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HomeMy WebLinkAbout29963-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30630 Date: 12/14/04 THIS CERTIFIES that the building ALTERATION Location of Property: 615 DOGWOOD LA EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 37 Block 1 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 22, 2003 pursuant to which Building Permit No. 29963-Z dated DECEMBER 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 BATHROOM ALTERATION IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DIANE D DUNBAR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 82301C 09/09/04 PLUMBERS CERTIFICATION DATED 11/08/04 THOMAS HOGAN u ori d Si nature 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. 29963 Z Date DECEMBER 22 , 2003 Permission is hereby granted to: DIANE D DUNBAR 19 SCOTT DRIVE MELVILLE,NY 11747 for CONSTRUCTION OF A BATHROOM ALTERATION AS APPLIED FOR at premises located at 615 DOGWOOD LA EAST MARION County Tax Map No. 473889 Section 037 Block 0001 Lot No. 011 pursuant to application dated DECEMBER 22 , 2003 and approved by the Building Inspector to expire on JUNE 22 , _20Q5 . Fee $ 150 . 00 Authori ed Signature ORIGINAL Rev. 5/8/02 Form No.6 TOWN OF SOUTHOLD 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. A. For new building or neer 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 2110 of 1% lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificf of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For eristing buildIM(prior to April 9,1957)non-conforming uses,or buildings and"pre-existing"land use. 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 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 Pro-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$1r 5.00 Date. l 0 New Constmction: Old or Preexisting Building:_ / (check one) Location of Property: /� 7"tr ufo�� I A A/c' �G Ste -✓d�c1 House No. r Stream Owner or Owners of Pro Suffolk County Tax Map No 1000,Section Block Lot !/ Subdivision I Filed Map. Lot: Permit No. lv Date of Permit. / 4 j Applicant:_ !AHealth Dept.Approval: Uudarwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certrf' nate: ✓✓ (check one) Fee Submitted:$ vl S. Applicant Signature C o-t 30 30 NOV 06 '04 02:50AM SOUTHOLD BUILDING 631 765 9502 P.1 Town Hall,53095 Main}toad � � Fax(631)765.9902 P.O.Box 1179 Telephone(631)763.1802 Southold.Now Yoilt 11971.0959 BUILDING DEPARTMENT TOWN Or SOUTHOLD CERTIFICATION Date:3 ' Building Permit No. La`t 0 Ovvnez: (Please print) Plumber: hQl�,S N QIP (Phase Print) I certify that the solder used iu the water supply system contains less than 2110 of 1% iead. (Ph mbers Signature) Sworn to before me,this ' #h- day of A.tda 20-10-4 Notary Pvblio,_ _County NOT 11 Yore ;. Qu m S r�MY1) Xnirne I1tgE , ��� f} � Electrical Inspection Certificate Issue Date Electrical Inspection Service,Inc. Application a; • 9/10/2004 375 Dunton Avenue 82301C 's ' �y East Patchogue,New York 117726 r� (631)288-6642 Issued To: Dunbar '.,f.) . :- Street: 615 Dogwood Lane �M, Village: East Marion Zip: 11939 Town: Southold -- , 4! . n _ Section: Block: Lot: Contractor: Anything Electric (L) Lic. # 5220-E Was examined and found to be in compliance with the National Electrical Code. ❑ Commercial ❑ NV Defects ❑ Pool © 1st Floor ❑ Indoor ® Basement ❑ Hot Tub 1 n Residential ❑ Det.Garage ❑ Attic ❑ 2nd Floor ❑ Outdoor ® Addition ❑ Survey Switches Receptacles Fixtures GR Heaters AIC Fans 18 26 16 4 1/30 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves 1/20 1 20 1 30 � Furnace Oil Gas Circulators Smoke Detector Bell Transformer r 1 x 1 5 ' Meter Amps Phase UG/OH Jacuzzi Television CO Detector -y 1 200 1 /❑x ' t Bldg. Permit: 29073 ' Other Equipment 00amp panel with main breaker Hugo S. Aurdf ' President Rough Inspection: 11/11/2003 Inspector: Sean P.Hightower Final Inspection: 09/09/2004 _ a?' Inspector: John McMahon III This certificate must not be altered in an manner. Inspectors may be Identified b their credentials. Y Pe Y Y sd� +5166692102 NOTARO GRUPP & ASSC 137 P02/04 DEC 16 103 11:18 LOCATION OF MASTEPBATN \ s � / 1 i S 1� - • h / r'J � 4 o �ArD ARC, �2059'Z �G¢ 3 OF N�Vy P R 0 P 0 5 E D 51TE PLAN M .Richtman Architect RA.AIA. 282 Baylawn Avenue Copiague, NY 11726 PhnnPfC:Fi I 1 A47_.Id.Af7 F-mail mn�6wn�nhnnLno noF FOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT / i a h e bun FORMER OWNER N E ACR S W TYPE OF BUILDING i a 0-c-.0 RES. Z�D SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKSs- ,Ie d14dld4) - /Y ; PoTo vti 6a)-, ���iiS/// �. , ,�.9 � - '` �°lz? 7�- � °► - �� o - ecce - o© 31 o0 Sao go ► P aM - a ions e� - loo 32-00 $012-a/2AI10 AGE BUILDING CONDITION \ NEW NORMAL BELOW ABOVE FARM Acre Value Per Value - Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD — r ';^ ',�, 493 Meadowland I DEPTH House Plot BULKHEAD Total DOCK -r Vt � . n� �; :,; .