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HomeMy WebLinkAbout33936-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33147 Date: 07/11/08 THIS CERTIFIES that the building ADDITION Location of Property: 645 HICKORY RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 54 Block 9 Lot 2 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. 33936-Z dated MAY 27, 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" ENTRY AND DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HERBERT L JOHNSON (OWNER) of the aforesaid building. SIIFFOL& CODNTY DEPARTMENT OF HSAI.TH APPROVAI, N/A HLSCTRICAL CHRTIFICATS NO. N/A PLDFIDSRS CERTIFICATION DATBD thorized Signature Rev. 1/81 Fortn No: 6 ~~ ~ l'1 / ~ / TOWN OF SOUTHOLD ~~ ~ BUILDING DEPARTMENT ~ a,1J" Q ~ ~,/„/ 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 I% 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 Apri19, 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. 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 $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 p Date. S" ~O ' ~~ New Construction: Old or Pre-existin//g Building: / \ (check one) / Location of Property: 6 S Ko/ ~ SO!/~~/~ Ol House No. // L S eet / Hamlet Owner or Owners of Property: ~Gr/J~ti T TO/7Y1 SOV! p~ Suffolk County Tax Map No 1000, Section s ~ Block / Lot Z Subdivision Filed Map. Lot: Permit No. 3 ~ I ~ So _ Date of Permit. S'-27 O8 Applicant: PPiLOrI /G pC/rYliT' lih//CAit/r15 Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 2 Underwriters Approval: Final Certificate: ~ ~ 33 l ~! ~ (Zo L 1 `4019 (check one) 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. 33936 Z Date MAY 27, 2008 Permission is hereby granted to: HERBERT JOHNSON 645 HICKORY RD SOUTHOLD,NY 11971 for "AS BUILT" DECK & ENTRY ADDITIONS AS APPLIED at premises located at 645 HICKORY RD SOUTHOLD County Tax Map No. 473889 Section 054 Block 0009 Lot No. 002 pursuant to application dated MAY 13, 2008 and approved by the Building Inspector to expire on NOVEMBER 27, 2009. Fee $ 500.00 /~ Aut`~ o zed Signature ORIGINAL Rev. 5/8/02 ~ Architects • Engineers • Construction Management ~, 671 Franklin Avenue Garden City, N.Y. 11530 www.blvdplan.com Phone: 516.877.0400 Fax :516.746.8622 ~ ~ _~ 1 _, , _ ~ _.-~ Building Department Town of Southold Re: Johnson Residence, Permit # 339362 To Whom It May Concern, June 5, 2008 I hereby certify to the Department of Buildings of the Town of Southold that I have inspected the above locations; I have supervised the preparation of the building plans as per State Education Laws; and [have determined to the best of my professional knowledge and belief that the structural elements are safe and that the footings, framing, and high wind strapping was installed in conformity, with the filed building plans, the New York Residential Building Code, and generally approved construction practices. If you have any further questions, please feel free to call me at any time. Boulevard Planning PC. 3~9-~~ ~o~,~OfSOUTyo6 "'/.Cs ~d'~~l= a o • o ~~ ~~`` Ty~0UNf1,'~ lJ~~j/~f' TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION l~ [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INS