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HomeMy WebLinkAbout31198-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31666 Date: 07/12/06 THIS CERTIFIES that the building PATIO Location of Property: 440 JERNICK LA SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 3 Lot 18 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 8, 2005 pursuant to which Building Permit No. 31198-Z dated JUNE 13, 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 RAISED CEMENT PATIO TO EXISTING SINGLE FAMILY DWELLING. The certificate is issued to RONALD & JEAN YEDLOUTSCHNIG (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A thorized Signature Rev. 1/81 _.) Form No.6 r�d C: ` TOWN OF SOUTHOLD JUL I I BUILDING DEPARTMENT TOWN HALL 765-1802 _21 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 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. 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 Date. New Construction: Old or Pre-existing Building: X (check one) Location of Property: .21y0 TCF A,) le L IU S G CX r -lo, House No. Street Hamlet Owner or Owners of Property: Xp �J-} (�, /,,�7 0Urs Gff1_)/l Suffolk County Tax Map No 1000, Section Block 0 00 Lot (� Subdivision /y 6�L T 4d wt ( S Filed Map. Lot: Permit No.21 / g? Z Date of Permit. 4&� O Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ Applicant Signature E >tc.70 557 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. 31198 Z Date JUNE 13 , 2005 Permission is hereby granted to: RONALD YEDLOUTSCHNIG 440 JERNICK LA SOUTHOLD,NY 11971 for "AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 440 JERNICK LA SOUTHOLD County Tax Map No. 473889 Section 070 Block 0003 Lot No. 018 pursuant to application dated JUNE 8, 2005 and approved by the Building Inspector to expire on DECEMBER 13 , 2006 . Fee $ 300 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 hO�,,OF SO�T�o6 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSP CTION REMARKS: DATE 7�� INSPECTOR 765.1802 BUILDING DEPT. ✓ G INSPECTION [ ] FOUNDATION IST [>ROUGH PLO [ ] FOUNDATION 2ND [ ION FRAMING [ L [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: _ L� 1� DATE jy �� INSPECTOR 3119 8 atf solIA19 TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ULATION [ ] FRAMING / STRAPPING [L FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: __� � om- DATE �s �� INSPECTOR `�4 �o��oF souryo� 3111 ? z ©� TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING P<FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE �� �' �� INSPECTOR ✓i /'' � FIELD INSPECTION REPORT DATE COMMENTS W� FOUNDATION(1ST) x ------------------------------------ FOUNDATION(2ND) z 0 Q ROUGH FRAMING& y PLUMBING r INSULATION PER N.Y. �3 STATE ENERGY CODE r A V` d i `7 X 6 FINAL e i an IF:A1 TZ ' ADDITIONAL COMMENTS LL� N o �z 31 3 � w� � H Q O 6' z x y x d ro y TOWN OF SOUTHOLD PROPERTY RECORD CARD 1111- 2-7 OWNER STREET VILLAGE DIST.I SUB. LOT / // ! :i/�fi �',.;.,,{°"�..f',z:a,✓1�_ ...f- � / � -'t,C.f2L--� /`��., {..-F1. 1�J-�j��-,c,..� !. n CAL tf�SC N N! . ( .{.,�!-• ..� / !" V" FORMER OWNER N E ACR. } S W TYPE OF BUILDING RES-2eM . SEAS. VL. FARM COMM. CB. MICS. Mkt. Value � (� w ✓ LAND IMP. TOTAL DATE REMARKS p 0 0 /000 �1/ x-« S'3 �Sr (o,'i D/71 a e e ==tro CO yvyA o &7oo 3 a8 7 9a� y- a te, 4a { &,j ca 231f ill /fad dna o 00 5 Op p 2 ?2;— S Op 7 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total DOCK COLOR N p 7 TRIM I �1 t 5 M. Bldg• p y k Extension a„o x G = S.Z Extension Extension Foundation Both / 46—f—, DR. te Porch 3,x a. / v �—v S V Basement -J L Floors S Sei Zo = 5Zc4 2s /t� O �• Walls U /NG Interior Finish SyE�Breezeway Fire Place Heat / jj Garage a Ox G Z. SA 0 S•2-0 Type Roof Rooms 1st Floor BR. Patio Recreation Room Rooms 2nd Floor FIN. B O. B. Gy :--,00T 1 on Dormer Driveway Total s6 67S 2. zpr TOWN OF SOUTHOL6 _ n - 1-iILI ' BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTME 1` Do you have or need the following,before applying? TOWN HALL ' Board of Health SOUTHOLD,NY 11971 iJ _ j 4 sets of Building Plans TEL: (631) 765-1802Z_ of 'T Planning Board approval �.. FAX: (631) 