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Home My WebLink About30897-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30690 Date: 01/14/05 T~IS CERTIFIES that the building REPAIR Location of Property: 150 BROADWATERS RD (HOUSE NO.) County Tax ~ap No. 473889 Section 104 Subdivision CUTCHOGUE (STREET) (HAMLET) Block 10 Lot 8 Filed Map No. __ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 30, 2000 pursuant to which Building Permit No. 30897-Z dated JANUARY 14, 2005 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 RECONSTRUCTION/REPAIR ON AN EXISTING COTTAGE. The certificate is issued to GLENN & CHRISTINE DAWSON (OWNER) of the aforesaid building. SUFFOLK COUNTer DEPARTMENT OF }~%LT~ APPROVAL BLEc'rRIC_~L CERTIFICA~ NO. PLUMBERS CERTIFICATION DA'£~U NIA N/A N/A ~gnature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 30897 Z Date JANUARY 14, 2005 Permission is hereby granted to: GLENN & CHRISTINE DAWSON 37 10TH STREET CARLE PLACE,NY 11514 for : RECONSTRUCTION OF AN EXISTING DECK ON AN EXISTING COTTAGE. at premises located at 150 BROADWATERS RD CUTCHOGUE County Tax Map No. 473889 Section 104 Block 0010 Lot No. 008 pursuant to application dated OCTOBER 30, 2000 and approved by the FeeBUilding Inspector to expire on J~ ~/~~$ 150.00 ~ ~t h~z~e \~i 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 t)T,e;witer or ink and submitted to the Building Department with the followizig; ' . . A. For new building or new use: l. 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 fi.om architect or engineer responsible for the building. 6.Submit Planning Board Approval of completed site plan requirements. B. F~r existing b~i~dings (pri~r t~ Apr~~ 9~ ~957) n~n-c~nf~rming nses~ ~r bui~dings and ``pre~existing~~ ~and uses: 1. Accurate survey of property showing all property lines, skeets, building and unusual natural or topographic featta'es. 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 v, Titing 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 Certifi.cate of Occupancy - Residential $15.00, Commercial $15.00 New Construction:'"'"4 Location of Property: House No. Date. Old or Pre. existing Building: Sweet Ow erorOwn sofPropeay: Suffolk County Tax Map No 1000, Section Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ e'~ ~'~' ~ Co Date of Permit. Block Eilcd Map. (check one) Lot ~ (check one) Applicant: Undem~riters Approval: Final Certificate: Applicant Signature Dale R eric',,, cd [)afc Project Description: .REOUIRED FOR REVIEW_ Suffolk Cotmty Health Dept. New York State D.E.C. To,an Trustees l'ovm Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: _N.O YES~ P~e rm i~t Nu~mber ,,, ~ // ~ /_ I/G8 4/3 ELS Associates Engineering - Land Surveying 730 Park Avenue Huntington, NY 11743 (516) 427-5133 LOt /E?/ #/'-~ SITUATE (/f//P'flJi/~*~/.*/~g'' SUFFOLK COUNTY N Y GUARANTEED ONLY gOR ~ ( ~/ff~/~ ~ 3 -.& FORH biO. I TOi~N OF SOUTHOLD BUILDING DEPARTHENT T OI, Rt HALL SOUTBOLD, N.Y. 1197 ] TEI.: 765- 1802 Disapproved a/c .................................. (Building Inspector) 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORH ................... DEC ........................... TRUSTEES ...................... NOTIFY: CALL .................. HAlL TO: ................... OCT 3 0 2.000 APPLICATION FOR BUILDING PEPaXilT INSTRUCTIONS a. 'ibis application mast he c~mpletely filled in by tyr~ariter or in ink and anhnitted to the Building Inspector ~ 3 sets of plaas, anettrate plot plan to acale. Fee according to schedule. b. Plot plan stmuring location of lot and of buildings an premlans, relatic~ship to adjoining premises or public streets or areas, and giving a detailed dnscriptian of layout of property mast he dra~ on the dingr~n ~nich is part of this applicat ion. c. 