HomeMy WebLinkAbout33666-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33133
Date: 07/03/08
THIS CERTIFIES that the building DECK ADDITION
Location of Property: 17130 MAIN ST
(HOUSE NO.)
County Tax Map No. 473889 Section 117
(STREET)
Block 9
NEW SUFFOLK
(HAMLET)
Lot 28.1
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
JANUARY 28, 2008 pursuant to which
Building Permit No. 33666-Z
dated
FEBRUARY 4, 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 DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MICHAEL & SHANNON SIMON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE 110.
N/A
PLUMBERS CERTIFICATION DATED
N/A
~ed~
Rev. 1/81
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.
33666 Z
Date FEBRUARY
4, 2008
permission is hereby granted to:
MICHAEL & SHANNON SIMON
PO BOX 303
NEW SUFFOLK,NY 11956
for :
DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at
17130 MAIN ST
NEW SUFFOLK
County Tax Map No. 473889 Section 117
Block 0009
Lot No. 028.001
Fee $
200.00
28, 2008
oved by the
pursuant to application dated JANUARY
Building Inspector to
ST
Signature
ORIGINAL
Rev. 5/8/02
... - ,. 4' _... loJV\..!.....I....V.1.JU
PERMIT NO. 33~b 0
J::SUILUINU PhKMU APPLICATIUN CHbCKLlS'J
Do you have or need the following, before applying'
Board of Health
3 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502 .
www.northfork.net/StlUthold/
Examined
Approved
Disapproved ale
,20_
,20
Expiration
,20
Mail to:
Phone:
)
I
L
28
;,
~~LICATION FOR BUILDING PE
'O,,}
" j'~/'
" ,
INSTRUCTIONS
Date V~ d 8'"
200 g>
'-
a. This application MUST beemhpletely 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 oflot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and watelWays.
c. The work covered by this application may not be commenced before issuance of Building Pennit.
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.
APPLlCA TlON IS HEREBY MADE to the Building Department for the issuance ofa 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.
"
. (Si atore of applic,mt or name, if a corporation)
J:Jt!EJ roa'-wc ~~ C~Atcl1.~-e,
(Mailing ad ress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
AA...til-(Te ~ T
Name of owner of premises . tlj, t[.4,tt.~ f..s~ CN ~U11oN
(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 R~oposed work will be done:
J1J 1,0 , 1'YJ8:IN So f.
House Number Street
County Tax Map No. 1000 Section---,( \1
Subdivision
Block
Filed Map No,
q
New S1JrpctJ:,
Hamlet
Lot 2~, 00 I
Lot
(Name)
~
2. State existing use and occupancy of premises and' tende
a. Existing use and occupancy '1'1
"
b. Intended use and occupancy
StUMh
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
Alteration
Df'(',k Cldcll1-IGiII
(Description)
if b; COO.
Fee
4. Estimated Cost
5. If dwelling, number of dwelling units
If garage, number of cars V\ 0....
(To bc 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 2..l? ~. Rear 'LR' .{1. Depth
Height ~ p..t. Number of Stories i;:uJo
Dimensions of same structure with alterations or additions: Front J'l? it.
Depth .3 2.- a. Height. Number of Stories
V\.A.. .
~2..~.
1~.pt,
Rear
8. Dimensions of entire new construction: Front_I '2.. ~ . Rear
Height Number of Stories VI 4..'
9. Sizeoflot:Front~Rear ~ m.De. +!:Depth
It (t.
Depth
5.[J,
''2.5. "5 ,*.
] O. Date of Purchase
Name of Former Owner
, .
1 ]. Zone or use district in which premises are situated ~ - 4-D
]2. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO / '
]3. Will lot be re-graded? YES_ NO I Will excess fill be removed from premises? YES_ NO /
]4. Names of Owner of premises SimoN Address ~o303 NewS~lkPhoneNo. '12JLf.:-723l
Name of Architect '~~ ~ Sfm.NlA-N Address ~~it~ Phone No l ~~'i - (D-+~-
Name of Contractor If ~ Address Phone No. 71o::J -q ~ '4--
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 BIZ REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES -'-- NO ./
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
] 6. Provide survey, to scale, with accurate foundation plan and distances to property lines.