ATION [ ]FRAMING /STRAPPING [ INAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKS: INSPECTOR `'`~-~ ~~ 3393,~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING FINAL [ ]FIREPLACE 8 CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKS: ~. No ~"" DATE ~~~~ ~ ~ INSPECTOR ~~i FIELD INSPECTION REPORT DATE ~ COMMENTS ~; ro w.i trs ~ ~ ~ FOUNDATION {1ST) ?, ~ ~ i r r~[ ~ ~ FOUi`IDATION (2ND) i ~~ i z 0 ~y ~~ ~ ROUGH FRANlTn`G & PLUMBING ~ y _ --- ---- ----- x --- - ~"'~ -- - - -- n Ln'SULATION PER N. Y. aTE ENERGY CODE ST - '"~ ~ . t ~ ~%, ~ 3 '~ ,u, ~ ~ ~ / ~~ FINAL ~~. "`\ ~o / ~' ~ ~ J' ,,~ ~--J ADDTTIONAL COMNICNTS ;~~ ^ l - Z ~m A T a. °_ ~,.,~. v H ~ O `~ 2 - ti > ~_-3 w d r 7 J, v -i- TOWN OF SOUTHOLI~ , BUILDING DEPART1V1fENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802. FAX: (631) 765-9502 SoutholdTown.NorthFork.net Do you have or need the following, before applying'? 3 J' ~, ~ ^. PERMIT NO. 3 3 93 ~ Examined ~ ~, 20 ~'y/ Approved, 20° " Disapproved a/c Expiration 1 d' , 20 ~ ~~C~~-~- Building Inspector Phone: 734' ~3 ~[ APPLICATION FOR BUILDING PERMIT Date ,~- INSTRUCTIONS 20 ~ a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 se k 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. £ 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 regulati ,and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) 3~~7 6 ~R IrI ~pG . !iG ~G~~_ i GG (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~15~h ~ Name of owner of premises y ti' ~~C~ T d p ~h S O /~ (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. rvtewa~n~t a a~t~v 1. Location of land''iSh` ,,: done: Board of Health 4 sets of Building Plans Planning Board approval Survey Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail HOUSe Number,,, :~ n:, ,,~,US~tre~i~ilnx3 .~atealrt~:na~ yM County Tax Map No. 1000 Subdivision Hamlet Section s¢ Block 9 Lot .~ Filed Map No. Lot BUILDING PERMIT APPLICATION CHECKLIST 2. State existing use and occupancy o1 a. Existing use and occupancy use and occupancy of proposed construction: b. Intended use and occupancy /1 >i3/Of ~o <-G 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work ~ prci/i sa-/iarl (Description) 4. Estimated Fee (To be paid on filing this application) If dwelling, number of dwelling units ~ Number of dwelling units on each floor If garage, number of cars N/f3 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ,34, `1' Rear 3gi~ Depth j~. Height ~'-/- ZO ~f 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 .34,~. Rear .3Q..2 Depth ~~ Height % 2 0 ~~ Number of Stories 2 9. Size of lot: Front ~ ~ 0 Rear / 0 O Depth / 30 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated /~ ' 'f a 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X 13. Will lot be re-graded? YES NO x Will excess fill be removed from premises? YES NO~ 14. Names of Owner of Name of Architect, Name of Contractor S Addressfnr~/r/ig ,~+G~ G'G Phone Nos/6-877 OgOG Address Phone No. 