HomeMy WebLinkAbout29440-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32182 Date: 02/05/07
THIS CERTIFIES that the building ADDITION
Location of Property: 380 MADISON ST GREENPORT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 40 Block 5 Lot 18
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 28, 2003 pursuant to which
Building Permit No. 29440-Z dated MAY 29, 2003
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 DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to GARY C & CARLA L BLASKO
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Au oried Signature
Rev. 1/81
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:
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" Ianuses:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topograph c
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$25.00, Alterations to dwelling$ 5.00,
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: XC Old or Pre-existing Building: (check one)
Location of Property: N J r nno
House No. Str et , f ^ �/ Hamlet
Owner or Owners of Property:�_ )� 1 ' � y 11k� g )
Suffolk County Tax Map No 1000, Section `-tD Block �� Lot 15
Subdivision Filed Map. Lot:
Permit No. a Q` \40 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: V (check one)
Fee Submitted: $
Applicant Signature
Q� 7f7 9�
Co �3,218
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. 29440 Z Date MAY 29, 2003
Permission is hereby granted to:
GARY C & CARLA L BLASKO
15 MADISON STREET
GREENPORT,NY 11944
for
CONSTRUCTION OF A REAR DECK ADDITION AS APPLIED FOR
at premises located at 380 MADISON ST GREENPORT
County Tax Map No. 473889 Section 040 Block 0005 Lot No. 018
pursuant to application dated MAY 28, 2003 and approved by the
Building Inspector to expire on NOVEMBER 29, 2004 .
Fee $ 150 . 00
Au r zed Signature
ORIGINAL
Rev. 5/8/02
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH BG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING FINAL
[ ] FIRED CE A C IMNEY
REMARKS:
DATEffX/�a INSPECTO
164
7 Z �
M-1802
BUILDING DEPT.
SPECTION
Z)/0UNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPL A CHIMNEY
REMARKS
I
DATE 1419,5- INSPE
M-1802
BU DING DEPT.
1 pPECTION
[ ] F DATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
jl
DATE �� INSPECT
FIELD INSPECTION REPORT DATE CObIl41EN1S
FOUNDATION(1ST) ,C
d ac
------------------
C
FOUNDATION(2ND) t
z
- - o
y
ROUGH FRAMING&
PLUMBING `3
o '
f
INSULATION PER N.Y.
STATE ENERGY CODE r
7
7
FINAL
ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD PROPERTY RECBRD� CARD
OWNER STREET VILLAGE DISTRICT SUB. LOT
F ER OWNERNe�merC.Qp„p// N E // ACREAGE
EST, ED. f ovELL6 �t�rJ G
S ,,. t W i TYPE OF BUILDING
2ES. ,21U SEAS. VL. FARM COMM. IND. I CB. MISC. I Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
2 21
600 goo 2-o 6
az
z 30/G S--
!2. 28 8 g/is %R. fsf F eovctto
o s T H. c. 1PcviLLo
AGE BUILDING C DISI 7
NEW NORMAL BELd BOVE FRONTAGE ON WATER
Farm Acre Value Per Acre Value FRONTAGE ON ROAD
fXOY e_o - }.
Fillable 1 BULKHEAD12 y `
9 i agcwi
7o �i Go mor/
-illable 2 DOCK
-i I lable. 3
Voodland
swampland
trushland
louse Plot
'otal
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Bldg.A.
Foundation
xtension :. ..
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Soo' SURVEY OF PROPERTY
a AT GREENPORT
TOWN OF SOUTHOLD
N/op P"�5H 12g6' SUFFOLK COUNTY , N. Y.
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1AS S I: A GARY BLASKO
`•Y m - CARLA 8LASKo
CONTINENTAL CAPITAL CORP.
1 A ' COMP TY TITLE INSURANCE
COMPANY OF NEW YORK Z
TITLE NO. FNT 3817501
LOT NUMBERS REFER To
MAP OF FLEETFIELD' FILED
• H .- IN THE SUFFOLK COUNTY
CLERKS OFFICE AS MAP
J NO. 1351.
p1F"i11
U0, SEW YU
B
120 AREA = 15.166 sq.,k. o
q' pg Fp' W H� SEK
Z ?
5 76 N/o/l 4-1.
