HomeMy WebLinkAbout37779-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
2/12/2013
CERTIFICATE OF OCCUPANCY
No: 36131 Date: 1/31/2013
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 340 Birch Dr, Laurel,
SCTM ti: 473889 Sec/Block/Lot: 128.-1-7
Subdivision: Filed Map No.
conforms substantially to the Application for Building Permit heretofore
1/23/2013 pursuant to which Building Permit No.
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" carport altered to garage and renovate first floor area and finish second floor bathroom in an existing one
family dwelling as applied for.
Corrected 2/12/13 for carport altered to garage and finishing of second floor bathroom.
Lot No.
filed in this officed dated
37779 dated 1/29/2013
The certificate is issued to
Fox, Constance
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
H 064081 4/30/99
Town of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
2/12/2013
CERTIFICATE OF OCCUPANCY
No: 36131
Date:
1/31/2013
THIS CERTIFIES that the building
Location of Property: 340 Birch Dr, Laurel,
SCTM #: 473889 Sec/Block/Lot:
Subdivision:
AS BUILT ALTERATION
128.-1-7
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/23/2013 pursuant to which Building Permit No. 37779 dated 1/29/2013
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" carport altered to living space and renovate fu:st floor area in an existing one family dwelling as applied for.
The certificate is issued to
Fox, Constance
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
H 064081 4/30/99
~~t~e~r 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 #: 37779
Permission is hereby granted to:
Fox, Constance
PO BOX 186
Date: 1/29/2013
Laurel, NY 11948
To:
enclose a carport & renovate 1st floor interior space "as built" as applied for
At premises located at:
340 Birch Dr, Laurel
SCTM # 473889
Sec/Block/Lot # 128.-1-7
Pursuant to application dated
To expire on 7/31/2014.
Fees:
1/23/2013
and approved by the Building Inspector.
AS BUILT - SiNGLE FAMILY ADDITION/ALTERATION
CO - ALTERATION TO DWELLiNG
Total:
$1,128.00
$50.00
$1,178.00
Building Inspector
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/I 0 of 1% lead.
5. Commercial building, industrial building, multiple resideaces 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:
I. 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 slate the reasons therefor in writing to the applicant.
C. Fees
I. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00.
2. Certificate of Oceupancy on Pre-existing Building ~ $100.00
~....Copy of Certificate of Occupancy - $.25
.~Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
rote. / - / -/_3
New Construction:
.Location of Property:
House No. Street
Owner or Owners of Property: ~ 6/.~.~,/7~v
SuffOlk County Tax Map No l000, Section /'59- ~
Subdivision
Old or Pre-existing Building:
Permit No. .5 '~7 ~ 7~ DateofPermit.[ '~o~}'
(check one)
Hamlet
Block / Lot
Filed Map. Lot:
App cant:
Health Dept. Appro'val:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ _
Underwriters Approval: /
/
Final Certificate: / (check one)
Applicant Signature
THE NEW YORK B'OA~D DF FIRE* UiN~ER!WiR]TERS ' PA;~, 1
8074218 BURE~%I OF .E~.EC?RiClTY
F- 40 FULTON STREET, NEW ~RK, NY 10038
D~e ~R~ 30,1999 ~p~n No. ~ ~ ~7582099,/99 H 064081
THI~ ~E~TiF~ES THAT -
only the e~c~ e~me.t ~ desexed be~w a~ ~uc~ by-~ ~F~t ~d o, ~ ~O.e ~ ~u~er ~ ~ the ?r~m~s of
CONST~CE PETTE~EN, 34~ BIRCH DR~, ~L,
w~ .x~i.ed o. ~R~ 27,1999
DRYERS FURNACE MOTORS FUT
SERVICE DIS~ONNE~ I ~o. OFI
PADDLE FANS-8
G.F.C.I:-5
SMOKE DETECTOR: -6
CONSTANCE PETTERSEN
340 BIRCH DRIVE
P O BOX 186
LAUREL, NY, 11948
This certificate must not be o tered n any i
-:GENERAL~MANAGER
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:[ ] ELECTRICAL (R~UG ~H)~/,~ [ ] ELECTRICAL (FINAL)
DATE
INSPECTOR
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN. SUCTION
[ ] FRAMING/STRAPPING [ ,~]~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
/
DATE
INSPECTOR~~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. NorthFork.net
Exa,nined If-L-q, . 20 ~
Approved
Disapproved a/c
Expiration
BLDG.
fOW~ OF SOUTHOLD
Building Inspector
BUILDING PERMIT APPLICATION CHECKLIST
Do .xou have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey_.
