HomeMy WebLinkAbout28464-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30938 Date: 05/26/05
THIS CERTIFIES that the building ADDITION
Location of Property: 1315 GOOSE CREEK LA EXT SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 77 Block 3 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 12, 2002 pursuant to which
Building Permit No. 28464-Z dated JUNE 14, 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 DORMER ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JOYCE WESTERBEKE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1105828 04/07/03
PLUMBERS CERTIFICATION DATED N/A
A o zed 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. 28464 Z Date JUNE 14 , 2002
Permission is hereby granted to :
ROBERT & JOYCE WESTERBEKE
N BAYVIEW ROAD
SOUTHOLD,NY 11971
for
CONSTRUCTION OF A DORMER ADDITION TO AN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR
at premises located at 1315 GOOSE CREEK LA EXT SOUTHOLD
County Tax Map No. 473889 Section 077 Block 0003 Lot No. 019
pursuant to application dated JUNE 12 , 2002 and approved by the
Building Inspector to expire on DECEMBER 14 , 2003 .
Fee $ 150 . 00
Authorized Signature
ORIGINAL
Rev. 5/8/02
r 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 subtnitted 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 farm).
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 210 of I% 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 "prc-existing^ land uses:
1. Accurate survey of property showing all property lines, streets, building and .inusual natural or topographic
features.
A propeli completed application and consent to inspect si ncJ b" thc ;q pli'�;utt. It a (_'enillc.tic of up:ui } is
deified. the Buildnig 11bped0l <hall sttur the rc: > ni>, tiercfoi it) ,\i iunu n- the applicant
C. Fees
I Certificate of()supancy - Ncu, dwelluit $25.10. Additum to & cl1m-_, . _)5.00, Alter:uions to dkk elling $21.00.
Swimming pool $25.00, Accessory buildtug $2� 00, Addie ion., a I acccs�r-ry building $_S (10, Bu'inesses $10.00.
2.
Celt[ficme of Oc.upancp on Pi e-ez istitr_ Building - $10001)
3. Copy of Certificate otOccupancy - $
4 Updated Ccitilicalc of ( )- Iupan-s w,
Tcuihnr. -, Un0i'ntc of i iccup.�ii: . - Ile-i,lenn.�l `f:15 info i',,nuw�ici;il $I nil
New Construction Old or Pre-CXlShng 13uilding: tchecl: atel
Location of Property:
House No Sueet Hamlet
Owner or Owners of Propeit}' "}A{
Suffolk County Tax T\lap No 1000, Section A7I Block 66 G _ Lot-Ga
Subdivision Filed Dfap. Lot _
Permit No. 1 ���r,C�Z Date of Permit. _Applicant:_
Health Dept. Approval: Underwriters Approval:
Planning Board .Approval:
Request for: Temporary Certificate_ _ Final Certificate: (check one)
Fee Submitted: $
�� �4 n �� .Applicant Sigrtatur�
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BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS 5
' 5
i BUREAU OF ELECTRICITY 5
40 FULTON STREET — NEW YORK, NY 10038
5
••1 CERTIFIES THAT 5
,.., 5
5
Upon the application of upon premises owned by 5
., 5+
PAULR. BURNS JOYCE WESTERBEEK 5
P.O. BOX 1061 GOOSE CREEK LANE
SOUTHOLD, NY 11971-0932, SOUTHOLD, NY 11971 5
5
Located at GOOSE CREEK LANE SOUTHOLD, NY 11971 rj
Application Number: 1105828 Certificate Number: 1105828 r5j
Section: Block: Lot: Building Permit: BDC: NS11 ff5
Described as a Residential occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at: 5
Second Floor, 5
5 5
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5
found to be in compliance therewith on the 7th Day of April, 2003. 5
Name OTY Rate Ratin Circuit Twe
Alarm and Emergency Equipment
Sensor 1 0 Carbon Monoxide 5
SSensor 4 0 Smoke 5
Wiring and Devices C
Receptacle 19 0 General Purpose 5
Switch 9 0 General Purpose
Fixture 5 0 Incandescent 5
Receptacle 1 0 GFCI C5J
5
5
5
5
5
5
5 seal 5
5
1 of 1 55
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. J
5
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING INAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
oe
DATE INSPECT
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUN TION IST [ ] ROUGH PLBG.
[ ] F NDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
[ ] FIREPLACE CHIMNEY
REMARKS:
2
/YDS'
DATE Y ".ST0
46
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] R GH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE D �/ INSPECT
FIELD INSPECTION REPORT DATE CONINI om
a
FOLTUATIONk1STi
-----------------------
FOUNDATION
---------------------FOUNDATION i 2 ID i
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PLUMBING
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ST-.ATE ENERGY CODE
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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 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FA-X: (631) 765-9502 Survey
PERMIT NO. oZS f 6 tF Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 11-6,20 D'>- Contact.