`.F tMF AN AC ( v: DR ADD TON T- T"S SUR E+ IC A nJ GTIC'J
fl o, :._T 'e'JS Or THE EN 'OPK STP.L EDvCATIIJN_GN r :_ �� ��S•P
7105-$UBDIYIy01 2. At, CER E-A'0eS 1671 'r c cJ FAX/630 763-3020
"S MAP AND 0'115 �_EPEGf ON r r c C O ! 9(p
OPEE BEAR THE IMPRE55ED SCA: Or SHE YF
SVR •JR 7 Pu;E c 'REE'
- RE "'EARS Hf RED 98-33
r _ _ TOWN OF SOUTHOLD PROPERTY REGARD
OWNER STREET VILLAGE DISTRICT SUB. LOT
FCKMER OWNER ffer-r-rrerk,C.Qowll N E // ACREAGE
S7- RovELGo I C'cicr iSI=V /J;✓,C { !r% 'Y i 3 5-3 -
S // Why ^ TYPE OF BUILDING
RES. o��U SEAS. VL. FARM COMM. IND. I CB. MISC. Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS 5 / A q p
(�
00
zon
6o o goo /tad % �� I �� _
(ov pc rs ` L (a o- s� .3 L GSA y ,i'-(4
0 c CJ �l 0 t5 9 1 i zg� 8 AT i s iR. Esf aF �ov ertco 7oH. C Ravrcta
3-7 00 G R�7 o I L 90 — v�l/o E5f OSbOO
AGEFaow BUILDING C. DI1I 7 �t [> J , 1
NEW g70NORMAL BEL Q BOVE FRONTAGE ON WATER
Farm Acre Value Per Acre Value FRONTAGE ON ROAD Y� D� l
�7 n' y�3
Tillable 1 BULKHEAD 9 12 Z OC$�'fb Q /�7 �//J �d /���
Tillable 2 DOCK
Tillable, 3
Woodland
Swampland
Brushland
,r►
House Plot �^
Total
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mmm■ ■■■■mmmlm■
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Bldg.M.
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Extension
Extension interior Finish
Extension Fire Place
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•. �.. .-
..
3reezeway • • Roorns 2nd Floor
3arager 1 • �.
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
www. northfork.net/Southold/ PERMIT NO. a°14 qp-q, Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 1 20 3 Contact:
Approved S I Z 9 20 Mail to:
Disapproved a/c
Phone:
Expiration 11 20
Building Inspect
I. .
I•'IAY 2 a 2W3 APPLICATION FOR BUILDING PERMIT
Date 20-03�c INSTRUCTIONS
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 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.
(Signature of ap licant or name,if a co oration)
/Ba re S4 7
(Mailing address of applicant)
State whether applicant i owne lessee, agent, architect, engineer, general contractor, electrician, plumber o builder
Name of owner of premises 4e E/Q s,Kd
(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 will be done:
IS ( sio) rmaa sow c,-7L t�YPP� CJ
House umber Street Hamlet
County Tax Map No. 1000 Section �� Block Jr' Lot /8
Subdivision Filed Map No. >r Lot
(Name)
2. State existing use and occupancy of prp,}ises and ' tended use and 9f 5upancy of proposed construction:
a. Existing use and occupancy ?7eS r Ml r ri A-4 nd Q
b. Intended use and occupancy .K — r 1 M ctC l/L/ /4xX.// l U
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
,/ (Description)
4. Estimated Cost f O — 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 Rear 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 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. Will lot be re-graded? YES NOXWill excess fill be removed from premises? YES NO_X,
6or�
14. Names of Owner of premises CGLA6. i�(QS lddress/S It riidtson Sf Phone No. 477 '3(a 24,
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
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY �E_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 OFS�K
//
C�1a ��czs ll o being duly swom, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
vi
(S)He is the ( L lyr
(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
2 day of � 2003 dt'6_
/?ZaA
v
Notary Public Sign ure of Applicant
ELIZABETH A STATHIS
Ne of Now York
NoQR0
ST 081AY 73, Suffolk County
Tenn Expires June 8, l�
OCCUPANCY OR UNDERWRITERS CERTIFICATE
USE IS UNLAWFUL REQUIRED
WITHOUT CERTIFICATE APPROVED AS NOTED
OF OCCUPANCY
OIITEY,y - B.P.