� :, �,,� ��i .�x �:. ■■■�■■■■■■■■i■■ice■■( :. room ■ ■■■■■■■■■■■■■■■■■■■■■■■■■ii ■■■■■■■■■■■■■■�■■■■■■ a■■■■e iiiiiiiiiiiii■in■■iii:®iiia ■IME■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■1la" ��i■■■t'iii�7i■■■■■■■■■■■■■■■ ■■!�._����■��ii■iii■■■■■■■■■■■■■■■ NINE : .. iii - - ■■■i■!i■1�■■■■moi■■■■ ■■■■■■■■ ■■MENU■■■■■■■■■■■■■■■MEN ■■■ 0 WE jj� ; i �■ •• _� , 1. A Interior FinishRooms Floor ■ Rooms Ist Floor • • • • - a TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT ACR. REMARKS TYPE OF BLD. PROP. CLASS LAND IMP. TOTAL DATE FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT TOTAL ■■■■ �■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■If■■■I7�.ice■■■■■■■■■■■■■■ : 66 Foundation 41 Fin. B. ■■■■■■■■■■■IRS■■■■■�■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ . :. .. ®® . ���IEIEIIE WIN Fire Place D.R. WIN SEE W.• [;_ , ® ► ' ENIN SEEMININE INEENIEN NININEINEENNINE ■_ FIN ME ass-1so2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ OUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ k]/FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: /do �Sf LL_a� DATE � 7 '� INSPECTOR `�'� ass-iso2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS TION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: C� DATE - INSPECTOR-",�� `ti`� FIELD-INSrEMONRVP6W ' DATE CONIlY�dg FOUNDATION(1ST) C, . FOUNDATION(2ND) r � zz 'AOUGO FBAXWG& FL TbVMG ��LATION PES N.Y. STATE EN$$Gy CODE Q CA d o . 5 . �nvAL ADDMONAL COb ` m o ►y.. 4 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancyF� b. Intended use and occupancy SF/e 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 r_ Rear V Depth r Height 41 Number of Stories / r , r Dimensions of same structure with alterations or additions: Front Rear Depth 7r Height G ' Number of Stories / 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front 1A.6, Rear /OS' 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 6/.-tk,6- oA 44 14. Names of Owner of premises )1 i' / Address eo,Jjo!� j(lb Phone No. (o3I-V�7�����-� Name of Architect Address /,-W7 jj&.6�� -Phone No Name of Contractor Address AN 119- 9 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 /9GIL 4Afi' _4061 )qX— being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the a 010 (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 thiAAA— day of _LGu,(; 20 of Pu 1 SAMY&HEITEL Signature of Applicant �' Notary Public,Ctate of Newyork No.3146440870 Qualified in New York County Commission Expires February 28,VJ2�6 'ruWN Or' OUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets 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. Trustees Examined ' Z Z,20 Contact: Approved v 20___:� Mail to: - 1 Disapproved a/c �T d-lb� r Phone: V11 VI Expiration IJ ,20�_ uVdengVspecior APPLICATION FOR BUILDING PERMIT DEC 2 220 Date ,20 a-3 INSTRUCTIONS a.' s-ap cation 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 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 Inspectc_t way 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. ( ignatureof applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises �� }AJe_ �UAJISJ97'L (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. 1. Location of land on which proposed work will be done: `i t, h odd u House Number Street Hamlet County Tax Map No. 1000 Section es 3"� Block o t Lot Subdivision Filed Map No. Lot (Name) +5166042102 NOTARO GRUPP & ASSC 137 P03/04 DEC 16 '03 11:15 COMPLY WITH ALL CODES OF Oc NEW YORK STATE & TOWD TIONS OF USE IS UNDN CODES -'-J r✓ �- AS REQ `IRED AND CON SOUTHOLD TOWN ZBA WITHOUT CERTIFICATE SOUTHOLD TOWN PLANNING BOARD OF OCCUPANCY SOUTHOLD TOWN TRUSTEES N.Y.S.DEC f4 UNDERWRITERS CERTIFICATE f �'N REQUIRED PLUMBER CNRE�T BEFORE ON LEAD CO I� ,. CERTIFICATE OF OCCUPANCY GLO PLUMBING SOLDER USED IN WATER ALL PLUMBING WASTE SUPPLY SYSTEM CANNOT &WATER LINES NEED EXCEED 2 10 OF 1% LEAD. TESTING BEFORE COVERING P#*%-r PLAN S Is U16 110" l: ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS STATE.APP VED AS NOTED CODES OF NEW YORK DATE: B-P-# FEE: gY' ���ED A�Cy NOTI BUILDIN�� -='A TMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED * . FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 4�05�Z pQ� 3. INSULATION OF N�`N y 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. r ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR ✓v �� Aes , DESIGN OR CONSTRUCTION ERRORS. w�� Oaa•tv=p LP fAwi-I M A9-1-*A 1 Ste. t +5166092102 NOTARO GRUPP & ASSC 13'7 PM/04 � is v� ai•jo r.+ 0 0NrAI U Glow fbiL AM41 , PRa TUIroA1 �R I� yT. 7 AV" PI. W"POQ Ar4eo AOft O IL C f N tf- FRA m b &0 "c (gy $►y) 2t� 1 N*R f"Me -To Ra'If i N 45weu 644T NAPJ4Wb: AWD 7� FIT '5MVtor 0 ANC 20592 yU� F pF N�V� sw�..10