'lhe ~ork co,red by this application my not he ecwareaced before issuance of Building Pemit. d. Upon approval of this application, the Building Inspector ~¢ill issue a Buildlng Permit to the applicant. Such Permit shall be kept on the ~ses available for inspection throughout the ~ork. e. No building droll he occupied or used in ~/nole or in part for any purpose ~/hatever tmtil a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICblrI(I'I IS 'I~LREB¥ NAI~ to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the To~n of Sonthold, Suffolk County, ~ York, and other applicable La~s, Ordinances or P~gulations, for the canstrnstion of buildings, additions or alterations, or for rem~al or di~olitins, as herein described. The applicant agrees to comply ~aith all applicable la~s, ordinances, building code, housing code, and regulatiorm, and to a~mlt anthoriz_~d inspectors on premises and in bu~/¢~ tlona. (Signature of applicant, or name, if a corporation) (l~ailing .-~4d~ens of applimmt) / State ~tmther applicant is o~mer, lessee, agent, architect, engineer, general contractor, electrician, plurber or buil& ...................... .o.~...w...e. ~.. .................................................................................... ,.~ofo~ofpr,~ses (~r,.~/~,e 15. P,~,u ,- d-le/,/,u 7:. D~t, aso,u (as on the tax roll or latest deed) If applicant is a eerporation, signature of duly anthorized officer. (Nm~ and title of corporate officer) Builders License No .......................... Plumbers License No .......................... Electricians License No ...................... OCher Trade's License No ..................... I. Ix~cation of land on t~hich proposed ~ork ~rill be done .............................................................. · '~2,'~'~ ...................... il;i ......................................... ~;;i ........................... No. ....... B,o ....... ..... ........ .¥. .... F~ubdivision ...................................... Filed t4ap No ................ lat ............... (~e) 2. State existing use and oncupesey of premises and intended use and occupancy of proposed construction: a. Nsting use and occupancy ......................................................................... 3. FL'~ture ofa~od~ (check ddch applicable): ~ ~ildi~ .......... ~iti~ .......... Alterati~ .......... ~~l~--- ~,~ .............~,~ud~ ............ o~.~ ~ ........... ~ ~'~{~"~i"qlOo. f~ .............................................. (to ~ ~id ~ filing ~his a~llca~l~) 5. If ~lli~, ~mr of ~lli~ ,mits ............ t~r o~ ~lling traits ~ ead~ fl~r ................ If ~rage, ~Nr of ~rs ...................................... 6. If ~i~ss, ~ial or ~ ~, ~i~ ~ture ~ ~teet o~ ead~ ~ o~ u~ ...................... 7. Dimnsi~s of ~stiq st~s, if a~: ~t ................ ~ar ............... ~pth ................. t~i~t ......................... ~r of Stories ...................... 9imnsi~ of ~ st~ ~th alteratims or ~iti~s: ~t ............... ~ar ............... ~pth .................... ~i~t .................... E~r of Stories ............... 8. Dimnsi~ of enti~ ~ =st=ti~: ~=t ................ ~ar ............... ~p~ ............. ,,. ........... ............... Il. ~ o~ ~ dJ~t~Jct Jn,~J~ p~i~ a~ s~t~ ........................................ ~ 13. mi1 lot ~ ~ ........ 2 .......... ~ill ~ess fill ~ ~ ~ ~ of ~dt~t .................................... ~ress .............................. ~ ~ ............... ~ of ~tr~tor ................................... ~ress ............................... ~ ~ ............... 15. Is fids p~fl~in ~ f~t of a till ~tl~? * ~$ .......... ~ .~ ...... PLOT DIAGRAH l~eate clearly and distinctly all Imildings, ffn~tlmr ~xisting or propoaed, and indicate all ~t-bac_k dirmnsions f,u. proImrO] lin~s. Oi~ strut and block ~t~er or description according to deed, and ~oaho~ street r~ms and indicate uhetlmr interior or conmr lot. ........... ? ................ I~eing duly .~ror~, deposes and ~y~ thnc I~ is tl~ a~l i~nt (~ o~ i~ivi~t si~i,,g c~tract) I~ ia the O~ ~ o[ ~d ~r or ~rs, a~ is ~[y ~tl~ri~ to ~r[o~ or h~ ~r[o~ O~ ~id ~ mil to ~ke a~ file this a~licati~; that all stat~ta c~tai~ in this ~1 icati~ are t~ to ~e ~st of his k~l~ and ~l. ief; m~ that the ~ wilt I~ ~ffo~l in the ~er ~t forth in the a~l. icati~ fil~ t~. ........ ...... . .... ~ NOtArY P~L~O~ew Yo~ . . .. . // ~. 01K~ Q~fied in ~un~ (s,~m~ (ff ~I ~c~t) Commission Expires, 07/1812002