HomeMy WebLinkAbout32597-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32128 Date: 01/10/07
THIS CERTIFIES that the building ACCESSORY GARAGE
Location of Property: 26755 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 109
(STREET)
Block 2
CUTCHOGUE
(HAMLET)
Lot 14
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
DECEMBER 19, 2006 pursuant to which
Building Permit No. 32597-Z
dated
DECEMBER 27, 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" ACCESSORY GARAGE AS APPLIED FOR.
The certificate is issued to JAMES & GINGER TOMASZEWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~d~
Rev. 1/81
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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:
I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic featores.
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 builtlings (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 a 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, A1temtions 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 - $25.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. iZ - 111 20Ck
New Construction:
Old or Pre-existing Building: ./
HflM RoA1)
Street
'hir..lf-tft' 1Of71/tJZtu.JJic/
/0 q Block;;;
(check one)
ttAt~tU
H et
Location of Property: d (P 75 S-
House No,
.-/
Owner or Owners of Property: .J f71I1 /:,J
Permit No.
Date of Permit.
Filed Map.
Applicant:
Underwriters Approval:
Lot
Lot:
/<j
Suffolk County Tax Map No 1000, Section
Subdivision
Health Dept. Approval:
Planning Board Approval:
Request for: Tempomry Certificate
Fee Submitted: $
Final Certificate:
-/ (check one)
Q~~
App'l'icant Signatore
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lC:) Z: 3::2.1J. gr
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.
32597 Z
Date DECEMBER 27, 2006
Permission is hereby granted to:
B THURSTON (TOMASZEWSKI)
26755 MAIN RD
CUTCHOGUE,NY 11935
for
"AS BUILT" ACCESSORY SHED AS APPLIED FOR
at premises located at
26755 MAIN RD
CUTCHOGUE
County Tax Map No. 473889 Section 109
Block 0002
Lot No. 014
pursuant to application dated DECEMBER 19, 2006 and approved by the
Building Inspector to expire on JUNE 27, 2008.
"
Fee $
150.00
d~ C/1l~
Authorized Signature
ORIGINAL
Rev. 5/8/02
}l-S177-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING o<i FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARK~ ~ ~~
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DATE 1'-- J -- 0 1
INSPECTOR ffi. flL-
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FIELD INSPECTION REPORT DATE I
COMMENTS
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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.net/Southold/
BUILDING PERMIT APPLlCA nON CHECKLIST
~'Piration-= t Ji-'!-. 2~-A\)
/)
f!{:;';;L ,
Building Inspector
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans ~
Planning Board approval
Survey /
Chec~ ,/ <6 '1~
Septic Form______
N.Y.SD.E.C.
Trustees
Contact: ~. ,
Mail tol:Ji,.J0bZ- /O.AAjCt-wJk<
, q!(,SD HA"v &A1:> kl11l:>U:t..)'1
Phonc:jp31- 7,",~-- t;/(,4 .... "q 7
&J/. S~S' /7/'}-
PERMIT NO. ,'3;::/. 5"'17 ~
Examined ~ . 20 bJ;
Approved _ '. -----'nf11. 20 _f) {.,
Disapproved aie _____________
18.'2006
APPLICATION FOR BUILDING PERMIT
Date
fcctNbue Jq
20 0&
'-
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 oflot 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.
I d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall t = 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.
y <7-------
1J(;5O HAl;"; ~ ..k/l-fOLb NlJ I Ie; 7(
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
, .-.-;
· Q/lJb(fe.. /DMIlSUwJIu
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
Name of owner of premises
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No,
I. Location ofland on which proposed work will be done:
cJ&75S ~R',.,j /tO4/',
House Number Street
(,U!-(J,ow.e.
Hamlet
County Tax Map No.1 000 Section
Subdivision
/01
Block cl
Filed Map No,
Lot J<!
Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy V r1 (a.r. + - f: lC/'Jr (N~ Jif.tCAf::} I: JI{f::/:)
b. Intended use and occupancy .JlrrA{q(; JhtD.
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work "'fA
.
Alteration
,.JS} ...J/:ol:t> (D
(Description)
4. Estimated Cost
Fee
5. [fdwelling, number of dw~lling units
If gafage, l1umber of cars . " .;111
(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 I,) (
Height I;) \ l/I" Number of Stories
Rear
/~ I
\ 5'
Depth d
Dimensions of same structure with alterations or additions: Front J'i:\1"11::
Depth JAM? Height ~t' Number of Stories
Re"-fJ~~
JAIA1..-
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9, Size oflot: Front
..>-0 I
Rear
SO'
Depth
/75'
10. Date ofPurchase~ Z. - It ~ ex:x.., Name of Former Owner k)nJ!. t 1}IvtJ/O"J
- [J.fCJ(;
II. Zone or use district in which premises are situated
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 ~
.:JflMtJ '6;-Jt:1fft-
14. Names of Owner ofp-remises ---rD"'AJZtwlk
Name of Architect Ci-.Drllo PtJIO(;tJfJ.
Name of Contractor
Address <fP(,SO -+1_"';;/. J~.t/Phone No.
Address J-fA,;,j ~. J~, Phone No
Address Phone No.
{(po'- tf/lPt;
I(;S- - C,S.l1:J
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 )
/
ClJ'tJfq6r rJ. ~lJ-jztwJIU.' being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
D.>>rr.w -
(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.
o before me th:D
- day of I fltf/'VIher
J)1~1
Public
20 J)b
~~ A 1-
Signature of Applicant
"
--------
MELANIE OOROSKI
NOTARY PUBLIC. State of New Vorl!
No, 01004634B70
Qualified in Suffolk CountY ,,, \ 0
Commission Expires September 30~
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CHORNO ASSOCIATES
architects.
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