765-9502 iqW' 4 - - ,} Survey www. northfork.net/Southiff& PERMIT NO. J Check Septic Form N.Y.S.D.E.C. Trustees Examined /o/ /5 ,205-- Contact: Approved 3 20jQ�C Mail to: Disapproved a/c Phone: Expiration /1/ 32064 ? i Building Inspector APPLICATION FOR BUILDING PERMIT Date 20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 set�pof 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 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 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 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. ( ignature of applicant or n q,if a corporation) 1-/ m�,k!U �e�.u.c� L �a (Mailing ad ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises Ill(Jt]� c L�bOt tlSCz W /G (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. p Other Trade's License No. �(� - �— O 1. Location of land on which proposed work will be done: !%LO Lt! � s�✓D� l) House Number Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision {LhR Ue? ,T �40µG`S Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,p,�jg��.0 b. Intended use and occupancy 1,24rj U 3. Nature of work(check which applicable): New Building Addition Alteration Repair_ 4 Removal Demolition Other Work 4- (Description) 4. Estimated Cost � D D d Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units / Number of dwelling units on each floor / If garage, number of cars / 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front G/ Rear ! r 3 � 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 Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase /iu 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 x 13. Will lot be re-graded? YES_NO---2(-Will excess fill be removed from premises? YES_NO_ 14. Names of Owner of premises ie�kddress qVd 1ef20 i/e( j Phone No. 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 NO X * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NOS_ * 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 s-f f•lkl Za r/` 16 J Y 2,A a A S C � nr2 q being duly sworn,deposes and says that(s)he is the applicant (Name of individual igning contract)above ed, (S)He is the (0 W N C/-- (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 true 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 this 8-4h day of So je- 20Oj fir. � �� ///U otary Public o 61 Signature of Applicant John M.Judge NOTARY PUBLIC state of New York No.OIJU6059406 y oualified In suttgijes May Y 9,20$� commission Exp �D( I S T I rl G }f 0 U S I: 1 270 1 & �{J� RVCST HOMt,5o CERTIFICATION OF NAIf LING & CONNECTI 2 SSG 2 A I REQUIRED. Lu GL CONSTRUCTION S HA I ME TMEREOUIREMENTS T E CODES OF NEW YORK ST f= `� OCCUPANCY ORE u&5°19 ooE 120 . 03 - USE IS UNLAWFUL 3 Wp k HpUT CERTIFICATE ;OCCUPANCY C4_ APP OVED AS NOTED o (� czs` CCA REMoV1�G y �XI.ST 14 G DATE: 3 B.P. Y So USE 1 U rt z X I CCA H t`I BY _���� F0. I c �ryJ �1 FEE: 0_ ARTMENT AT 351 - -- — Li 785 1802 8 1Z .7_�r cf L ObLp,WING INSPLC 'FOUNDATION "vvp REQUIRED l bT 2 `SRO LUMBING OSE3I FOR POURED UUNCRc. H 2. ROUGH - FRAMING & P .cru "RVEST i"'ES �., 3. INSULATION stca 4. FINAL - DONSTPUCTION MUST f!) BE COMPLETE FOR C-0- ON___ ALL CONSTRUCTION SHALL MEET CC-.6 REQUIREMENTS OF THE CODES S G '3 v C ul L p Yx f YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 1 M s `AFI c. &o 9, RETAIN STORM WATER RUNOFF I� 3 PURSUANT TO SECTION 45-10C OF THE TOWN CODE. ` �9 of \ ! eta°FEss� J . YEDL0l1TSCHk1 y =10 6F- 77pt �r Applicant/ p r r Date. A Owners Natile:.., f` _ -- Reviewed Architect! Qate: Engineer:. Submitted: SCTM #: District: I A0 Section. _ZD Block: LOO: ._ Project ./ 7 Subdivision ' Location: �/� J fir, Name: ---- ef Sigle d. separate Required certification: (Yes I No) �r Zottiq DistricC (t.ot size: Actual: .�%�� �� l (I of cuvcragc .��u '(rrot)tised Rey ( Req. ,�V / Req: ` ((root i'ard Propoicd: i (Side'Yard Proposed: ✓✓ j (Rear YardCO J V_"Prot�oscd •,/� Project Description: 12E0UIRED FOR RRA W `.A NO YES Suffolk County Health-Dept. Naw York State, D. R C. Town Tntstees — Town Zoning Board approval., Town Planning Board approval: — Flood bane Elevation??? 6,a Flood Zone:- •'