HomeMy WebLinkAbout30261-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30969
Date: 06/09/05
THIS CERTIFIES that the building ALTERATION
Location of Property: 2797 CEDAR BEACH RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map NO. 473889 Section 79 Block 8 Lot 15.2
Subdivision Filed Map No. _-- Lot No. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 23, 2004 pursuant to which
Building Permit No. 30261-Z dated APRIL 26, 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 INTERIOR ALTERATION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to GIACOMO CHICCO & CLARE CROSSLEY
(OWNER)
of the aforesaid building.
SUFFOLK COUIF~Y DEPART~lgT OF H]~ALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'l'~u
Rev. 1/81
N/A
2048441 o8/o3/o5
05/26/05 GIACOMO F. CHICCO
riz~ S i~f~ature
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. 30261 Z Date APRIL 26, 2004
Permission is hereby granted to:
GLENN BEHR
35 ASHAROKEN DRIVE
NORTHPORT,NY 11768
for :
INTERIOR ALTERATION TO A_N EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at
County Tax Map No. 473889
pursuant to application dated APRIL
Building Inspector to expire on OCTOBER
Fee $ 150.00
2797 CEDAR BEACH RD SOUTHOLD
Section 079 Block 0008 Lot No. 015.002
23, 2004 and approved by the
26, 2005.
ORIGINAL
Rev. 5/8/02
. :.Ir .... I! TOWS OF SOVTHmD
?' ~ , -- __-, !/ } BUILDING DEPARTMENT
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
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.
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.
Bo
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
New Construction:
Location of Property:
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No. 3
Health Dept. Approval:
Pla]ming Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
Old or Pre-existing Building: / (check one)
House No. Street / Hamlet
Filed Map. ~ Lot:
Date of Permit.__ Applicant: ~"'/~'~ff ~ ~
Underwriters Approval:
Final Certificate:
/~ (check one)
Ap at
20 2OO4
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TO V~qN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department xvith the following:
Ao
For new building or new use:
1. Final sun,ey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of xvater 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.
Bo
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 x~mting to the applicant.
Co
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.
3.
4.
5.
Certificate of Occupancy on Pre-existing Building - $100.00
Copy of Certificate of Occupancy - $.25
Updated Certificate of Occupancy - $50.00
Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. ~"~('_ ~
Y (check one)
Old or Pre-existing Building:
House No. Street
Nexv Construction:
Location of Property:
Owner or Owners of Property: & t'~ t
Suftblk Count' Tax Map No 1000, Section
Block
Hamlet
Lot
Subdivision
Permit No. 3 (~r~6
Health Dept. Approval:
Planning Board Approval:
Date of Permit.
Filed Map.
L//~o>~ Applicant:
Underwriters Approval:
Request for: Temporary Certificate
Fee Submitted: $
Final Certificate:
Lot:
(check one)
Apt~,.c~nt Signature~-~ v
~ BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
~ BUREAU OF ELECTRICITY
~ 40 FULTON STREET ~ NEW YORK, NY 10038
~ CERTIFIES THAT
~ Upon the application of upon premises owned by
~ BEN DOROSKI JOHN FRANCO CHICO
~ 42D MONSELL LN 2797 CEDAR BEACH RD
~ PO BOX 781 SOUTHOLD, NY 11971
CUTCHOGUE, NY 11935
~ Located at 2797 CEDAR BEACH RD SOUTHOLD, NY 11935
Application Number: 2045441 Certificate Number: 2045441
[ Section: 79 Block: 8 Lot: 15.2 Building Permit: 8DC: ns11
~ Described as a occupancy, wherein the premises electrical system consisting of
Fa electrical devices and wiring, described below, located in/on the premises at:
~. Basement, Second Floor, Attic,
~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
Fa herein, was conducted in accordance with the requirements of the applicable code and/or standard
~ promulgated by the State of New York, Deprajtment of State..C,o,d.g.~.nforcement and Administration, or other
g_ authority having jurisdiction, and found to be :~[~ compliance the~tt{U~r~'the Day of
~ Rat__.q Rating Type
Name
9TY
Circuit
~ Miscellaneous
Fa move sub panel
~ add 2nd floor bathroom
Fa & basement laundry circut
1 Appliances and Accessories
Exhaust Fan 1 0 F.H.P.
