HomeMy WebLinkAbout28841-Z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southo1d, N.Y.
CERTIFICATE OF OCCUPANCY
No, Z-31780
Date, 08/28/06
THIS CERTIFIES that the building
ADDITION
Location of Property, 1930 MARLENE
(HOUSE NO.)
County Tax Map No. 473889 Section 144
LA
(STREET)
Block 2
LAUREL
(HAMLET)
Lot 32
Subdivision
Filed Map No.
Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
OCTOBER 15, 2002 pursuant to which
Building Permit No. 28841-Z
dated
OCTOBER 18, 2002
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 HANDICAP RAMP ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to WALTER M SHARKEY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO_
N/A
PLUMBERS CERTIFICATION DATED
N/A
~~
Authorized Signature
Rev. 1/81
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Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TO"''N HAU,
765-1802
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," ._j<\.PPLlCATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submiUed 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 2/1 0 of I % lead
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a cerlificate
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) nOlI.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 - Ncw 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. TemporalY Certificate of Occupancy. Rcsidential $15.00. Commercial $1 5.00
Date. --Au-~ ~ 0 t) 6'__
New Construction: Old or Pre.cxisting Building: _____ (check one)
Location of Property: /130 Harlfl/lr' 1i1 _ Il1ott;1UcL__
H6use No. Street Hamlet
Owner or Owners of Property: M 4 /te L/fj_ 4-_ .uilv;; il/fC?) 5" kd/',fa )/
Suffolk COlUlty Tax Map No 1000, SectiOn _~____ Block _~ ___ _ Lot 3c-J____
Subdivision
_ ___ [<J!ed Map
-._--.~- ----
Lot:
Permit No.
Date of Pe1'lllic__ .____ Applicanl:____ ________
Health Dep\. Approval:
Planning Board Approval:
____ Underwriters Approval:
Request for:
Temporary Certificate _
Final CertJficate:
(check one)
Fee Submitted: $
?J ,ffi~ -~, )t.{J.f:J,.\~
Applicant Signature i
64.. <<... .70 't 5 I
(f)?::~177:J..
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.
28841 Z
Date OCTOBER
18, 2002
permission is hereby granted to:
WALTER M SHARKEY
PO BOX 1558
MATTITUCK,NY 11952
for :
CONSTRUCTION OF A HANDICAP RAMP ADDITION AS APPLIED FOR
at premises located at
1930 MARLENE LA
LAUREL
County Tax Map No. 473889 Section 144
Block 0002
Lot No. 032
pursuant to application dated OCTOBER
15, 2002 and approved by the
Building Inspector to expire on APRIL
18, 2004.
Fee $
150.00
L/"
ORIGINAL
Rev. 5/8/02
, . ..
FIELD INSPECTION REPORT DATE COMMENTS- -
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FOUNDATION (1ST) ~ ~
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INSULATION PER N. Y. - I
STATE ENERGY CODE ~
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.netlSouthold/
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact: _ /
Mail to: Il/-C.K !J-ee7 YI tV
Phone:)o/tf- '1'3~7
PERMIT NO. .;;leS'1/l::
Examined
Approved
Disapproved alc
Ie /6
It. ~-e
20 J.,
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,20iL
Expiration
~110
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Building Inspector
,/
APPLICATION FOR BUILDING PERMIT
Date
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 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 South old, 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 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
()wner
Nameofownerofpremises [, )o.."/tU" 'f Cc::t.1he..rIY\t' S~CJ' KeL/
- (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.
1. Location ofland on which proposed work will be done: 11.1... L
19,~) (Y}v/ene L"l.hp., fYJ~x
House Number Street
J /9502-
Hamlet
County Tax Map No. 1000 Section
Subdivision
) 1-/1/
,
Block c;t
Filed Map No.
Lot ~ -=30l..
Lot
(Name)
2. 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
Addition Alteration ~
Other Work R Cu.1P
~ (Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specifY nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
9. Size oflot: Front iJ~ CLC..re. Rear
! '1 go
Depth
40 ''wid <e.. 33" (-ise
Rear
,q~~+, 10:5
Depth
tJ Oyy\<v-4(
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. Wi1llotbere-graded? YES_NO~Wi1l excess fill be removed from premises? YES_ NO ,/
Vohlfl:.lC"I' wt1,eii",e.. 1"'3D fV)c).i/e.r.€- k>ne.. - .
14. Names ofOwnerofpre1nises-Sh:::>r-Kt'1 Address ~+bt, >.-1- ,uV Phone No. c::)Oj R-'!=,'i77
Name of Architect Address ' Phone No
Name of Contractor OLV f\t.r Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO L
* 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_
* 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 )
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing 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 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.
2~
iHQMASJ UI-lUNGER
I'lO\aIY pWIc. _ of New Yorll
No. 01-4733066
QuflIlfle<! In SufloII< countY 0 <
eorrv-nIN1on ElIjllmt Feb~ 28, 2O.:-L,
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WITHOUT CERTIFICATE
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