HomeMy WebLinkAbout30895-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 04/10/07
No: Z-322S1
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property: 10740
(HOUSE NO.)
County Tax Map No. 473889 Section 54
SOUNDVIEW AVE
(STREET)
Block 6
SOUTHOLD
(HAMLET)
Lot 4.3
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
JANUARY 13, 2005 pursuant to which
Building Permit No. 30895-Z
dated
JANUARY 13, 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 FIREPLACE, BATH ALTERATION & DECK ADDITION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to ROBERT R & DIANE SCHROEDER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
Rev. l/Sl
5)P-J50~L(3 70
PR I 02Li
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 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. Conunercial 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 Plalming Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-couforming 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
I. 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 - $] 00.00
3. Copy ofCerlificate of Occupancy - $.25
4. Updated Certificate ofOceupancy - $50.00
5. Temporary Celiificate ofOcetlpancy - Residentia] $15.00, Commercial $15.00
Dale.
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New Construction: . Old or Pre-existing Building:
Location of Property: /01% S()(fNf)V{~iJ/ I\1fB"
House No. Street
(check one)
$.Ql/17t7Ju;>
Owner or Owners of Property:
.
PI ftN'6' f- ~eee..1 &.tf~IJG'K
Sf
Hamlet
Suffolk County Tax IVIap No 1000, Section
Block
(p
Lot
*3
Subdivision
Filed Map.
Lot:
PI ftA€ 'f ~ Sc:tttceJ;t!<-
Pennit No.
}fJ'015-2-
Date of Permit. 12, 5. D').-
~. 70,05
Applicant:
Health Dept. Approval R,o-qq-()()!Rf;
Underwriters Approval:
Planning Board Approval:
Request for:
Temporar~y Cerlificate
Final Cel1iflcaie:
x
(check one)
Fee Submitted: $ ;)':>,07)
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Applicant Signature
6\~11?~)
QQ l- 3d-)S'
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.
30895 Z
Date JANUARY
13, 2005
permission is hereby granted to:
ROBERT R SCHROEDER
PO BOX 119
PECONIC, NY 11958
for :
FIREPLACE, BATH ALTERATION & DECK ADDITION TO AN EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR
at premises located at
10740 SOUNDVIEW AVE
SOUTHOLD
County Tax Map No. 473889 Section 054
Block 0006
Lot No. 004.003
pursuant to application dated JANUARY
13, 2005 and approved by the
Building Inspector to expire on JULY
13, 2006.
Fee $
150.00
t~~ r2&/~
! Authorized Signature
ORIGINAL
Rev. 5/8/02
3Df7$ --=C-
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS:
[ ] ROUGH PLBG.
[ ] ~ULATION
[ffiINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
C6J
r
DATE L(f Lj 107
v I
INSPECTOR
..
FIELD INSPECTION REPORT
FOUNDATION (1ST)
---------~~c--------------------
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FouNDATION (2ND)
.
ROUGH FRAMING &
PLUMBING
.
INSULATION PER N. Y.
STATE ENERGY CODE
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FINAL
DATE
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ADDITIONAL COMMENTS
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TO~:Oji' SOUTHOLD
BUILDING DEPARTMENT
TOWN HA1~L
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
-
PERMIT NO. .3 0 <a-9 S- -C
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
Septic Form
N,Y,S,D,E,C,
Trustees
Contact:
" 13 ,200.1
'. k?> ,200>"
, -
Examined
Approved
Disapproved afc
Mail to:
Phone:
Expiration
11 ' 3 , 2<t:2L
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Oc...gA--
(,~ Building Inspector
,IAN I 3 ' ~--
'APPLICATION FOR BUILDING PERMIT
Date
1112-
20 OS-
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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 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.
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)
f~ P;O'lI/t( P~#lC-
M/ lit/56
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
~o~a:r (<, S~or D{!I-N~ ~Iiif)fff<.-..
(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, Locati?n of land on which proposed work will be done:
to ~1D $DtJpfPv/W,f/tIl;;
House Number Street
.3Jf/(}WL[)
Hamlet
'/! r~'i . 'f
wt-
Lot
1?
County Tax Map No, 1000 Section
Subdivision
Sf
Block
Filed Map No,
6~
L~l
(Name)
-~
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Vi-
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2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy F:'{.671/Wfr 'StAl'tfU;;- F1rHttt..f PtlJElLinf;-- .
b. Intended use and occupancy -6 15Tl/rfr SIN~ f71-m1l.- D/.IfEiLIIJtr 11Jmf- ~
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
4. Estimated Cost
{6 (f5lfb-
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
I
(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
PWlb
Dimensions of same structure with alterations or additions: Front S~ A-rrAct<t3J Rear
Depth Height Number of Stories
S~iI17ltt'tW ~
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size oflot: 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. Willlotbe re-graded? YES_ NO_Will excess fill be removed from premises? YES_NO_
14. NamesofOwnerofpremisesP1iIYG ~ Address P.b, ~((q P6JJNiL.- Phone No. 1f6'ft?;:>
Name of Architect :Sft{~tI ~ern 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 MA Y ~r;: REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES_NO--L
* 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 SvFFbt.K..J
f>ttHE ~
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
tJlJf~
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duIy 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.
20L
~
Signature of Applicant
MELANIE DDROSKI
NOTARY PUBLIC, State of NewVork
No. 01004634B70
Qualified in Suffolk CountY
Commission flqJires September 30. 2a2b
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SUR~I EY OF PROPERTY
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T WN OF SOUTHOLD
SUFFO K COUNTY, NEW YORK .,~
S.C. T~X No. 1000-54-06-4.3
1 SCALE 1"=40' ,
. FEBRUARY 10, 1999
MARCH '1' 1999 ADDED PROPOSED HOUSE
JUNE 9, 1999 REVISED PLOT PLAN
FEBRUARY ,2001 REVISED PROPOSED HOUSE
DECEMB'R 6, 2001 REVISED SITE PLAN
OCTOBER 23, 2002 REVISED PROPOSED HOUSE OCATION
AReA = 49,625.30 sq. ft.
.1 1.13900.
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CERTIFIED TO:
FIRST AlAERICAN TITLE INSURANCE
ROBERT R. SCHROEDER JR,
DIANE SCHROEDER
COlAPANY OF NEW YORK
TEST HOLE DATA
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TOWN OF SOUTHOLD
SUFFOLK COUNTY, .NEW YORK .;,'l;
s.c. ;TAX No. 1000-54-06-4.3
I SCALE ,"=40'
I FEBRUARY 10, '999
MARCH ,12. 1999 ADDEO PROPOSEO HOUSE
JUNE ,9. 1999 REVISED PLOT PLAN
FEBRUARY, 3. 2001 REVISED PROPOS EO HOUSE
DECEMBER 6. 200 1 REVIS EO SITE PLAN
OCTOBER 23. 20D2 REVISEO PROPOS EO HOUSE LOCATION
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CERTIFIED TO:
FIRST AlIERICAN TITLE INSURANCE
ROBERT R. SCHROEDER JR.
DIANE SCHROEDER
COllPANY or NEW YORK
TEST HOLE DATA
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