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HomeMy WebLinkAbout31184-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-31040 Date: 07/15/05 THIS CERTIFIES that the building ADDITION Location of Property: 650 VANSTON RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County T~x ~ap No. 473889 Section 104 Block 12 Lot 10.4 Subdivision Filed Map No. __ LOt No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 1~ 2005 puzsuant to which Building Permit No. 31184-Z dated JUNE 6, 2005 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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · 1~e certificate is issued to EILEEN SANTORA of the aforesaid building. (OWNER) SUFFOL~ COUIF~Y DEPARTMENT OF ~%LTH APPROVAL ELECTRICAL CERTIFICATE NO. PLL~MBERS c~TIFICATION DA'r~,U N/A N/~ N/A AutHorized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOXVN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Tiffs application must be filled in by typewriter or ink and subnfitted 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. Conwnercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Subnfit Plamfing 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 respect sikmed by the applicant. If a Certificate of Occupancy is denied, the Building hxspector slmll state the reasons therefor in wn0ng u~ the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelhng $25.1)0, Alterations to dwelling $25.00, Switraning pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buiktmg- $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $StL00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $ l 5.00 Date. New Construction: Location of Property: __ Old or Pre-existing ~'I~)~C ~-- (ci~eck one) House No. Street Owuer or Owners of Property: '~-I (_._ ~"i~' 1'4 ~-~pt Jr.! FO Suffolk County Tax Map No 1000, Section __ ~ '~ N ,~ fi_ Block Hamlet [.or/' cO~<5:~r5;> ~ Subdivision PemlitNo. "~]1~5~7/2 DateofPermit. Filed Map. Applicanl: Health Dept. Approval: Underwriters Approval: Plamfing Board Approval: Request for: Temporary Cmlificate Fee Snbnfitted: $ q:':'~ - O(~ Final Certificate: (check one) Applicant Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 31184 Z Date JUNE 6, 2005 Permission is hereby granted to: EILEEN SANTORA 650 VANSTON RD CUTCHOGUE,NY 11935 for : "AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 650 VANSTON RD CUTCHOGUE County Tax Map No. 473889 Section 104 pursuant to application dated JUNE Building Inspector to expire on DECEMBER Block 0012 Lot No. 010.004 1, 2005 and approved by the 6, 2006. Fee $ 300.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ] FRAMING / STRAPPING ~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: FIEtD INSPECTION REPORT I DATE I COMMENTS FOUNDATION (1ST) FOUNDATION (2ND) PL~G ~S~ATION PER N. STATE ENERGY CODE F~ .~DITION.~ COMSIENTS TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ~v. northfork, net/Southold/ Examined ,200 ~ Approved .20 O 5' Disapproved a c Expiration t~ ,20 Ob PER31IT NO. 311~z¢ ~ Building Inspector BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before appl_~Sng? Board of Health 4 sets of Building Plans Planning 5ard approval Surve3 Check ~t- I ~ ? ¥ Septic Form N.Y.S.D.E.C. Trastees Contact: ~,~ / L-C-=-g-x'./~/ Mail to: APPLICATION FOR BUILDING PER3HT Date INSTRUCTIONS .JO~¢ I ,20OD 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 conmaenced 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. Ever5' 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 M:M)E 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, tbr 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 necessars' inspections. (Signature of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ©1..42',4 ~7 ;k Name of owner of premises ~-/C ~ ~ tx) ~ i',.-I V cD L/-"C (As on the tax roll or latest deed) If applicant is a corporation, signature of dui.,,' 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~p, ro. pog~d work will be done: House Number Street - ~'l~-d~q~[~ Tax Map No. 1000 Section / C 3 Block [ '(./ Lot County Subdivision ~/5} ~ O 72D//~/7~ Filed Map No. (Name) Lot / q ¢ 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 ~ /51 0690. 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition ' Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specie' nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~O Height_ Number of Stories Rear ,~'0 Depth Dimensions of same structure with alterations or additions: Front Depth ~ ¢~ Height. Number of SSories 8. Dimensions of entire new construction: Front ~' ~ Rear Depth Height Number of Stories 9. Size of lot: Front ,70 (p, C~ ~ Rear '~ :~, Or5 Depth ~[~ LOi /~ 10. Date of Purchase , / Name of Former Owner Rear 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 'xX' Will excess fill be removed from premises? YES __ NO ,,~. t..., t Address PhoneNo. 14. Names of Owner of premises Name of Architect Address Phone No Name of Contractor Address Phone No. l 5 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * IF YES. SOUTHOLD TO%"N 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. NO 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: COLtNTY OF.~f-~. !t_L~ ~IC.~ ~ /x,{ ~:}/X/{OiSjj::k being duly swom. deposes and says that (s)he is the applicant (Name of individual si=m'ting 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 tree to the best of his knowledge and belief; and that the svork will be perforated in the manner set forth in the application filed therewith. Signature of Applicant