HomeMy WebLinkAbout37221-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
6/5/2012
No: 35734 Date: 6/5/2012
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 565 Stillwater Ave, Cutchogue,
SCTM #: 473889 Sec/Block/Lot: 103.-1-11
Subdivision: Filed Map No.
conforms substantially to the Application for Building Permit heretofore
5/11/2012 pursuant to which Building Permit No. 37221
was issued, and conforms to all of the requirements of the applicable provisions of thc law. The occupancy for
which this certificate is issued is:
handicap ramp for an existing one family dwelling as applied for.
Lot No.
filed in this officed dated
dated 5/17/2012
The certificate is issued to
John&Dorothy Behr
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
ed~natu~e
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 37221 Date: 5/1712012
Permission is hereby granted to:
Behr, John & Behr, Dorothy
3 Lewis Rd
PO BOX 1025
East Quogue, NY 11942
To:
construct a Handicap Ramp at an existing single family dwelling as applied for
At premises located at:
565 Stillwater Ave, Cutchogue
SCTM # 473889
Sec/Block/Lot # 103.-1-11
Pursuant to application dated
To expire on 11/16/2013.
Fees:
5/11/2012 and approved by the Building Inspector.
SINGLE FAMILY DWELLING - ADDITION OR ALTERATION
CO - ADDITION TO DWELLING
Total:
$200.00
$50.00
$250.00
/¢~lnspector
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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 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 all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. Ifa 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, Commemial $15.00
New Construction:
Location of Property
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
J Old or Pre-existing Building:
,ff /Tt/
House No. Street
Subdivision
PermitNo. ~-~7~ / DateofPermit.,_.4~/~-f~,(O.
Health Dept. Approval:
Planning Board Approval:
(check one)
Block
Filed Map.
Applicant: ./~/'~ ~/~ ~
Underwriters Approval:
Lot
Lot:
Request for: Temporary Certificate
Fee Submitted: $
Final Certificate: (check one)
/ Applic~mat ure
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
~FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
[ ]FIRE RESISTANT CONSTRUCTION [
[ ]ELECTRICAL (ROUGH) [
[ ] ROUGH PLBG.
[ ] INSULATION
~FINAL
[ ] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
] ELECTRICAL (FINAL)
REMARKS:
DATE
INSPECTOR
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECT
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING / STRAPPING
[ ] FIREPLACE & CHIMNEY [
[ ] FIRE RESISTANT CONSTRUCTION [
[]
[]
] INSPECTION
] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] EI, ECTRICAL (FINAL)
REMARKS: ~
DATE
INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
PERMIT NO.
Examined vg/? ,20 ~-~
^ rov 3 2,
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
Septic Form
Trastees
Hood Permit
Storm-Water Assessment Form
Contact:
Mail to:
Disapproved~/c ' Ph°ne:S/~ . 7,~ ~.~M~,~3
~ 2 [~ ' Bu~dinglnspector
II [ [ Il APPLICATION FOR BUILDING PE~IT
~ ~i~ion MUST b~ completely filled in by ~pewdter or in ink and submi~ed to the Building lnsp~tor with 4
s~~~e. Fee accor~ng to schedule.
b. Plot ............ plan sho~ng Iocatio~ ~ ~ ~ .....n of lot and of buildings on presses, relationship to adjoining p~emises or public s~e~ or
~e~, and wate~ays.
c. ~e wo~ covered by ~is application may not be commenc~ before iss~ce of Building P~it.
d. Upon approval of~ application, ~e Building ~pector wi~ issue a Buil~ng Pemit to ~e applic~t. Such a pemit
shall be kept on ~e premises available for inspection ~roughout ~c work.
e. No building shall be ~cupied or used in whole or in pa~ for ~y pu~se what so ever until the Building Inspector
issue~ a Certificate of Occup~cy.
f. Eve~ build~g pe~t ~1 expire if~e work au~odzed h~ not co~enced within 12 monks a~er ~e ~te of
issuance or has not been completed ~in 18 monks ~om such date. If no zoning m~en~ or o~er m~lafiom affecting ~e
prope~ have been enact~ in ~e intern, the Building Inspector may au~ohze, in ~ting, ~e extension of~e ~it for an
a~ifion six monks. ~ema~, a new ~mit ~all be req~red.
~PLICAT1ON IS HE'BY ~DE m ~e Bulldog Depmmem for ~e iss~ce of a Bulldog Pe~t pmu~t m ~e
Buil~ng Zone ~n~ce of the Tom of Sou~old, Suffolk Co~, New York, ~d other applicable ~ws, ~din~ces or
Regulations, for the cons~ction of buildings, additions, or alt~ations or tbr rmoval or demolition as herein deschbed. The
applic~t a~es to c~ply wi~ all applicable laws, ordinances, building code, housing code, ~d regulations, ~d to admit
au~ohzed inspecto~ on p~ises and in building for necessa~ inspections.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises '~O~AI ~ff~/,~ /~OffOt/~/ $~//'{
(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.
I. Location of land on which proposed work will be done:
House Number Street Hafnlet
County Tax Map No. 1000 Section ~0~'~ Block )
Subdivision Filed Map No.
Lot
2. State existing use and occupancy of premises altd in~nded use a~3fl, occuI?ancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building_ Addition Alteration
Repair Removal Demolition Other Work ~/5
t (Descfiptfon)
4. Estimated Cost a~,~>d~ Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cam
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 Stodes
Depth
Dimensions of same structure with alterations or additions: Front
Depth Height. Number of Stories
Rear
8. Dimensions of entire new constraction: Front
Height Number of Stories
Rear .Depth
9. Size oflot: Front Rear .Depth
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES__ NO__Will excess fill be removed from premises? YES__ NO__
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address Phone No.
Address Phone No
Address Phone No.
15 a. ls 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__
· IF YES, PROVIDE A COPY.
NO
STATE OF NEW YORK)
SS:
COUNTY OF )
being duly sworn, deposes and says that (s~l~l~Nt~al~, Ill,niXieH
(Name of individual signing contract) above named, ·
Notary Public, State of Now York
(S)lle is the NO. 01BU6185050
(Contractor, Agent, Corporate Officer, etc.) L/Ualffi~J In aun~r. ~..a~,,,~ ~l
Commission Ex!oires Apd114, 2u/
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 statement~ contained in this application ave 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.
Sworn to before me this^ t _
]~ day of 0~ 20 Jq~.
Notary Public
/t - Signa~/~/~icant
I
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