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HomeMy WebLinkAbout31014-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32113 Date: 12/29/06 THIS CERTIFIES that the building ACCESSORY Location of Property: 4406 OLD NORTH RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 55 Block 2 Lot 8.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 20, 2005 pursuant to which Building Permit No. 31014-Z dated MARCH 23, 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 "AS BUILT" ACCESSORY STORAGE SHED IN THE REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to ROBERT A GRIGONIS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /,�Ah;yzed `Signature Rev. 1/81 Form No.6 TOWN OF SOUTHOLD I 1 17 / DEC 2 9 BUILDING DEPARTMENT TOWN HALL - i 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 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. I Z 2S b New Construction: Old or Pre-existing Building: X- (check one) Location of Property: (, 02-0 [v rslLT D 7J c(TH o Z p House No. Street Hamlet Owner or Owners of Property: 0 2 � A , (0 2( ('o 0 15 055- Suffolk County Tax Map No 1000, Section 47 3 Block CJ CJ o Z_ Lot Subdivision Filed Map, Lot: _ Permit Na Lf _,_. Date of Permit. Applicant: Health Dept. Approval: N A Underwriters Approval: _ n A Planning Board Approval: v r� Request for: Temporary Certificate Final Certificate: k (check one) Fee Submitted: $ -,;-L S—. o 0 Applicant Signat 0?_9 a l l y 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. 31014 Z Date MARCH 23 , 2005 Permission is hereby granted to : ROBERT A GRIGONIS PO BOX 4406 SOUTHOLD,NY 11971 for AS BUILT ACCESSORY SHED IN THE REQUIRED REAR YARD AS APPLIED FOR at premises located at 4406 OLD NORTH RD SOUTHOLD County Tax Map No. 473889 Section 055 Block 0002 Lot No. 008 . 006 pursuant to application dated MARCH 20, 2005 and approved by the Building Inspector to expire on SEPTEMBER 23 , 2006 . Fee $ 150 . 00 r / , Authorized Signature ORIGINAL Rev. 5/8/02 Blom 0, TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROU9H PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE I A'7 0 INSPECTOR I FIELD INSPECTION REPORT DATE COMMENTS W� FOUNDATION(1ST) x -------------------------------------- FOUNDATION(2ND) JQ6�M s 't z �o O 6' ROUGH FRAMING& y PLUMBING Z _ d INSULATION PER N.Y. _ y STATE ENERGY CODE --- - l z7 C0 FINAL ADDITIONAL COMMENTS (� d � O � z m ro x x H d I O Q • ' TOWN OF SOUTHOLD PROPERTY RECORD CARD (cl OWNER STREET VILLAGE DIST.1 SUB. LOT opt F� 6r orlr5 t,uf dv�� lsl FORMER OWNER N E ACR, S I f IW TYPE OF BUILDING < Y I Y RES. (� SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS b Q Z 5 Z9 0 - 1 v o C oa CO (o oa 4 s s i L I o4 39 3�3 A.L-r'c s 3 8 - # - *- �} b 3o3 rep&s Ffto3 Tillable ® rta FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot t I BULKHEAD Total 1 ■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■I!�/��■■■■ ■■■ ■■■■■■■• es■■■■■■■■■ ■■■■■■■A■©o■■■■e■■■■ ■■■■■■ ■■■■■■■I■■■■■ ■■■■■■ ■■■■■■■■■■■■■ __ - - e• a • • TOWN OF SOUTHO "—'�u _ �� s BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPART T y� j f Do you have or need the following,before applying? TOWN HALL 8 Board of Health SOUTHOLD,NY 119,71 i 4 sets of Building Plans TEL: (631) 765-1802 1. , 4 p- J Planning Board approval FAX: (631) 765-9502 ''` ' Survey www. northfork.net/Southold/ PERMIT NO. Fl0/Y-3 Check Septic Form N.Y.S.D.E.C. _ Trustees Examined L 20 Contact: Approved 3 2 I ,20___t�— Mail to: daoee o e a IUAT., Ag. Disapproved a/c Sa u TNc 140 'LA % . 11; 7j /_' Phone: art. 7 4-S-- Expiration ,20_,6_ ­ 7/ uildi pector APPLICATION FOR BUILDING PERMIT Date �2 2065 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. o. 