HomeMy WebLinkAbout33917-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33045
Date: 05/27/08
THIS CHRTIFIES that the building ADDITION
Location of Property= 515 MOOSE TRAIL CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 103 Block 4 Lot 46
Subdivision
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 13, 2008 pursuant to which
Building Permit No. 33917-Z dated MAY 16, 2008
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
The certificate is issued to KATHRYN LAGATTA
(OWNER)
of the aforesaid building.
SIIFFOLR CODNTY DEPARTMENT OF HEALTH APPROVAI,
ELECTRICAL CERTIFICATE NO. N/A
PLDMBHRS CERTIFICATION DATED
uthorized Signature
Rev. 1/81
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Form No. 6 ,
TOWN OF SOUTHOLD 2
BUILDING DEPARTMENT
TORN HALL i 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 al] 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 azchitect or engineer responsible for the building.
6. Submit Planning Boazd Approval of completed site plan requirements.
B. For effisting 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. Tf 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. Jr _Z/- 08
New Construction: Old or P/rt~et-existing Building: ~( (check on/e) /
Location of Property: .S/S /'I~OSG T/Yn~ ~ G~~GN ~SGG
House No. II Street / Hamlet
Owner or Owners of Property: Koi ~N /'Y h /j ~ S if 7 Gt.
Suffolk County Tax Map No 1000, Section ~ 0 3 Block ~ Lot
Subdivision Filed Map. Lot:
Permit No. 3 3~ I ~ Date of Pennit. Jam- /6' O~ Applicant: GQ 5 k ~' ~ 4
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: x (check one)
Fee Submitted: $ 2'~
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Appli rgnature
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. 33917 Z Date MAY 16, 2008
Permission is hereby granted to:
KATHRYN LAGATTA
515 MOOSE TRAIL
CUTCHOGUE,NY 11935
for
"AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
FOR
at premises located at 515 MOOSE TRAIL CUTCHOGUE
County Tax Map No. 473889 Section 103 Block 0004 Lot No. 048
pursuant to application dated MAY 13, 2008 and approved by the
Building Inspector to expire on NOVEMBER 16, 2009.
Fee $
400.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
33917z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING FINAL
[ ] FIREPLACE A CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
REMARKSe
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DATE INSPECTOR
FIELD INSPECTION REPORT DATE ~ COMMENTS
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FOUNDATION FIST)
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FOUNDATION (2ND) ~' \
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ROUGH FRAMING &
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PLUMBIN ~.\
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INSFJLATION PER N. Y.
STATE ENERGY CODE - -- ~
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FINAL
ADDITIONAL COMMENTS
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TOWN OF SOUTHOLUl jp ~ ; BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMla)NT i Do you have or need the following, before applying?
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802 i
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
Examined ~ ~ , 20 ~~
Approved S I u, 20~
Disapproved a/c
Expiration , 20~
13 J
s
PERMIT NO. ~ 39i 7'T
Board of Health
4 sets of Building Plans
Planning Board approval
Septic
N.Y.S
Flood Permit
Storm-Water Assessment Form
ContacC:
Building Inspector
Mail to:
Phone: 734 " 8.j ~/
APPLICATION FOR BUILDING PERMIT
Date ~ y ~ .3 , 20 O 8
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 afrer 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. Thereafrer, 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 constmction 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 ad
authorized inspectors on premises and in building for necessary inspections.
(Signature of ap rcant or name, if a corporation)
~/~QJr Maiq Rd } ~~ 9Ch05liC_
(Mailing address of applicant
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
' (As on the ta~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 Li~,~t~~~ ~ ~~~
>Ippr W9H ip ttAtt~~iJtW Y~ASOM
l . Lro~cation of lart~ ~otss+>wicb liyloposed work will be done: /'
,l~,r)" Ytr..~oJ Alottl~i~j~~~u0 ~.^ar~ Ci y~C
Hous~°I~u4AU>"lQ°A'•'ta'; "3ltt~l"1°~ r"" Hamlet
County Tax Map No. 1000 Section ~ ~ 3 Block ~ Lot_
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and
a. Existing use and occupancy
use and occupancy of proposed construction:
b. Intended use and occupancy ~G~/~tG~ c-G
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work LeS~fI/yw~ion
(Description)
4. Estimated Cost
Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units N//g Number of dwelling units on each floor
If garage, number of cars N /it
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions o xisting structures, if any: Front ~ 7 Rear 7 ~ Depth gZ
Height Number of Stories 1
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front ~ 7 Rear ~ 7 Depth
Height ~t Number of Stories !
9. Size of lot: Front ~ 4 ~ Rear ~ ¢ S Depth 2 ~
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated K- 4 0
s8
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO~
13. Will lot be re-graded? YES NO x Will excess fill be removed from premises? YES NO x
14. Names of Owner o
Name of Architect
Name of Contractor tiaaress
No.
No S/~-817-o~joo
uaue No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO JC
* 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.
18. Are there any covenants and restrictions with respect to this property? *YES NO~
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
R o ~ Z!r ~ G~ 'I // >/~'T being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
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 beli~~r~ tl~~~-k will be
performed in the manner set forth in the application filed therewith. NOTARY 9YRlN:•tTAiE Of NEW YORK
Sworn to before me thisn No. 02MC~1~/61•
/n~~-' /7~/L/L 20U~ oua1HW In funak unty
~ day of o upup Orl. 2009
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Notary Public Signature of Applicant
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