-kpproved I q ,20A?g_ Mail to:
Disapproved a
Phone:
Expiration 2003
Building
FrnAPPLICATION FOR BUILDING PERMIT
JPI
22002 I (J
- - --- I Date 1A t> t to I 20 OZ-
J INSTRUCTIONS
_f1.+OLD
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with
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 laws,ordinances,building code,housing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
T
(Signature of af#cant or name,if a corporation)
4oX AM i&-71
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises L25-k-�e V b�
(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. Locatiot of land on whi h proposed work will,be done:
1311 9'ome-�c �� l G �x �— o f 'l- Ic0
House Number Street Hamlet
County Tax Map No. 1000 Section '7 Block 3 '
Lot
Subdi-ision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises d intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy. i
. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost 17 t �'C,a - 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.
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 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
4. Names of Ortmcr of premise° __Address_______—_ Phone No._
Name of Archite Address Phone No
Name of Contra I lit 2 r o 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)
S:
COUNTY OF )
,��l being duly sworn,deposes and says that(s)he is the applicant
— Na,H'e of individual signing contract) above named,
(S)He is the ` �_ ti_-�u
(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 to4zfore me this /
I4ay of ( 20 6Z—'
Al
Notary Public
Signature,of ApWcant
NOTARY PUBLIC Stattee of New York
No.01806020932
TerrmExpi es March 8,20
- l
,.rrKIIV NI_ I
O H S NUS
STATEMENT OF INTENT
'O THE WATER SUPPLY AND SEWAGE DISPOSAL
Ot
SYSTEMS FOR THIS RESIDENCE 'WILL
wacant� r I I CONFORM TO THE STANDARDS OF THE
—^ CO DEPT _F HEALTH SERVICES
SUFFOLK
(s'
f l�'JAF- OF= F�2Uf-'F=ti� I�Y' APPLICANT
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i `'�U�'_V '✓f_=L (�.Yc° I SUFFOLK COUNTY DEPT OF HEALTH
i
•-� S ,` Y •f� S : r.-- r ,Y` � SERVICES FOR APPROVAL OF
hCONSTRUCTION ONLY
-. I AT DATE- ---- -
i-. 50. ! �yY`✓'(E�V1r I H S. REF NO -
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SUFFOLK C^v TAn •^-.f' [`E£, I:�NATIO.1.
DIST. SECT, BLOCK PCL-
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OWNERS ADDRESS:
S :' p lel �� Scale 30'- i
DEED: L."' P -
n a Nj,-.� . ,,..�a, "4- • lips �
store/ _ .r . . TEST HOLE STAMP ._
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RO ERICK VAN TgyL, P.C. N
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NOIcTM 0AYView 12040 LICENSED LAND SUR EYORS
GREENPORT NEW YORK
JL ) DETECTING
,MOKE-
ICES IN S
;!ARM DEV
AS TO PART. 721.1
N.Y.S BUILDING CODE.
PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
REQUIRED BY PART 714 OF
N.Y. STATE BUILDING CODE.
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OCCUPA
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NOTED
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BY:
1,40-.-ifY BUILD NG DEPARTMENT AT
V6 5,1002 9 A 'TO 4 PM FOR THE PROVIDE ANTI-SCALD AND/OR
INING IN E PLUMBiNG
FO IN 01ECTIONO' ALL PLUMBING vyAsTE THERMAL SHOCK PREVENTING
1 !DATI '� . rw(-. RE,"A D &WATER LINES NEED DEVICES AS TO PART. 902.6(K)
rOURE CONCRETE
2 '0t, TESTING BEFORE��VERINO
GH - F MING..4PLUMBING N.Y. STATE BUILDING CODE.
3. I�GULATION IF"
4, F) MAL uelION
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ALL C T CTION SHALL MEET PLUMP177? CER �17'1-�'7'
THE rEOUIR MENTS OF THE N.Y.
IS RUCTION
If copper tubing Is used ON LEAD C0P!7'1r_A1!,1' 63 ' j",
STATE CONS RUCTION & ENERGY
)T R 8
for water distributing CERTIFICATE
CODES. NOT RESPONSIBLE FOR C ?' : ,r
RUTRt
DESIGN OR CTION ERRORS Sy : piping shall be
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Of types K or L only SOLDER Ur74
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UNDERWRITERS CERTIFICATE SUPPLY SYSTE'A.-! Cli ""4`07-
; 1W) LEAD.
REQUIRED L-XCEED 211 Oof
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