] 7. If elevation at any point qn property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
iSJffiJl< SS:
::;OUNTY OR 1- J
1lt.oY\'\A->S (; ,~IM,.{,I..W being duly swom, deposes and says that (s )he is the applicant
(Name of individual signing contract) above named,
~A11 tt~T
(Contractor, Agent, Corporate Officer, etc.)
:S)He is the
Jf said owner or owners, and is duly authorized to perform or have performed the said work and to make and ti]e this application;
hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
Jerformed in the manner set forth in the application filed therewith.
)worn!9-beforemet~ .1~/
'z..~ day oU(lI'\,v~ 20~
9~
Notary1fPHfcl,~ R!Ci-iARDd , '
No:sry Public. 5'ale of New York
No. 01 P.16042467
Qualified in Suffolk County
Commission Expires May 30, ~
2-€)L 0
~xS.
Signature of Applicant
33Gkh ~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
/)
/
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONSTRucnON
[ ] ROUGH PLBG.
[ ] INSULATION
,A:FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
REMARKS:
DATE b - )0 -- 0 !
INSPECTOR ~~
~
FIELD INSPECTION REPORT DATE I
FOUNDATION (1ST)
------------------------------------
FOUNDATION (2ND)
ROUGH FRAi\1ING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
FINAL
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FILE NO. /t93/
SURVEYED SSP r: <:S~ 19~ BY
WILLIAM R. SIMMONS JR.
PIO BOX 377
JAMES PORT. L.I., N. Y. 11947
PAGE 24 GRIOK='..39
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-2~_ \ TOWN OF SOUTHOLD P.OP~RTY RECORD CARD
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STREET
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DISTRICT SUB.
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TYPE OF BUILDING
e.rc.
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FARM
COMM.
MISe.
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I Est. Mkt. Value
Q l.. 5;;07.
/:r JltJ 4\4
C/;o. .,.IeJ' K, i Ifwe i- 'f
RE~ SEAS.
LAND IMP.
,
TOTAL
DATE
700
/60IJ
IE Do ,/
r) 6)
~o< (5 c'
2S-d()
36 (;
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7i/:)
FRONTAGE ON WATER
FRONTAGE ON ROAD 7,,5>'-. d'" .. 0."" ..r~, ('
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BULKHEAD
DOCK
00 ~
lI"ablEl],gb
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Ti liable 3
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Swampland
BrushlanCl' " ..
House Plot
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'2-lOO ~ Basement
'3 '7:f- Z 70 Ext Walls
-- f--------- f--
'!)t.:- ~~ Fire Place
(W.
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Fin. B. Bath ~ Dinette /
~~,...",MAL Floors Kit /
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('<.~.sk._\. Interior Finish L.A. -./'
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~cS Heat D.A. ./
\2- 'J.. '3~ c 3~ L\- '" :>~~
Ext nsion '& 'f...,2S ~ 1M' (
7.v ~ I'A
\ ::;, ,59Jf'n..~o~ W 'B)( 't ~ 72
\:,>ktens~n ~":t ~ 72.. _. _. __. .
1".>~tiO_e:. 'B l< 2A = 192-
Porch ~ ~l "',,~ > Cr.?:>
5 ~.!>
, '5b
'fCeo
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32
Dormer
Woodstove BA. .. /' :3
-- ------ r-------'-.
Baths \ J_
Fam. Rm.
Garage
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OWNER
LAND
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~___l__ __
IMP.
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TOWN OF SOUTHOLD PROPERTY RECORD
STREET
VILLAGE
ACR
REMARKS
TYPE OF BLD.
PROP. CLASS
TOTAL
DATE
DIST.
FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD WOODLAND
BULKHEAD
DEPTH MEADOWLAND
HOUSE/LOT
TOTAL
117.-9-28.1 1lI04
M Bldg.
2!;;
2_=_
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Fil
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Basement
Ex! Walls
ca
Fife Place
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OUTHOLO PROP=~
VILLAGE
;;;....:..-~_.-
REMARKS
lATE
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REMARKS
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