HomeMy WebLinkAbout30840-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-30727 Date: 01/27/05
THIS CERTIFIES that the building ALTERATION
Location of Property: 185 OSPREY NEST RD GREENPORT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 35 Block 6 Lot 36
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 3, 2004 pursuant to which
Building Permit No. 30840-Z dated DECEMBER 10, 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 ALTERATION & WINDOW REPLACEMENT IN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ANTON SETTLER & MARLA MILNE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLUMBERS CERTIFICATION DATED N/A
///111t
ori d Sig ature
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. 30840 Z Date DECEMBER 10, 2004
Permission is hereby granted to:
ANTON SETTLER
320 EAST 19TH STREET
NEW YORK,NY 10003
for
ALTERATION, WINDOW REPLACEMENT AS APPLIED FOR
at premises located at 185 OSPREY NEST RD GREENPORT
County Tax Map No. 473889 Section 035 Block 0006 Lot No. 036
pursuant to application dated DECEMBER 31 2004 and approved by the
Building Inspector to expire on JUNE 10 , 2006 .
Fee $ 150 . 00
n
ed ignature
ORIGINAL
Rev. 5/8/02
• Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
./ Ll
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 19u 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. l --
New Construction: Old or Pre-existing Building: k —(check one)
Location of Property: �S � !j`o �./ � -�F'on •C74^
—House No. Streit Ha let
Owner or Owners of Property: /`4)� M 51 &ZYEA y 126&-,! l`%1L/✓G
Suffolk County Tax Map No 1000, Section 053-- Block Lot 3
Subdivision Filed Map. Lot:
Permit No. _Z Date of Permit. - ) f Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ 77j - L
/ r Cz _ Applicant Signature
Com 30?97
TOWN OF SOUTHOLD I OPERTY RECgRD CARD -26
OWNER Y G ��� STREET VILLAGE DISTRICT SUB. LOT 3 , .
.-
FORMER NEWe-'0 S i # Civ>O N E ACREAGE
S W TYPE OF BUILDING
=LA:NDIMP.
VL
FARM COMM. I IND. I CB. MISC. Est. Mkt. Value
TOTAL DATE REMARKS417
+
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Z / 4), to &t�IeKdgol 9 4,266,01e),S)
nBELOW
ONDNEW NORMAL ABOVE FRONTAGE ON WATER
Farm Acre Value Per Acre Value FRONTAGE ON ROAD t7
Tillable 1 BULKHEAD
Tillable 2 DOCK
Tillable 3
Woodland
Swampland
Brushland
House Plot
Total
Jill
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Both
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N■■�i�1�iF�N�iN■■
Foundation
xtensid Basement Floors�
Extension Ext. Walls n Interior Finish
E Fire Place Heat
-_ PorPorch� _ • r �
ch Roof Type
•' �I ` Rooms
Breezeway
Garage Driveway Dormer
• B. -_
SUFFOLK CO.HEALTH DEPT.AP'PROr
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r + •� 0 Al , P a�L6� .ga } I STATEMENT OF INTENT
C! R /YI + , I, THE WATER SUPPLY AND SEWAGE DIS,"ALizz: _ - SVSTEMS FOR THIS RESIDENCEf fd WILLt _ ICONFORM TO THE STANDARDS OF SNE` Fd
1 'GLEVES rhl ,__ I I SUFFOLK CO. DEPT.OF HEALTH SERVICESM Flr.n:eFs) f�S _ 4{ .. (dNff.Flt.�'Fr.�.MOr6 NN. 87'Sy) ' RPPLICA NTSUFFOLK COUNTY DEPT. OF HEALTH
C { --- - SERVICES - FOR APPROVAL OF
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F-Q/ DATE:
z 0 !r':tr.r wrcir L .. t �S."` .i N.4 REF.NO.:.
APPROVED'
{ .N N :o'.s n+IonwnraaY, .f.,
SUFFOLK CO TAX MAP DESIGNATION:" r
:L°_:•. !r _r i�� - DIST. SECT. BLOCK
rOOO 03$
W
ONERS ADDRESS:
�1+110i r �; r La CFIT/oN
141aP 9 Cof h!O/!'OW Raaf
e"'Y" Ue, :!. Y. 11719
12
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I. b - DEED:L. MIA P.