Check
Septic Form
N.Y.S.D.E.C.
lYustees
C.O. Application
Flood Permit
Single & Separate
Storm-Water Assessment Form
Contact:
Mail to:
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
a. This application MUST be completely filled in by typexwiter or in ink and snbmitted to the Building Inspector with 4
sets of plans, accurate plot plan Io 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 belbre issuance of Building Permit.
d. Upon approval of this application, the Bnilding 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 pan for any porpose xxhat so ever until the Bailding Inspector
issues a Ce~ificate of Occupancy.
f. Eve~ bailding 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 t¥om snch date. If no zoning amendments or other regulations aftkcting the
prope~ have been enacted in the interim, the Building Inspector may authorize, in xwiting, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Boilding Department for the issuance ora Boilding Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suftblk Coonty. 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, boilding code, housing code, and regulations, and to admit
authorized inspectors on premises add in building for necessm'y inspections.
~'~ r~ a~a,ne, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner ofprenlises C'o/')~J~otlOc_ ~_ /~ X
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly anthorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
l,ocation of land on which proposed work will be done:
House Number Street Hamlet
Tax Map No. 1000 Section ]D,~a' Block ~ '~
County
Lot
Subdivision Filed Map No. Lot
State existing use and occupancy of premises and intended u.se and occupancy of proposed c. onstruction:
a. Existing use and occupancy [~.z~ta\}{ tq~ 1.5 'c5"r~5~ -~l~'t~x/ ~*'~['~¢5
b. Intended use and occupancy ~_o-d ~t°~_.~/jt::x,{. _'IF, ,/~5 '~F~ ~ .~oF, .- Il ~''~..q~ ct3o
Alteration'~
3. Nature oI~.work (check which applicable): New Building Additio~r
Repair"~ Removal Demolition Other Work
4. Estimated Cost Fee
(Description)
If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occnpancy, 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
Rear Depth
9. Size of lot: Front Rear Depth
10. Date of Purchase
Nanle of Former OxAqler
11. Zone or use district in which premises are situated
12. Does proposed constrnction violate any zoning la,~. 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. 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
· IF YES, PROVIDE A COPY.
NO
STATE OF NEW YORK)
~X~g~ '~ )Q being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He isthe
(Contractor, Agent. Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have perfm-med the said work and to make and file this applicatioa;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
perlbrmed in the manner set forth in the application filed therewith.
Sworn to.before me this,..w, '
~:x~9 dayof
Notary Public
Signature of A'pplicant
'7 TOWN C)F SOUTHO. PROPERLY' RECORD
ACI~
W TYPE OF BUILDING
FARM CO/IAM. CB. ~tCS. Mkt. Yalue
N
LAND [MD. TOTAL
AGE
NEW
FARM
NORMAL
Acre
BUILDING CONDITION
BELOW ABOVE
Vnl~e Per Value
BULKHEAD
DOCK
OWNER STREET V~LLAGE
sEAs. VL. I FARM
LAND . IMP. TOTAL I DATE
AGE
NEW
Tillable 2
Tilld~le 3
Woodland
Sv,,anxoland
BrusHoff'"
House Plot
NOP~AL
Acr~
BELOW
Value Per Acm
ACREAGE 7~-
ABOVE
Value
'-! I !'
~ ~ H
· -'"ri-" ~.°33.~ ...... :
_2. , , 7
' I/ ) -
~ ~ -~ ~ ~ I (2) 2X10 w/1/2'
ALL PLUM61N~TE .~ ~~~%.- Janua~ 26, 20Z3
& WATER UN~-~ED % ~-ESS~*~: 1' 0"
TESTING BEF~E C~ERING ~, ~ ~ /
-- T r / SHEET NO:
~UMBER C~FICA TION L J
ON LEAD CONTENT BEFCRE
CERTIRCA TE OF OCCUPANCY
SOLDER USED IN WA TS ~
SUPPL Y SYSTEM CANNO T
EXCEED ~10 OF 1% LEAD.