HomeMy WebLinkAbout31855-ZFORM
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31491 Date: 03/23/06
THIS CERTIFIES that the building ALTERATION
Location of Property: 1425 NORTH SEA DR ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County T~ Map No. 473889 Section 15 Block 5 Lot 27
Subdivision Filed Map No. -- Lot No. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 16, 2006 pursuant to which
Building Permit NO. 31855-Z dated MARCH 16, 2006
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" BATHROOM ALTERATION IN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
· ~ne certificate is issued to MIRKO & TERESA KULIC
(OWNER)
of the aforesaid building.
SUFFOLK COUN~I~f DBPART1~ENT OF HEALTH ;%PPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'r~u3
N/A
N/A
N/A
Rev. 1/81
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 submitted 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 installatiun 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.
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 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.
C. 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: Old or Pre-existing Building:
Location of Property:
House No. Street
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section __
(check one)
Block
Lot
Hamlet
Subdivision
eermitNo. 31~)~--~'~ DateofPermit.
Filed Map.
Applicant:
Lot;
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ..~ _~'~-- '-
Underwriters Approval:
Final Certificate: ~
(check one)
Applica~
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUII~DING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 31855 Z Date MARCH 16, 2006
Permission is hereby granted to:
for :
BATHROOM ALTERATION
MIRK0 & TERESA KULIC
45 EVERGREEN AVE
BETHPAGE,NY 11714
"AS BUILT"
at premises located at 1425 NORTH SEA DR ORIENT
County Tax Map No. 473889 Section 015 Block 0005 Lot No. 027
pursuant to application dated MARCH 16, 2006 and approved by the
Building Inspector to expire on SEPTEMBER 16, 2007.
Fee $ 300.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATIOI~/~ ~ ~
[ ] FRAMING / STRAPPING [//~ FINAL ~~
FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE
INSPECTOR
FOUNDATION (2ND)
ROUGH FRANIING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
DAli
CO~TS
FINAL
ADDITIONAL COMMENTS
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL tl
SOUTHOLD, NY 1~71
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined
Approved
Disapproved a/c
:3'/I b' 20
Expiration
200'7_
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
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
,20
a. This application MUST be completely filled in by typewriter 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 tl'fis 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
prolf~y 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.
(Signature of applicm~t or name, if a corporation)
~-~ (Mailing address of applicant) ~,l //7/
State whether applicant ~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
/
Name ofowner ofpramises I~'.lr E % c-x /[,.ct Z.[ (_._
(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.
Location of land on which proposed work will be done:
House Number Street
County Tax Map No. 1000
Subdivision
(Name)
Section
z7
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisfing use and occupancy S~{~/~ff.Z /~te/-~t/(~/~ A~P-~ ,S'/ggi~-'~t~/Olff-.
b. Intended use and occupancy t~'~'~ ~'
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost
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, specify nature and extent of each type of use.
7. Dimensions o f existing structures, if any: Front Rear Depth
Height Number of Stories
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
9. Sizeoflot: Front Depth
Depth
Rear
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated ~ 4 ~
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
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address
Address
Phone No.
Phone No 7~3 ~ ~4/oO,~'-
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 ofatidal wetland? * YES NO ~F~
* 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)
CO TY OF& ;o I}L
'~ [/~' ..<~C~.~ ~/~ [ j C being duly sworn, d~oses and says that (s)he is the applicam
~me of individual si~ing contract) above named,
(S)He is the ~ ~ ~)~. ~
(Contractor, Agar, Co.orate 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.
Sworn to before me thisv3A r, . ~ /~
dayof / tClAL/C 20 ,L,
Notary Publ ll~l~ ~
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