HomeMy WebLinkAbout33555-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPA~RTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34082
11/17/09
THIS CERTIFIES that the building PORCH REPAIR
Location of Property: 1805 YOUNGS AVE SOUTHOLD
(HOUSE NO.) (STREET) (HA~4LET)
County Tax Map No. 473889 Section 60 Block 1 Lot 4
Subdivision Filed Map No. __ Lot NO. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 27, 2007 pur~,mmt to which
Building Permit No. 33555-Z dated NOVEMBER 29, 2007
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 PORCH REPAIR ON AN EXISTING ONE FD/~ILY DWELLING AS APPLIED FOR.
The certificate is issued to DAVID CICHANOWICZ
(OWNER)
of the aforesaid building.
S[~FFOI,K C~)[~qT~f DEPART~T OF ~LTH ~_PPRO%5~L
~.R~'~RIC3%L U~TIFIC_A~ NO.
PL~ u~KTIFIC3%TION DA'r~u
N/A
N/A
N/A
Authorized Signature
Rev. 1/81
Form No. 6
TOWN OFSOUTHOLO IIr ]l
BUILDING DEPARTMENT Iii III -711 III
TOWN HALL I- '"1 2 9 III III
APPLICATION FOR CERTIFICATE OF OCCUPANCY'"'----~$~f~m n-'~'"'t /
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" land uses:
1. Accurate survey of property showing ali 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
New Construction: _
Location of Property:
House No.
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No. ~ 5~55 --~_. Date of Permit.
Health Dept. Approval:
Old or Pre-existing Building:
Street
Date.
(check one)
0 GO.
Hamlet
Filed Map. Lot:
Applicant:
Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ c,~.~ * O~
Final Certificate: L~'~(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. 33555 Z Date NOVEMBER 29, 2007
Permission is hereby granted to:
MARY ROSE MINER
PO BOX 27
SOUTHOLD,NY 11971
for :
PORCH REPAIR ON AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at 1805 YOUNGS AVE
County Tax Map No. 473889 Section 060 Block
pursuant to application dated NOVEMBER 27, 2007
SOUTHOLD
0001 Lot No. 004
and approved by the
Building Inspector to encpire on MAY 29, 2009.
Fees 200.00
'-~---Authorized Sign
ORIGINAL
Rev. 5/8/02
FO~ATION (1S~ ~
~o~noN (~) ~ .~
ROUGH F~G & ~
PL~G
~S~ATION PER N.Y. ~
STATE ENERGY CODE ' ~
F~
~DITION~ COUNTS ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
PERMIT NO..'~'~:~
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
Examined // /,.~
Approved ~j//~//~
Disapproved a/c
,20
Expiration
., 20
Septic Form
N.Y.S.D.E.C.
Trustees
Storm-Water Assessment Form
Contact:
Mailto:
Phone:
APPLICATION FOR BUILDING PERMIT
Date ,20 0.7
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.
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 bas 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.
~' ( Signka,~re-
_icant or name, if a corporation)
Iailing 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 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.
Location of land on which, proposed work will be done: /r.//
Hous'e Number / Stret~ Hamlet
County Tax Map No. 1000 Section
Subdivision
(Name)
Block 0/
Filed Map No.
Lot
Lot
2. State existing use and occupancy of premises and intended use t~/~/&~g~'
a. Existing useandoccupancy --~/~t/W ~'*~}~t and°ccupagcy°fpr°p°sedc°nstructi°n:
b. Intended use and occupancy ~14~ ~
3. Nature of work/(check which applicable): New Building Addition Alteration
Repair -/ Removal Demolition Other Work
Estimated Cost ?q',.~gOO,~ Fee
If dwelling, number of dwelling units
If garage, number of cars
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, 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
Dimensions of same structure with alterations or additions: Front
Depth. Height Number of Stories
Rear
8. Dimensions of entire new construction: Front
Height Number of Stories
9. Size oflot: Front 7/9 Rear ~' ,t O
10. Date of Purchase
Name of Former Owner
Rear .Depth
Depth
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES
13. Will lot be re-graded? YES NO ,///Will excess fill be removed from premises? YES
14. NamesofOwneroflLr, emises/~,~_ ~ot~ Address [~,ff ~d12/7~$ /~hol~eNo.
Name of Architect 7f'o~'~ r'/~/~,,'1/ Address*,?o,5' t~ ~}ot{.~v-~n~n*e No
Name of Contractor Address Phone No.
