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Home My WebLink About30412-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30720 Date: 01/26/05 THIS CERTIFIES that the building ADDITION Location of Property: 370 HOBART RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 62 Block 3 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 12, 2004 pursuant to which Building Permit No. 30412-Z dated JUNE 18, 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 CHIMNEY ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT & DONNA M MOSQUERA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A uthorized 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. 30412 Z Date JUNE 18, 2004 Permission is hereby granted to: ROBERT & DONNA M MOSQUERA 370 HOBART RD SOUTHOLD,NY 11971 for CHIMNEY ADDITION AS APPLIED FOR. ADDITIONAL CERTIFICATION MAY BE REQUIRED at premises located at 370 HOBART RD SOUTHOLD County Tax Map No. 473889 Section 062 Block 0003 Lot No. 006 pursuant to application dated JUNE 12 , 2004 and approved by the Building Inspector to expire on DECEMBER 18, 2005 . Fee $ 150 . 00 Zt qSgnature ORIGINAL Rev. 5/8/02 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL JAN 2 0 765-1802 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 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 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 from architect or engineer responsible for the building. 6. Submit Planning 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 consent 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, 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 Certificate of Occupancy-Residential $15.00,Commercial$15.00 Date. U�� T New Construction: 2 Old or Pre-existing Building: (check one) �~mr 3-7 Location of Property: O kilil�b(� C+ PQL House No. Street Hamlet Owner or Owners of Property: _, D ber c Q�,_,2 (`tom Suffolk County Tax Map No 1000, Section Block �� .off Lot —O Subdivision ^`']� Filed Map. Lot: �G Permit No. LC" 12 —Z Date of Permit. Applicant: 1.O ter- - Hq'WuffeZN Health Dept. Approval: rl CN Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ C_ L57 L Applicant Signature 3o �fl � z 765-1 802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE / � 77- �� INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: /1/0 A S IF DATE - INSPECTOR ��'`� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ROUGH PLBG. [ ] FOUNDATION 2N [ ] INSULATION [ ] FRAMING { FINAL [ ] FIREPLAC 8 HIMNEY [ ] IRE SAFETY INSPECTION REMARKS: ,� C_,�e S--S DATE �� INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS p ,� VJ ro d tpp� FOUNDATION(1ST) 3' � y _ C FOUNDATION(2ND) 3 1 W ROUGH FRAMING& PLUMBING y v INSULATION PER N.Y. y STATE ENERGY CODE Lor 1[7d 17[7 FINAL ADDITIONAL COMMENTS ��^^ V` O 'z M X H O v�, z x r� .. x d b H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631)765-9502 Survey www.northfork.net/Souihold/ PERMIT NO. Z/ Check Septic Form N.Y.S.D.E.C. C� Trustees Examined ,20 Contact: Approved ,20 Mail to: l l DUe PTiKag f u6 A Disapproved a/c 370 11--1 Q D/l a l k ' Sa ti o f A Phone: Expiration ,20 -- ;B ' d' g o Q APPLICATION FOR BUILDING PERMIT DateZ Sk 7 , 20dy INSTRUCTIONS �,accu Tication MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plate 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 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. (Signature of app cant or name,if a corporation) 3-70 N2ho-r+ Rd. SaAboiOoly (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises PO (� 