~ Panels
Fa I 100 10
~i Vv'iring and Devices
Fa Outlet 1 0 Fixture
~ Fixture 1 0 Incandescent
Outlet 3 0 General Purpose
Switch 3 0 General Purpose
~ Receptacle 1 0 GFCI
Fa Receptacle I 0 20 amp Laundry
Fa seal
Fa 1 of 1
~ This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, Ne'.',' York 11991-0959
Fax (631) 765-9502
Telephone (631) v65-1802
BUILDING DEPARTMENT
TOWN OF 8OUTItOLD
CERTIFICATION
Building Permit No. ~ O ~.~& [
(Please print)
,~ase print)
I cefli(v that the solder used in the water supply system contains les~ than 2/10 of 1%
lead,
Sworn to before me this ~xg~-7/
dayof ,'~/~ , 20~
(Plum~bers
Notary Public, ~'~?/.,l~[~ County
ROBERT E. WALDEN
Noisy Public State of New Yor'-
NO. 01WA46t 3933
Commission Expire8 May 31,,~ 7
765-1802
BUILDING DEPT.
INSPECTION
[ ] ROUGH PLBG.
[ ] IN,~ATION
[I/~INAL
FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: ~
] FOUNDATION 1ST
] FOUNDATION 2ND
] FRAMING
DATE
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ R~~OUGH PLBG.
[ ]~UNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARkingS: ~__~__~ ~ -
DATE ~ INSPECTOR ~~--~'~
Z~ Z
FIELD INSPECTION REPORT I DATE
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
STATE ENERGY CODE
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. nor thfork.net/Southold/
Examined
Approved
Disapproved ac
Expiration
q 'L6 .20 t
,20
q 23 2011t
PEKMIT NO..2~0~
Building Inspector
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Check
Septic Form
N.Y.S.D.E.C.
Trustees
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS t I
,20
a. This application MUST be completely filled in by t~pe~vriter or in ink and submitted to the Building Inspector with 3
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 tbr 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 fbr the issuance ora Building Pemfit pursuant to the
B~iilding Zone Ordinance of the Town of Southold, Suffolk Count)', New York, and other applicable Laws, Ordinances or
R&gulations, 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
auth,,,~ized inspectors on premises and in building for necessa~ inspections.~ 2/,]~~
(Signature of applicant or name, if a corporation)
,aa ZSdx 7'r ot a .
(Mailing add[ess ofapplicam') ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
(As on the tax roll or latest deed)
If applicant is a corporatiom 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.
Location of land on which propQsed work will be done:
House Number Street
County Tax Map No. 1000 Section
SubdMsion
72
(Name)
Hamlet
Block I~ Lot
Filed IVlap No. Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy_
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost ~ GOO Fee
5. Ifdxvelling, number of~lwelling units
If garage, number of cars
Addition Alteration
Other Work /'5~7H~ ,qc/'~t't,,~,'/-'t
(Des~ription~
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front /t//~ 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 /l'/'~t Rear_ _Depth
Height Number of 3tories
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 t/~
12. Does proposed construction violate any zoning law, ordinance or regulation? YES
__NO J('
13. Will lot be re-graded? YES__ NO Will excess fill be removed from premises? YES__ NO
14. Names of Owner of premises ¢ fftr.,g.* Address ~Tff 7 Sa~,/~o'~Phone No. 917 ' $g$' ~4~
Name of Architect ,~q,~l< ftc ~ r ~ Address Phone No~~7~
Name of Contractor ..JO ~ ,fC/-t~/~P 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 xvithin 300 feet ora 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. ~
./~.~./~ (J ('~.1~,~-~..~ being dui)' sworn, deposes and says that (s)he is the applicant
(Name of individual si~ing contrgct) above named,
(S)He is the ~'~
(Contra~o~omte Officer, etc.)
of said owner or own~s, and is duly authorized to peffom or have perfomed the said work and to make and file this application;
that all statements contain~ in tNs application are tree to the best of his ~owledge and belief; and that the work will be
perfo~ed in the ma~er set forth in the application filed therewith.
Sworn to before ,,me this/, .
d - N~tary JOYCE M. WILKINS
Public
Not~ry Public, State of New York
N', ,lnR'J;:A6. $!~ff,.gk County
:. ,. '::. :>oo?