HomeMy WebLinkAbout31454-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31333 Date: 12/15/05
THIS CERTIFIES that the building ADDITION
Location of Property: 360 JASMINE LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 70 Block 1 Lot 6.10
Subdivision Filed Map No. __ LOt No. __
conforms substantially to the Application for Muilding Permit heretofore
filed in this office dated SEPTEMBER 14, 2005 pursuant to which
Building Per~it No. 31454-Z dated SEPTEMBER 19, 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 PORCH ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MICHAEL & ROSE ANASAGASTI
( OWNER )
of the aforesaid building.
SUFFOLK COUNT~DEPART~ENT OF~tKALTHAPPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS C~/~TIFICATION DArmu
N/A
N/A
N/A
Authorized Signature
Rev. 1/81
Form No. 6
TOWN OF SOUTHOLD
BUH,DING DEPARTMENT
TOWN HALL
765-1802
APP~LICATION FOR CERTIFICATE OF OCCUPANCY
Th~s-a~ation must be fill~:I-{~ ~y typewriter or ink and submitted to the Building Department with the following:
Ao
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 fi:om 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. Conunemial 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.
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.
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:
House No.
Owner or Owners of Property: /~t a~/~ae
Suffolk County Tax Map No 1000, Section
Subdivision
PermitNo. ,~1'~S'5f ~ DateofPermit.
Old or Pre-existing Building:
Street
Date. /~;1.- ! ~ .- 0 5"
(check one)
__ Block ~ /
Filed Map. Lot:
Applicant:
Hamlet
Lot
Health Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ '"'~, oo
Final Certificate: ~ (check one)
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. 31454 Z
Date SEPTEMBER 19, 2005
Permission is hereby granted to:
MICHAEL AiqASAGASTI
SOUTHOLD,NY 11971
for :
PORCH ADDITION TO Ai~ EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR
at premises located at 360 JASMINE LA SOUTHOLD
County Tax Map No. 473889 Section 070 Block 0001 Lot No. 006.010
pursuant to application dated SEPTEMBER 14, 2005 and approved by the
Building Inspector to expire on MARCH 19, 2007.
Fee $ 150.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
['~ FRAMING / STRAPPING
[ ] FIREPLACE & CHIMNEY [
[ ] ROUGH PLBG.
[ ] INSULATION
] FIRE SAFETY INSPECTION
REMARKS:
DATE / ~) ~ 2-~ O_~ INSPECTOR
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REM~ ~ ~~,
DATE
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
......INSPECTION
[/4~ FOUNDATION 1ST [ ] ROUGH PLBG.
] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
[ ]FOUNDATION 2ND [
[ ]FRAMING / STRAPPING [
[ ]FIREPLACE & CHIMNEY [
REMARKS: ~L~
DATE
INSPECTOR
U
0
FIELD INSPECTION REPORT
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
DATE COMMENTS
FINAL
ADDITIONAL COMMENTS
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALt,
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined ,20 O %
Approved ,20 O~'~
Disapproved a/c
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Plamfing Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
)/ one: '76 S'
Expiration ,.~//'- ~ 2007
~5~ B~ilding Inspector
~ ' "'5 ~?' INSTRUCTIONS - ' --
a. ThlV'a~pp~c~ST be completely filled in by~t ewdter or m I~ ana submitted to the Building hspector with 4
sets of plans, ac~a~lot pl~ to scale. Fee according to schedule.
b. Plot pl~ ghowing location of lot and of buil~ngs on premises, relationship to adjoining premises or public streets or
areas, and wate~ays.
c. ~e work covered by this application may not be commenced before issu~ce of Building Pe~it.
d. Upon approval of t~s application, the Building hspector will issue a Building Pe~it to the applic~t. Such a pe~it
shall be kept on the premises available for inspection ~oughom the work.
e. No building shall be occupied or used in whole or in pan for ~y pu~ose what so ever until the Building Inspector
issues a Ce~ificate of Occup~cy.
f. Eve~ building pemt shall expire if the work au~ofized has not commenced withn 12 months after the date of
iss~nce or ~s not been completed within 18 months from such ~te. If no zoning amendments or other re~lations affecting the
prope~y have been enacted in the interim, the Building ~spector may authorize, in writing, the emension of the pemit for an
addition six months. Thereager, a new pe~it shall be required.
~PLICATION IS HE,BY M~E to the Building Depa~ment for the issuance of a Building Pe~it p~suant to the
Buil~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ordin~ces or
Re~lations, for the construction of buildings, additions, or akemtions or for removal or demolition as herein described. The
applicam agrees to comply with all applicable laws, ordin~ces, building code, housing code, and re~lations, and to a~it
authorized inspectors on promises ~d in building for necess~ inspections.
(Signa~e of applicant ~am~ it a co¢oration)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises /lq, e,k~,~ / ~' /~vs~_ ~,*'.4XAo-4(]';
(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.
County Tax Map No. 1000
Subdivision
(Name)
Location of land on which proposed work will be done:
House Number Street ~.? ~ ,$~et
Section ~ O Block ~,~ lia~ *~, }~}~1~:0 __Lot
Fi~~ ~,aa ~a,~..,,.~ Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed co,nstruction:
a. Existing use and occupancy 5'),~d~ ~'~,~,-, ][
b. Intended use and occupancy 5", ^,,~ / ~ ~,,,,--, [ /
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost 5,7'o O, o ~ Fee
5. If dwelling, number of dwelling units
If garage, number of cars
Addition Alteration
Other Workv'
(Description)
(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 3 ~ Rear _~
Height Number of Stories ~-
Depth
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
8. Dimensions of entire new construction: Front / '/ Rear
Height Number of Stories
Depth
Rear
9. Sizeoflot: 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 y/Will excess fill be removed from premises? YES NO P/
14. Names of Owner of premises PI.~ [ ,~o4,r4c~ddress .~'6 q'~-~r4-,,,,-- ~,,~ Phone No. '"] ~ 5' - / 7 ~o
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__
* 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 t,~
* 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'
COUNTY OF~,5'[( ("~0 ~~'-''''
taq, ¢;-~.~ / ,~,4,'~t iA O'-lq ~v P. being duly sworn, deposes ~d says that (s)he is the applic~t
~ame of individual si~ing 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 work will be
performed in the manner set forth in the application filed therewith.
Notary Public
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