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 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 0 ~ c/ ~' (. ~ i7 n-(, /' ~ 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 tme 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. PETER R. MCOREEW NOTARY PWLIC-STATE OF NEW YORK Sworn to before me this No. 02MC61 ~ 1614 © day of 20 0~ C ~n EuffolK C 2 lon Eap , Y009 Notary Public Signature of Applicant ~~~ ^ erg; ~,~ ~, TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET ~ VILLAGE DIST. SUB. LOT ~ ~ (~ ~. ~ 1 r ~ c~ e I So h ~S o~ ~~ rJYS ~~ e J~' o r o a _,, ~ ,. ---- FORMER OWN7~ET2 /Soa~~, A,So~r,n50~ /~ K 4Jf Y d P lQ- d N ~. i ..-~-i7li-.` ' r. " ~ ~ h' .~. / E ` it' 1 ~ f I ACR. , ~~~~ ~ss~4~~~ ~ K f/e. /6 ~1 $ (! ~ ~, ~~~.. V~/ ~- u~ru ~ TYPE OF BUILDING RES. a~~ SEAS. VL. FARM COMA. CB. MICS. Mkt. Value LAND ~ IMP. TOTAL DATE REMARKS -.f= j ~ ~' Gp cJ ~~, ~-<'. C7 %~e.. ~ ~Z ~ ~ t~ ~/ r4~ei/ :.a = ~' ~ ,C, L-sry .~- .~ , ~ 0 0 0 o U o ~vz S ! e Soo. p_ 36o qs Es a i/~ aF ~ W. ~~ c~ e ~`~{- ul l" ~ ~ 3'7o c~ ~, u o ~ ' y ~ ~ o .SiQ Sf~S ri°- ~9zs".o~ 93 J ~G/ f7vr~e ~~•c~/~-moo _ ~%::~ .'>Gr~w.t"o ./ _~ ~ ~'V c ~ O ~ - ~-, ,, ~±o~ ~ Z Sho`°~ *" 4 ~ . ro ~ ~$~- ~ "T5~"3- recon~-}r c ~F ~~ I' .~c~ 1~D ~ ._ ~oQ S ~ ? ~ - boa / ~ ~ ~ `..- r'z~ ws-L~z3 5 ~?8-J'o s Ja~ins~z ~ pis ~ ~s~l. rh e~- f t ~ nson ~P ~~ ~~ ~ l,~-e ~s~~-L.. AGE , BUILDING CONDITION NEW NORMAL BELOW ABOVE - _ FARM Acre ~ Value Per Acre Value Tillable ' FRONTAGE ON WATER Woodland FRONTAGE ON ROAD O p ~ ~; -~-~ ~ d ~ O t7 Meadowlamd ' DEPTH ~ 3 p House Plot BULKHEAD Total i DOCK a +~' t ~' .A v ~ _,-_ COLOR. --4G'7..~.~-• TRIM t.~.-..,~;,-~-<. ~, , -- -- _ i i I ` I I t ~ ~ o i ~ i ~ ~ _ f ~j ' ~/ ~ ~ ti _ ~ - Z i __ ~ ~ ~ ~ ' Ext Sian i ~ ~ ~ ~ ~y tensSOn f X Ohl /G ~ 20X2{= ~}~p 3Sd r'° 2G `(a i ' I e Sion ~¢x?-~'= 336 J sJ.') , '?-ju, Foundation a Bath ~ Dinette 'Porch Basement Floors K. P ~ ~~(n ZS ~ ?~ Ext. Walls ~Z JI ~~\ Interior Finish ^' `,7~--~ LR. $reezewaY Fire Piace I Heat .y ~ DR. :Garage Type Roof r ~ . Rooms tst Floor ~ BR. Patio ; Recreation Room Rooms 2nd Floor FIN. B O. B. Dor er Driveway , Total ~ ~~ _ ~ -hOZZbE~ttZi r 6 LAND NOW OR FORMERLY MURTAGH THE E%ISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE E%ISTING CODE OF PRACTICE FUR LAND SURVEYORS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 72D9 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NDT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED ID BE A VALID TRUE COPY. NO OFFICIAL OF THIS STATE, OR OF ANY CITY, COUNTY, TOWN OR VILLAGE THEREIN, CHARGED WITH THE ENFORCEMENT OF LAWS, ORDINANCES OR REGULATIONS SHALL ACCEPT OR APPROVE ANY PLANS OR SPECIFICATIONS THAT ARE NOT STAMPED. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON AN- TO THE ASSIGNEES OF THE LENDING INSTITUTION. CERTIFICATIONS ARE NOT TRANSFERABLE TO A-DITIDNAL INSTITUTIONS OR SUBSEDUENT OWNERS. SUFFOLK COUNTY TAX MAP DIST: 1000 SECT: 54 BLK: 9 LOT: 2 MAP NO: DATE: LOT(S) BLOCK MAP OF: DESCRIBED PROPERTY LOCATION: SOUTHOLD TOWN OF SOUTHOLD, COUNTY OF SUFFOLK, STATE OF NEW YORK SURVEYED: MARCH 19, 2008 CERTIFIED TO: KEVIN J. SMITH FIDELITY NATIONAL TITLE INSURANCE COMPANY SCALE: 1 "=20' FILE NO: 08-147 Wallace T. Bryan Licensed Land Surveyor MAINTAINING THE RECORDS OF BURTON, BEHRENDT do SMITH 559 Middle Road. Bayport' New York 11705 (631) 472-1770 Fax 4T1-1771 ~~s~` ~ N47°44'20"W 100.00'