HomeMy WebLinkAbout32444-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 11/17/06
No: Z-32013
THIS CERTIFIES that the building ADDITION
Location of Property: 480 NORTH
(HOUSE NO.)
County Tax Map No. 473889 Section 78
BAYVIEW RD EXT
(STREET)
Block 9
SOUTHOLD
(HAMLET)
Lot 41
SUbdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
OCTOBER 16, 2006 pursuant to which
Building Permit No. 32444-Z
dated
OCTOBER 23, 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" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to KAREL & LAURIE B ZMRLIK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
ignature
Rev. 1/81
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Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
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APPLICATION FOR CERTIFICATE OF OCCUPANq
A. For new building or new use:
I. 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 I % 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:
I. 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:
Date. If; - /1- e fa
V--
Location of Property:
1 I (Fl-
Hamlet
Owner or Owners of Property:
Suffolk County Tal' Map No 1000, Section
Block
Lot
Subdivision
Permit No. 32-4- tf t.f
Filed Map.
DateofPermit~~_ Applicant: t-4ue.1 e-
I .. Uld=iters Approval:
Lot:
13. ~(,2.. \'l~
Health Dept. Approval:
Planning Board Approval:
Requesl for:
Temporary Certificate
Final Certificate:
(check one)
Fee Submitted: $
C/o ~ 3 ')...0(3
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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.
32444 Z
Date OCTOBER
23, 2006
Permission is hereby granted to:
KAREL ZMRZLIK & WF
480 N BAYVIEW
SOUTHOLD,NY 11971
for
"AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
at premises located at
480 NORTH BAYVIEW RD EXT
SOUTHOLD
County Tax Map No. 473889 Section 078
Block 0009
Lot No. 041
pursuant to application dated OCTOBER
16, 2006 and approved by the
Building Inspector to expire on APRIL
23, 2008.
Fee $
300.00
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: Authorized Signature
ORIGINAL
Rev. 5/8/02
'3 J., If Iff ::c.
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING [ ~NAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS~/-ht-1J);~(J I4J4J~J ~
Sr74-ttts ,. 8 ~(~~ 10
~~7 IL; Un-,~ A# C&vS:~L
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DATE IOI.3tfO~
INSPECTOR
JAMES J. DEERKOSKI, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-7116
Date: November 6, 2006
To: Town of South old Building Dept.
Re: Deck Certification
Zrnrzlik
480 Bayview Rd.
Southo1d, NY 11971
To Whom It May Concern:
After a deck framing! footing inspection at the above mentioned pre built deck, it is
deemed that the deck is constructed as per plans submitted, and met all the state and local
codes at the time of construction. Any questions feel free to call.
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FIELD INSPECTION REPORT
FOUNDATION (1ST)
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DATE I
COMMENTS
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FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
FINAL
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
.
SOUTHOLD,NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southoldl
PERMIT NO.
.3 Vi41{-;t-/
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 300.00
Septic Form
N.Y.S.D.E.C.
Trustees
Contact: '--_ ~_ ~~t MU-ts f\)\f ~
"."" no'-'" Dr ~::; . (lo,,,,,-
Mail to:
Approved
Disapproved ale
I i)fti20~
lo,200b
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Examined
Expiration
t~, 20 ~~
Phone:
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! Building Inspector
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OCT , 6 2006
APPLICATION FOR BUILDING PERMIT
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Date
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INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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.
&.
ling ~~o/ess of applicant)
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State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
OWNGR...
Name of owner of premises 2mrz.. \;l k.t:!.'('"e.,\ 'i.t LU""
.I (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.
01&
County Tax Map No. 1000 Section
Subdivision
'7~
Block '1
Filed Map No.
Lot 4 J
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
Other Work
Alteration X
iff Joo
(To be paid on filing this application)
Number of dwelling units on each floor
(Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
I
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
Rear
Depth
9. Size oflot: Front Rear Depth
10. Date ofPurchase~Name of Former Owner -.t1 A-~I € .S-!:_uJz.cR.
II. 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 ~ Will excess fill be removed from premises? YES_NO l><
14. Names of Owner of premises .2mrz..l~k
Name of Architect :::r. "Q.er ~t")''',\--~ IRE:.
Name of Contractor
Address~ N~~ &i?hone No.c~.3I) 7~- 8~~lS"
Address "'0 )). PhoneNc&3J,).;ljl?-'7IIv>
Address tJu>.:: . Phone No.
IS a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _ NO ~
* IF YES, SOUTH OLD 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~L)
k\..J oJ \ ~ 2.Yl" vz.\ \ \e being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
i!lLU~
(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 t~efore me t .
t ~ day 0
BARBARA ANN RUDDER
Not.ry Public, State of New York
No. 4855805
Qualified In Suffolk County::>p11:?
Commllllon !xplr.. AP11l14. ~
Notary Public
Q
Q06 ~ 7 S'.. 9 - 1t TOWN OF SOUTHOLD
OWNER STREET-C
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VILLAGE
DIST.
sua.
LOT
LAND
Jvo <<6 WS,
FARM
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TYPE OF BUILDING
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It Ref.;Z 'l'2L~A-"+ 4f
FORMER OWNER
/>? '" " t< .$"T"4 'Tz ,.. ~
)/(114 J1Ie j Lc) ...fe e /. .. ./-IA J:
SEAS. VL.
RES. ;!. / D
IMP.
TOTAL
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110
II Cr()
AGE
NEW
FARM
BUILDING CONDITION
NORMAL
BELOW
ABOVE
Acre
Value Per
Acre
Value
Hau~e 4110"-
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FRONTAGE ON WATER
FRONTAGE ON ROAD /S,'
DEPTH ';;JD'A~
BULKHEAD
Tillable
Woodland
Meadowland
DOCK
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,
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II
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OCCUPANCY OR
USE IS UNLAWFUL
\VITHDUT CERTIFICA IE
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ALL C0NS""'-5\S';rL!.~N ~AA'H" Mrr.
THE R.EQU'R~MENTS. OF IHE N, . \
5T A TE CONSTRU~i'i(Wi'''It''fflmG'
CODES. NOT RESPONSIBLE FOI
DESIGN OR CONSTRUCTIOt--! c;'~r:.
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I~UCATION LAW.
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