HomeMy WebLinkAbout27575-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31139
Date: 08/29/05
THIS CERTIFIES that the building ADDITION
Location of Property: 645 GIN LA
(HOUSE NO.)
County Tax Map No. 473889 Section 88
Subdivision Filed Map No. __
SOUTHOLD
(STREET) (HAMLET)
Block 4 Lot 6
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 19, 2001 pursuant to which
Building Permit No. 27575-Z dated SEPTEMBER 10, 2001
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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
THe certificate is issued to HELEN SONITIS
of the aforesaid building.
( OWNER )
SUFFOL4~ COUNT"f DEPARTMENT OF H]~ALTH A~PROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBEP~ CILRTIFICATION I)~£~u3
N/A
Authorized Signature
Rev. 1/81
Form No. 6
TO%VN OF SOUTHOLD
BUILDING DEPARTMENT
TOVVN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUt
This application [nust be filled in by typewriter or ink and subnfitted to the Building Department with thc following:
For new building or new use:
1. Final survey of property with accurate location of all buildings, prope{~y lines, streets, and unusual natural or
· topographic features.
2. Final Approval from Health Dept. of water supply aud sewerage-disposal (S-9 for{n).
3. Approval of electrical installation from Board of Fire Undenvriters.
4. Sworn statement from plumber certifying that the solder used itl system contains less than 2,'10 of 1% lead.
5. Conmlercial building, industrial building, multiple residences and similar btdldings and installations, a certificate
of Code Compliance from architect or engineer responsible for the bailding.
6. Snbmit Plamtiug Board Approval of completed site platt requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or bnildings and "in'e-existing'' land uses:
l. Accurate survey of property showing all property lines, streets, building and unusual natnral or topographic
t'eatures.
2. A properly completed application and consent to inspect sigued by the applicant. If a Certificate of ()ccupancy is
denied, the Building h~spector shall state the reasous therefor in writing to the applicam.
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swiuumug pool $25.00, Accesso%, building $25.00, Additions to accessoD' building $2q.00, Businesses $50.00.
2. Certificate of Occapaucy on Pre-existing Building - $100.00
3. Cop5' of Ceitificate of Occupancy - $.25
4. UpdatedCertificate of Occupancy- $50.00
5. '[emporaD' Certificate of Occupancy- Residential $15.00, I.?otmne~cial $15.(i0
Date.
New Construction:
Location of Propertv: ~4.~ ~,~ k~&
Owner or Owners of Prope~y: ~
Suffolk County Tax Map No 1000, Sectiou ~ ~
Old or Pre-existing Building:
Street
(check one)
Block
llamle~
[,~,t OOF_¢.
Subdivision
Pemfit No.
Date of Perufit. ~o/o /
Filed Map.
Apf, licant'
Lot:
Health Dept· Approval:
U ndem'rite~s Approx al:
Planning Board ,&pprox al:
Request for: I emporaW Certificate
Fee Submiu ed: $ o~,0Z 69 O
c_ i )-¢q
Final Cedi ficate:
(check one)
Applica~ Signatare
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. 27575 Z
Date SEPTEMBER 10, 2001
Permission is hereby granted to:
STEVEN & HELEN SONITIS
157 DEMOTT AVENUE
ROCKVILLE CENTER,NY 11570
for :
CONSTRUCTION OF A 16'X 32' DECK ADDITION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR
at premises located at 645
County Tax Map No. 473889 Section 088
pursuant to application dated JUNE
Building Inspector.
GIN LA SOUTHOLD
Block 0004 Lot No. 006
19, 2001 and approved by the
Fee $ 150.00
Authorized Signature
ORIGINAL
Rev. 2/19/98
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU~I.~ON
[ ] FRAMING [ ~j~FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ~
DATE /1~/-~//,~? I NSPECTOB ~~~,~,
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I~ULATION
[ ] FRAMING [ ~ FINAL
[ ] FIREPLACE & CHIMNEY
DATE /~¢/ I NSPE~O~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ] IN~.qlON
[ ] FRAMING [ ~ FINAL
[ ] FIREPLACE&CH~IMNEY
REMARKS~:
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ] FRAMING ~FINAL /~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
INSPECTOR ~,~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ] FRAMING / STRAPPING [~x~ FINAL ,~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
INSPECTOR
F'~) II~SPECTION REPORT
FOf~NDATION (]ST)
FOI]IqDAT~ON
ROU~I~t~E &
.I~L~ING
~'I~80LATION PER N. Y.
STATE ENERGY
CODE
FINAL
,1
^ddress~ 645 ?,in Lane Southo~d, NY 11971
ProJectl 16'x32' Free Standing Beck (Addition to Exls~clng House).
M~p Number.
SubdMslon Numberl
Block Number,
Lot .u~b~r, SITE PLAN~
P~ge, o~
?,IN LANE
T
Exlslg;Ing House
N
~ 125~ [~
125~
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
_ A_.P, tDROy£O AS NOTED
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR ~E
~LLOWING INSPECTIONS:
FOUNDATION - TWO REQUIRED
FOR POURED CONCR~E
ROUGH - FRAMING & PLUM~$
INSU~TION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REOUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPO~'SIBLE FOR
DESIGN OR CONSTRL~TT~ON ERRORS
Lot Number, TOP ELEVATIDN
Pege, o~ ~ ' ~cr~m~n~
38' ~ .
