this property located within 300 feet of a tidal
�� wetland? *Yes . . . . . No . . . . .
*If yes, Southold Town Trustees Permit may be requMed.
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
COUNTY
��OF ..�U.F�'4.4�. . . . S.S
C�,�A/,G . . .RCI T,C, . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Heis the . . . . . . . . . . . . . • . . . . . . . . .0.. . .. . . . . .-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(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
. . . . . . . . . . . . . . .day of. . . . . .C'.. . . . ., ifi.aa d
Notary Publi . . County
0
EU H J.FARRISH . . • • . . . . . . .
Notary Public,State of New York . . (.t re of licant)
No.01 FA4973285
Qualified in Suffolk County
Commission Expires Oct. 15,20
BOARD OF HEALTH
3 SETS OF PLANS / . -
FORM NO. 1 SURVEY . . .
TOWN OF SOUTHOLD CHECK 4W. . . . .
BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . .
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL - - - - - - - - - - - - - - - -
�l TEL.: 765-1802
"t MAIL T0 :
Examined . . . . . . . . . . s a � .-.
�' 3505
Approved . . . . . . .. .1 . . . ...K_ . . Permit No. . . . . . . . . . . .
Disapproveda/ . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
ing Ins
APPLICATION FOR LDING PERMIT 11 �00 L
JUL 2 1X04 Date . . . . . . . J., . . .
z INSTRUCTIONS'
a. This application must be 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
t:PPLICATION 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 mspecti s.
- .� S.,. t 1 ;. . n : . . . . .
(Signature of applicant, or name, if a corporation)
a . >< .,5,5Q. r+
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . ,�. .u. .►. .1. er.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nameof owner of premises . I. . . . .(. .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the to roll or latest deed)
If applicant is o oration, sign or' ed officer.
. . . . . . . .
ame an itle f corporate offlirer)
ALL C )NTRAC OR' S MUST BE SUFFOLK COUNTY LICENSED
Builder's Lice se No. 3. O. . .�-1 . . . . . . .
Plumber's License No. . . .
Electrician's License No. . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . .
1. Location of land on which proposed work will be done.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . : heaso�,�-�. .��v. . . . . . GGr eeryr- . . . . . . . . . . . . . . . . . . . . .
House Number Street Hamlet
County Tax Map No. 1000 Section . . .qQ.,,. . . . . . . . . . Block . . .I . . . . . . . . . . . . . . Lot . ..3. . . . . . . . . . . . . . .
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 . . . . . . . . !4: ..1� d CYA+a.A .). . . . . . . . . . . . . . . . . . . . . . . .
b. Intended ftse and occupancy . . . . � •�• �-J�• `!°. : 1 .1 a l. . . . . . . . . . . . . . . . . . . . . .