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. (Sign a of ap tcant or name, if a corporation) f!4`06 dol) A)d�H Co. �a i N�GO, 4. , 1187/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder UT CJ JAL Name of owner of premises (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 of land on which proposed work PPwill be done: LJg04 oa0 !Ua2rs(- K.a �a�el1+ot—i0 . 0-� , l[S House Number Street Hamlet County Tax Map No. 1000 Section S 5 Block 2 LOPE ^ Subdivision Filed Map No. T (Name) 2. State existing use and occupancy of premises and intended use and occupan Wioposed cofistruction: a. Existing use and occupancy _ s o -� r u - � L / b. Intended use and occupancy s s a 0,L� 3. Nature of work(check which applicable): New Building x Addition Alteration Repair Removal Demolition Other Work Ity (Description) 4. Estimated Cost (D C)0- ' 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 l lr Rear t (e Depth ( a Height lo ` Number of Stories------L 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 -i a7. c ( Rear 3 So , Depth `a t 10. Date of Purchase I j'i G Name of Former Owner Ali Tv.+4S Cfl l [eo 5 11. Zone or use district in which premises are situated 4 `r=n 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO u 13. Will lot be re-graded? YES—NOS Will excess fill be removed from premises? YES NO x 14. Names of Owner of premisesIgIo Gtt i L-,1 ,s Address 41 0c, ooh 9=asd V0. Phone No. 7 6-,,- 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 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 ) 1 `O �.e r-T ( 2( fCdN 1 S being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the O tti N ul2_ (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 thi day of va 20 r1) t Notary Public Si tore pplicant 6011INIELOOROS19 Notary Public,State Of New YA No.01006095326,SuBolk Count TermEgimluf 7.20.Q. SUFFOLK CO. HEALTH DEPT. APPROVAL H. S. NO.-BFi-`3C3- (98 � NO2TH —' - STATEMENT OF INTENT " U R t THE WATER SUPPLY AND SEWAGE DISPOSAL s i tt SYSTEMS FOR THIS RESIDENCE WILL ; F2 tJi ; 14y CONFORM TO THE STANDARDS OF THE 1 Q� SUFFOLK CO. DEPT. OF HEALTH SERVICES. t�T (S) APPLICANT ts u � �J L SUFFOLK COUNTY DEPT. OF HEALTH TOWNu1= C,)LJTH5t,D, N,Y � � ' C4c ,r,F1 SERVICES FOR APPROVAL OF n O ' r CONSTRUCTION ONLY DATE: H. S. REF. NO.:-3c-hJ )�fJ 1 ' r APPROVED: ED: �.•, �a �nCP,fJ SUFFOLK CO. TAX MAP DESIGNATION: I WrLL oo, P POOL t DIST: SECT. BLOCK PCL. I Goo Z, Ell OWNERS ADDRESS: _ Boy lc�� I - • _ fi _`-4 �,_ F -- n' ' UTi fuL J s', 1 p I � - LL1 GT 26wc p9>✓i'-S,Dc•DECK. _i_ DEED: L.`�7 P. TEST HOLE STA F l A i.- r y rc r h 1 t t i c U evr» v r 1 i LG.' t,-1/1 !'ueiu Fa 'c. r C h f i1,7, � Ir d4 I 1 WAc' P,MEInDL-: ` PT.I8F1967 ., � COU25E SEAL C h.1 S:.t..nf G $ ' G C--A\,E L P F 7?T.tTC't�rLi r. F E.i ,i? MEF�N ;:LA LEVEL, A's EPT81y86 - RODERICK VAN TUYL, P.C. LICENSED LAND SUR\fiYORS 17 LAND` �/.•' GREENPORT NEW YORK TrJ[HNf YJ4 Ni 41 COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES OCPUPANCY OR APPROVED AS NOTED AS RI-QLIR--D AND CONDITIONS OF ! DATE:- SRI �0 Z So'-ao._TnLSA USE.ISUNLAWFUL FEE: NMNGBCARD NOTI S LDWITHOUT CERTIFICATE , _r,,RTMENT AT SOLCr10._TJNN TRUSTEES OF OCCUPANCY 765-1802 5 A TO 4 P FOR THE J FOLLOWING INSPECTIONS: N.Y.S.DEC 'p -- 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE ' 2. ROUGH - FRAMING & PLUMBING 3. INSULATION FOOD ZONE--N-i'— 4. FINAL - CON^TRUCTION MUSTCOMPLY WITH CHAPTER"46" BE COMPLETE FOR C.O. FLOOD DAMAGE PREVENTION ALL CONSTRUCTION SHALL MEET THE ALL CONSTRUCTION SHALL SOUTHOLD TOWN CODE. REQUIREMENTS OFRESPCODES OFNEW MEET THE REQUIREMENTS OFTHF4 YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. CODES OF,FNEW, YORKy_S7(, ,_ f 1 s � I 1 ��'- 13oPlcn &n-,rtn as > — - _ Ctn �e R,4iliL-- 11�n°r�i �1ut -_F:LCV r.-cra.-1 LOSYa �.r-e-zT 5'r�r - - r , -----Q — -------—pl _`_____- ____ -_ ___ ____ MPHkrT-R_ L,A H0. I 2L H 1 I _ r0 J � F �t - -- NEW P�\ AGE T(i. 5 4, b Q h u• r w -r-LOui[.-'PCFi-' V 0 W Q � � a