!K - - - _ , 5,,.. S6 '`•!' qi� TEST MOLE STAMP
iik ��' =y�' R..,.,r�.y-"F�''7 $jar!' �y_�, 'r" , :�{•'
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ IF ATION 2ND [ ] INSU ON
[ FRAMING ti, INAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
fjo
DATE l �� INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION(1ST)
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FOUNDATION(2ND)
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ROUGH FRAMING& - m
PLUMBING
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INSULATION PER N. Y. -
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS (�
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPAR'IVENT 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
-vvivw. northfork.net/Southold/ PERMIT NO.?�� C��-�i Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 12 Contact:
Approved r7liko '204
Mail to: AAA R1 t H 1 Ll )5,
Disapproveda;'c P0• 8nx 7.L 4!G,Rw Pf, it''14�"
Phone: 7 7 - 341 1
Expiration L 0 ,20 \ • tej
K CALA,' kAREN 0Xj49L1'1
1 sector -7.3. 416-L7 't'o PiCk
t?i
Pf
APPLICATION FOR BUILDING PERMIT
Date66((,M E561Z .! 200L_
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 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 taws, ordinances,building code,housing code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
r;'2�
( ignature of applicatit or name,if a corporation)
Py. BOX- 73Z (�aE6A)05-R-r , i I `34`1
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
�
Name of owner of premises At Kort/ M A IR wk 61 , M 1 L�ryJ
(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: \
75 0--,PRE `( t J 65- RGA 0 <t R r,6,NJ J701
House Number Street Hamlet
County Tax Map No. 1000 Section -js Block Zp Lot i 3G
Subdivision Gi.r�gVi�S �A (f%5 Filed Map No. M--2-6, tot
(Name) SECT. *t"
2. State existing use and occupancy of premises and intended use and occupancy of proposed constluction:
a. Existing use and occupancy I tV
b. Intended use and occupancy_ !SAM
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
`.7 t� ,Nt7otr�S rIJ -T 1r r7
4. Estimated Cost Fee 1 N F3A5EM f-:pj((Description)
(To be paid on filing this application)
5. If dwelling, number of dwelling units I 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 a-9X
Rear
Depth
Height Number of Stories 2-
Dimensions
Dimensions of same with alterations or additions: Front '510 Y1� Rear
struct
Depth Height Number of Stories
8. Dimensions of entire new-eonstruction: Front Reaz Depth
Height / Number of Stories
9. Size of lot: Front 1,'CO Reaz Depth
10. Date of Purchase !�f � 1 U I 9O Name of Former Owner;/1 C-CoR (a Art L iR r F?►<1
11. Zone or use district in which premises are situated 12f 2r a 4,--�
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO V'
13. Will lot be re-graded? YES_NOZWill excess fil be emoveedd frorfi premises? YES NO
14. Names of Owner of premises_1(dF 6 f M 1 t4NGAddress G rtu�nr P�tz��_Phone No. '177 311
Name of Architect - 'r' ddress�A�Rr�� PhoneNo�gB SZSZ
Name of Contractor&(i{� 1 rk j Address Phone No.I�,Q� 4 SI'7
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 ' )
p ,1-4�i
®X "V] being duly sworn, deposes and says that(s)he is the applicant
'(Name of individual signing contract) abovenamed,
(S)He is the
(Contractor, gent, orporate Officer, etc.)
of said owner or owners, and is duty 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 t
-7+f da of ti 200+-,
Not Pu is Signature of Applicant
ROBEHTA�SCOTT,JR.
L
Notary Pubkc, State of New York
Qua lifi d in Suffolk County
101 SC472508
Term�X res May 31, ,
A4MA,
ialYr" 4ai'F'E 775ta
f
"$' a'�"
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^ T,
%
OCCUPANCY OR, 5
WFUL �
USE IS UNLA. y �, ,�IN
WITHOUT CERTIFICATE
OF OCCUPANCY
FLOOD ZONE H A �I 1 s -- • �w�Ii0
COMPLY WITH CHAPTER�46* �I; I I I ^ ' 1 1S'( Fj�� WINAoInJ tDNFI&JI"�Ri'tdkl\
FLOOD DAMAGE PREVENTION {I IE 5-�•r/-
SOUTHOLD TOWN CODE.
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ALL CONSTRUCTION SHALL �p �
r
r j _ V11 d' MEET THE REQUIREMENTS OF THE \J' EXIG✓�(I VA� 6MOW WALL. P9E? j
CODES OF NEW YORK,STATE. �� - 5 p �6� AK-31 kNDERS> W 10 i?au
coi PLY WITH ALL CODES OF
1
NEW ORK STATE &TOWN CODES �u
I AS RE�Ct1UIRED AND CONDITIONS OF -
vl
SOUTHOLDTOWN ZBA ' HJ(WQGP y
SOUTHOLD TOWN PLANNING 51WAfHb
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SOUTHOLD TOWN TRUSTEES
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VS.DEC V�R�IC �f(v, Z X6� � � " Q' ZXfl s ��
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' I H�AaER+�• T' W�S�riT"•�L1
r, a APPROVED AS NOTED =X� • �I (— ' A25aI�
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BATE: v� }o B.P.# � Z LAP MEAPaIc V0INrowI H A kVWk
1k E: �y
BY
'r NOTIFY SUII_Di�l3 DEPARTMENT AT
7GS iB02 8A TO 4 PM FOR THE (INS' AW. HAN6E� 'ti$.7�t
s IF,OLLOWING INSPECTIONS: a ''CO EX'L 5H EA7R1W-) . � .#ifHPi<�•. �•, tloc� - i
FOUNDATION - TNO REQUIRED F_x6;r.{ee77,,��,,
_r ;"I FOR POURED C'HCRETE
ROUGH - FRAMING & PLUMBING
FINAL -
UST
.�...._..._..._ _.... + LLNCONSTC NTT -OR 00.
N SHA MMIi€� - E____.�.._..-"___ •• iya ",�'`l af'[1.�J>r"f'I IC�i�f '�
REQUIREMENTS OF THE CODESOT�i W
YORK STATE NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
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