7b1XAr"-.L (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of c orate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on wn�'ch proposed work will be done: � � �-�d�iolc�. House Number Street Hamlet County Tax Map No. 1000 Section Block �2, Lot C) -3 — C>6 Subdivision Filed Map No. Lot (Name) * 1 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy f..5 t c. e'r-k 0-1 b. Intended use and occupancy C-eS I J-e-n-�l CJ 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other World C kA y-,a 94.s+l . c ,n"( ,ro (Desc ,ption 4. Estimated Cost Fee '�"� �1ord 0 (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 -T -L000 Name of Former Owner 14 .geCL 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 -c-l7anra.K• � 14.Names of Owner of premises�u erg 1� r+ Address�7o �- (�{�Phon�4-Inole No. '-7!o S-R30 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_j * 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 REQUIRE-J _ � ff 16. Provide survey, to scale, with accurate foundation plar,and distances to property lines. 113 cop]23) 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 ) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (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 20 Notary Public Signature of Applicant 9 *1 • SURVEY OF PROPERTY SITUATED AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK AIS OND S.C. TAX SCALE o. 1000-62-03-06 DECEIIMER 11, MAY 7. 2001 REVISED TO mwA T�� DETAIL MAY 26,2002 9UPDATE ADDfTIONS AREA = 9,127.72 p. it. 0.210 ea. Ta-TT JfQIJ JUTA (=T NXE OW BY ON 6C'm 30, a0W) IL Xvr rmamw r ✓✓ Na sotoa C. r JAI t1 v r�MMt�IM�/M'Ol r �M�QMOriri w q 00"Auc 14 E 't ��" , 5 t xAf \ \ �\ l� � \ \\ E x33 x2j0• ' � 9OC1 \J � 5 aft �, x \\\ s0jOLD P 0 N 0 s 4s NOMS: tllb 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS:,u EXISTING CONTOUR LINES ARE SHOWN THUS: - - - -s- - - - 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103COISS G ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE X: AREAS DETERMINED TO BE OUTSIDE 500-YEAR FLOODPLAIN. 3. EXISTING SANITARY SYSTEM AS PER OWNER. 4. GROUND WATER ELEVATION 3.2'. S. S.C.D.H.S. REFERENCE No. RIO-01-009 Y Joseph ono LS Veyor' W IM Oft`M RAU own w axw MR out" OF Me Awv" -&**A*I/ - 9b Phm - On lb-, Ih LaDoW TO K A wa IM OWI. PN= (931)737—ZC60 Fax (631)727-1727 R L.".0 P 0 N OFRW LOOM AT WAM AVARMS qqt� �r�rr�ome Tw 005mm of mw orWAYS I= R11A9 m AMil" P.O.On 1631 s�Nft 1 ilia AKNTMM NAED. NAPHO . Noir Yoek 11901 Nwhood, No York 11901-OW IV651v a 1t A w Zsc Zoz COMPLY WITH ALL CODES OF bS 06S NEW p CON AT {TIONS r�F A �1✓µevT bS �� AS REQUIRED AN PQM s �T SDT ZSa APP 0 ED AS NOTED DATE: B.P.# 3?� I•b �►A R� �, SOUTHO�D TO TRUSTEES FEE: BY: ,�f� NNOTI BUILDIN DEPARTMENT AT N.Y.S.DEC 765-1802 8 AM O 4 PM FOR THE FOLLOWING INSF ECTIONS: !I �, 1. FOUNDATION TWO REQUIRED Vj e- wovLJ 1�j r RED CONCRETE �Q R 2. ROUGH FRA ING & PLUMBING i r N N A L CONSTI RUC i;„�N Sr.-•,�� 3. INSULA ON 5ftePL CN�"lO�y�Nd r ME THE REQUIREMENTSOFTHE 4 BE CQNLFINAL - OETE NS RUCTION MUST MUST ))-Ace 0 L., 51je ��buSL ES OF NEW YO K STATE. � ALL CO - UCTI N SHALL MEET THE R c �'I1�'�Ny� REQUIREM NTS F THE CODES OF NEW YORK STA E. N RESPONSIBLE FOR DESIGN OR CON TRUCTION ERRORS. roR ��NS� o^' 1i "u! E �' COMPLY ITN CHAP ER °46" FLOOD DA AGE PREVENTION Pe — __—_� SOUTHOL TOWN CODE. - cq A R -T OCCUP NCY OR `�'`� � -- n z w� NLAWFUL `<: z USE a SPE MoRt� R - Q �Se Eue WITHOUTCERTIFICATE ;\ M T Y z —� OF OCC PANG _ kz� � I ' 0 0 ------- ------------ —1 0 0 ¢ i fr) tf1 (o zo tD 1 M