;WEST ELEVATION,
S~cruc~ure
2'x4' Cedar 4'~
1/2 ~Ool~st
-Gir~er~ DoubLe 2'x8'
,Pos~s, 4'x6' CCA
6' 0,C.
GRADE LEVEL
WEST ELEVATION,
Ho. md R~II
Cedar' Splnd~e~ ~
4'x4' Cedar Posts
Thru Bo[ted
7' D.C, Typ.
GRADE LEVEL
36' !al[in§
Helg
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: 765-1802
Examined
Approved
Disapproved Wc
oo ,2o o/
,20 o!
PERMIT NO.
~UtL,DINO PP. RNII 1 AFPLIC:A'flON CHECK.LIS
Do you have or need the following, before applying
Board of Health
3 sets of Builfling Plans ,~
Survey. "'
Cheek ~
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
m ~ng Inspector
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
- 20-o / 20
a. This application MUST be completely filled in b,y typewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee according to scl/edule.
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
shatl be kept on the premises available for inspection througho.ut the work.
e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupan
is issued by the Building Inspector.
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?ounty, New York, and other applicable Lay/s, Ordinances or
Regulations, for the c'onstruction of buildings, additions, or'alterations or for removal or demolition as herein described. The
applicant agrees to cYmply with all applicable laws, ordinanc?s, building code, housing code, and regulations, and to admit
authorized inspectors on premises and in building for neces, sary inspections.
· . (Signatur~/of applicant or name, if a corporation)
(Mailing address of ap ic~'
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of pi'emises
(as 0n the tax roll or latest deed)
If applicant is a corporation, signature of duly authori~i~d 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 w. bich proposed work will b~ done.~
House Number Street
County Tax Map No. 1000 Section eb:'g' Block
Subdivision
Hamlet
'6t Lot
Filed Map No. Lot
(Name)
......................... e..c .. eL use and occupancy' ofpropose,~ constructioll
a. Ex,sung a~ .md ,:,:cld~.:mcy
b. [iltended fist' ~nd 3('-u
Nature of v, cd.: !check v,'htch applicable., New Building Addition :t t¢t'alt,,ti
Repair ....... P. emo,'al ............ g)etnc, litit:,, _ ......... Other Work[~5~~ ~,~_ _~:.__i.5~... _~
}~ .- Dcscrmtion~
Esnmated Cos~ ................. Fee
t to be paid on filing th~s apphcation~
iI'd~elhng, number ofdwelhng units ,., t_,. Numocr ofd',~elhng units on each floor
If garage, number of cars t ~'.
If business, conmtercial or m~xed occupan%, specie, nature and extent or'each t)pe of use .... :} ......
Dimensions of existing structures, If an,.,': Front
Height Number of Stories
Rear
_Depth
Dimensions of same structure with alterations or additions: Front
Rear
Depth. Height·
Dimensions of entire ne~v construction: Front
Height ,O2,'B"
Number of Stories
Size o£1ot: Front /o75 '
0. Date of Purchase //
Rear .3,2
Number of Stories
Depth
Rear Ax D Depth
Name ofFormerOwner /~,)(4..?g~. /..."~t,~.Sob,, rd__
1. Zone or rise district in which premises are situated
'2. Does proposed construction violate any zoning law, ordinance or regulation:
3. Will lot be re-graded /']/) Will excess fill be removed from premises: YES
, / .. / ._
4. Names of Ov,'ner of premises ~)]Ct, Ol.d,P'[~..tpfl'Address O Oz, z~ &~rb[.
Name o f Architect A. / Fff Addres~
Name of Contractor '~,t/ ~' _Address
5 Is this property within 100 feet of a tidal wetland? *YES NO..~,.X'""
· IF YES, SOUTHOLD TOWN TRUSTEES PERIvIITS MAY BE REQUIRED
NO
Phone No. Z;"I
Phone No
Phone No. _ ...........
6. Provide survey, to scale, with accurate foundation plan and distances to property lines.
7. ff elevation at an.',' point on property is at 10 feet or below must provide topographical data on survey
TATE OF NEW YORK)
SS:
:OUNTY OF )__,
(Name of indivtdual s~ing contract)
¢'lHe is the
being duly sworn, deposes and says that (s)he is the applicant
above named,
(Contractor, Agent, Corporate Officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this apphcat~on:
~at all statements contained in this application are true to the best of his knowledge and belief; and that the work v. iii be
:rformed in the manner set forth in the application file~l therewith.
worn to before me this
dayof_ 9cc/~ _ _20 co(
' ~ublic ~'
-'~'t/ .... 3-',..~_../c.,
Signa(ure of Applicant
LINDA J. COOPER
NotaW Public. State of New Yore
No 4e22563, Suffolk CP~m-tY~x-.
~he sewage d~spes~ ~ct wat. e~ supply
inspected by %h~ d~p~r~ent ~d found
Chi$~ of'General ~gineeriu~
,. · Serviues
.