NOJ
et?7- ot 7,5 z_
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES
* 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.
NO
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 )
o
/3 ~1 d//~/~//3~./'/~ Z-~ being duly sworn, deposes and says that (s)he is the applicant
(Nan~e of indivi'dual-sit~fing contract) above named,
(S)ne is the ~,'¢ ,.
(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.
TOWN OF SOUTHOLD PROPERTY REI
OWNER
~FORMER~DWNER, , /) ., '
STREET j '~
VI LLA'(~E
ORD CARD
D~,.~. SUB.
ACR. J
LOT
/
~,ES. ~t0 SEAS.
LAND IMP.
AGE
NE~V NORMAL
FA]~M Acre
Tillable 1
¥illable 2
rillable 3
~oodland
~wampland
3rushland
~ouse Plot
'oral
VL.
TOTAL
FARM
DATE
BUILDING CONDITION
BELOW ABOVE
Value Per Value
Acre
e/ ,
TYPE OF BUILDING
'/ ~
COMM. CB. MIS Mkt. Value
FRONTAGE ON WATER
FRONTAGE ON ROAD ,.,, ,/' , ~
DEPTH
BULKHEAD
DOCK
M. Bldg.
Extension
Extension
Extension
Porch
Porch
Breezeway
Garage
Patio
O.B.
Total
COLOR
TRI,M
Zoundotion
~asement
:xt. Walls
Fire Place
Yype Roof
~ecreotion Room
Dormer
j Driveway
Bath
Floors
Interior Finish
Heat
Rooms 1st Floor
Rooms 2nd Floor
Dinette
LR.
BR.
FIN. B.
$7
j'OIIN ~'
cO~C
G
SURVEY OF PROPERTY
S[TUA T£
$OUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-60-01-04
SCALE 1"=30'
NOVEMBER 5, 2007
AREA = 22,521 sq. ft.
0.517 ac.
CERTIFIED TO:
DAVID CICHANOWICZ
THE EXISTENCE OF RIGHTS OF WAY
AND/OR F.~SEMEN'r$ OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED.
N.Y.S. Lic. No. 50467
Nathan Taft Corwin III
Land Surveyor
77tie Surveys -- Subdivisions -- Site Plans -- Construction Layout
PHONE (651)727-2090 Fex (631)727-1727
OFFICES LOCATED AT MAILING ADDRESS
322 Roenoke Avenue P.O. Box 1931
Riverheed, New York 11901 Riverhead, New York 11901-0965
~o4.
FEE:~ '
NOTIFY BUIL~:h ~,~,TMENT AT
765-1802 BAk~ '!O , R: FOR THE
FOLLOWinG
1. FOU,,~ ~L,~i ,. fl~OU~EU
FOR POURED
- FR~, ....... & PLUbiB',HG
2. ROUGH - ~
3. INSULATION
4. FINAL - CO !'.L,, 0., MUST
BE COMPLETE FL , C:.O.
ALL CONSTRUCTI3';4 5~*~L MEET THE
REQU~RE%~ENTS O,-
YORK STATE. NO: nESFONS:BLE FOR
........ ~n CmH,:'Fr~i I~TI~[~ FRRQRS.
OF OCCUPANCY
r f
b
r: Iq ;o"
HO¥ 2 ? 2007
IT IS A VIOLATION OF
LAW FOR ANY PERSON,
UNLESS ACTING UNDER ~
DIRECTION OF A LICENSI=n
ARCHITECT, TO ALTER ANY
ITEM ON THIS DRAWING IN
A,"JY WAY. ANYA..THO~I~n
ALTERATION MUST BE
NOTED, SEALED, ANO
DESCRIBED IN ACCORDANCE[
WiTH THE LAW.