HomeMy WebLinkAbout28821-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29427 Date: 05/08/03
THIS CERTIFIES that the building ADDITION
Location of Property: 3430 BRIDGE LA CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 85 Block 2 Lot 2
Subdivision Filed Map No_ Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 9, 2002 pursuant to which
Building Permit No. 28821-Z dated OCTOBER 10, 2002
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 FRONT PORCH ENTRYWAY ADDITION TO EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to LEONEL & ELENA PALENCIA
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
-�-4/ Z:7�4/
//,",Utk6rized-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. 28821 Z Date OCTOBER 10 , 2002
Permission is hereby granted to :
PALENCIA
POB 565
PECONIC,NY 11958
for
ADDITION OF A 144 SQUARE FOOT FRONT PORCH ENTRYWAY AS APPLIED FOR
at premises located at 3430 BRIDGE LA CUTCHOGUE
County Tax Map No. 473889 Section 085 Block 0002 Lot No. 002
pursuant to application dated OCTOBER 9, 2002 and approved by the
Building Inspector to expire on APRIL 10, 2004 .
Fee $ 150 . 00
i
utho iz d Signature
COPY
Rev. 5/8/02
Form No.6 --
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
A PLICATION FOR CERTIFICATE OF OCCUPANCY
U
I his applisuion trust Fe t i bN types racy or nil:and submitted to the Building Department v.ith the 1011o«ing:
A. For new building or new use:
1. Final surrey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic teatures.
2. Final Appro%al 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 tion plumber certifying that the solder Used in system contains less than 2 10 of l°o lead.
5. Commrercial 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:
L 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-$25.00
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial $15.00
Date. /,7
i
New Construction: Old or Pre-existing Building: s (check one)
Location of Property: Sc-11 j ( t«t7C 4- L fnt. r��"`�
House No. Skreet 1 Hart}l t
Owner or Owners of Property: t e Q N e- L_ l— F1 N t� (�A ` 2 1\jC_- t a
Suffolk County Tax Map No 1000, Section Block Lot_
Subdivision pp Filed Map.- Lot:
(/Permit No. � DDd�Date of Permit. 0 O 'a Applicata: Le a . e L a F.L-o P F;21 r- A
Health Dept. Approval: r w Underwriters Approval: ^ A
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
G
Fee Submitted: $ ---
rel° YC ' C4,- `
Applicant S gnature
c-of-- a1y,27
agg z i
M-1802
BUILDING DEPT.
INSPECTION
14/FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F NDATION 2ND [ ] I LATION
[ FRAMING FINAL
[ ] FIREPLA" & CHIMNEY
REMARKS:
DATES 7 �' INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ �INAL
[ ] FIREPLACES CHIMNEY
REMARKS: � � �✓r,,�
DATE INSPECTOR
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ l FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMA�KS:
�.XcJ NOS ��i`7,✓�
DATE 111o2-1162,- INSPECTOR \
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FIELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION(1ST) j
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FOUNDATION(2ND)
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ROUGH FRAMING&
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INSULATION PER N.Y. y
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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TOWN OF SOIFTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need dit 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
r«rw. northfork.net/Southold/ PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
� Trustees
Examined_ !O '-a20 Contact:
Approved 0 11 .20 e-;:, Mail to:
Disapproved arc ' _
Phon
Expiration ,20_ n r,n �3I , 6q
Building Inspector t ! &q
l ir1"--�- - }-`1 • APPLICATION FOR BUILDING PERMIT
� ' 1
Date 200
INSTRUCTIONS
L
a. completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets o 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 laws, ordinances,building code,housing code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
Elefi0 I��GQl2Ua -
(Signature of applicant or name,if a corporation)
p'oi3ox sGs. f�co>1« . 0 -Y IIgSS
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
I
I/ r�
Name of owner of premises �2oyt o r/t Ln c i�Ct .FCt)ck (fol
(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.--
I.
o.1. Location of land on which proposIed work will be done:
3 `Zn d`i�� � n cct FC,f1Ae1 to P-J. iln5
Ho se Number Street J Hamlet
County Tax Map No. 1000 Section �� Block � Lot
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intend use and occupancy of roposed construction: .
a. Existing use and occupancy r P c L&v
In. Intended use and occupancy -A &A .
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost_ ��b® r C) 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 Rear Depth
Height Number of Stories
Dimensions of same structure with alte(ations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front f o` Rear Depth �-
Height Number of Stories
9. Size of lot: Front ? Reaz Depth 3 y�
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_
14. Names of Owner of premises Address Phone No.
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
* 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_ )
E12Y) 01 (pa Icy] Cl a . being duly swom, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the jV1 ) e_r
(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.
Swojp to before me this A - ^ -
day of 20__g-2,
61e Y7 Gt
Notary Public Signature of Applicant
Notary JOYCE M.wILKINS
No.4852248,guff k Countof Now y
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GREENPOFT . NEW YORK
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UNDERWRITERS CERTIFICATE
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NOTIFY BUILDING DEPARTMENT AT 3 w 3
-----' 765.1802 9 AM TO 4 PM FOR THE o < Q
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
& INSULATION
4. FINAL - CONSTRUCTION MUST
1 BE COMPLETE FOR C.O. a
ALL CONSTRUCTION SHALL MEET U
THE REQUIREMENTS OF THE N.Y. Z
114" 5'-8114" STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR J6-8 Sw
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I DESIGN OR CONSTRUCTION N E
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