FEE: BYr a f,
NOTI BUILDING GEPART ENT AT { J
MEEALL T CE REOU REMENTSTRUCTION SOF THE ALL �GOixING INSPECTIONS:Am TO 4 PM 7HE
CODES OF NEW YORK STATE. 1. �PgIREO-CONCRETETWORUM ,' }
2. ROUGH • FRAMING A PLUMBWG
3. MSIAATM ;-
�f.. �.,.�._`.-----�--„ - CBTRUCTKNIYUBTBE COMPLETE FOR CO.
CONSTRUCTION SHALL MEET THE),,FMM
EQUIREMENTS OF THECODESOFNEW -j
L+`fls-sus�± tugs YORK STATE. NOT RESPONME FOR ,
I' All DESIGN OR CONSTRUCTION ERRORS.
I
COMPLY WITH ALL CODES OF a
NEW YORK STATE 3 TOWN CODES
AS REQUIRED AND CONDITIONS OF
SDUIHCIDT=Zu
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SOL
saRHaotDAxms��s �
7 FLOOD ZONE"'L___
- .`' COMPLY WITH CHAPTER w�. I+`
a L
# -- FLOOD DAMAGE PREVENTION ,
f L SOUTHOLD TOWN CODE. ! `�
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BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: S03
APPLICANT: � 'DATE SUBMITTED: _E x/03
SCTM#
DISTRICT: 1,000, SECTION: , BLOCK: _5- , LOT: SUBDIVISION: _
ADDRESS: CITY: ,A ZONINGDISTRICV. CONFORMING?
BUILDING PERMITS OPEN/EXPIRED:
BP a'41 -Z/ C/0 Z- Iqb ( , INFO WD D /BPa 7 -Z/C/0 Z-AF 4( , INFO 7�k &
BP 2�� -Z/C/0 Z-aquig , INFO /BP -Z/C/0 Z- , INFO
PRE CO: Y OR N BP -Z/ C/o Z- ,
SINGLE & SEPARATE CERTIFICATION-REQUIRED NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED J QXow&RQ44 dJ .N 1999^^W-25.Merger.(A nonconforming at any time after 7/1/;
REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. _ACT. LOT COV.
REQ. FRONT ,?)5 PROP. FRONT ,i REQ SIDE ACT. SIDE �O
REQ. REAR 2' 1_15 PROP. REAR REQ. HEIGHT PROP.HEIGHT
PROJECT DESCRIPTION:��AA
ESTIMATED PROJECT COST: 14 r-- ARCHITECT _7_i- t 1 ` FAST TRACK ,y c
WATER FRONT? DESCRIPTION.-
PANEL
ESCRIPTION:PANEL #: FLOOD ZONE: , COMPLIANCE:
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH DEPT: YES or Cb)(BED #): DTE: / / PERMIT#:
TOWN SEPTIC RECEIPT: Y or(
NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or
SOUTHOLD TOWN TRUSTEES: YESor
TOWN ZONING BOARD APPROVAL: YES o
TOWN PLAN. BOARD APPROVAL: YES or
TOWN HISTORICAL PRE (SPLIA): YES or l
NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): 1 ES>or NO
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: r P)a SF FEE FEE FEE
I. (-SF)- ( SF)= SF X $-- _$ +$ +$
2. (-SF)- ( SF)= SFX $ _$ +$ +$ _ $
3. (-SF)- ( _SF)= SFX $ =$ +$ _+$ _
FINAL TOTAL. $
NEW YORK STATE CODE COMPLIANCE CHECKLIST
USE/OCCUPANCY CLASSIFICATION:
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION:
DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE
FULL FRAMING DESIGN ELEMENTS:
HEADERS: Y/N WALL STUDS: Y/N
GIRDERS: Y/N CEILING JOISTS: Y/N
FLOOR JOISTS: Y/N ROOF RAFTERS: Y/N
LUMBER SPECIES AND GRADE: Y/N
DESIGN LOAD CALCULATIONS: Y/N
SHOULD INCLUDE LIVE,DEAD,SNOW,SEISMIC AND WIND(INCLUDING UPLIFT AND EXPOSURE)
WINDOW AND DOOR SCHEDULE:
MISSLE TEST REQUIREMENTS: Y/N
EGRESS, LIGHT, VENT: Y/N
LOAD PATHS: Y/N
ROOF TO FOUNDATION
NAILING/CONSTRUCTION SCHEDULE: Y/N
MEANS OF EGRESS: Y/N
PLUMBING RISER DIAGRAM: Y/N
LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N
TRUSS DESIGN: Y/N
CERTIFICATION: Y/N
ENERGY CALCS: Y/N
TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE)