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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.