HomeMy WebLinkAbout28198-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28296 Date: 03/21/02
THIS CERTIFIES that the building ADDITION
Location of Property: OFF EAST END RD FISHERS ISLAND
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 11 Block 1 Lot 9.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 18, 2002 pursuant to which
Building Permit No. 28198-Z dated MARCH 20, 2002
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 ROOF DECK & FRONT PORCH ADDITION TO EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to DANIEL & SARAH B GORDON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. PENDING 03/05/02
PLUMBERS CERTIFICATION DATED N/A
Authoriz Signatu e
Rev. 1/81
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. 28198 Z Date MARCH 20, 2002
Permission is hereby granted to:
DANIEL & SARAH B GORDON
1021 WEST HORTTER ST
PHILADELPHIA, PA 19119
for
CONSTRUCT ROOF DECK & FRONT PORCH ADDITION ON EXISTING SINGLE
FAMILY DWELLING AS APPLIED FOR. (REPLACES EXPIRED BP #14840Z)
at premises located at OFF EAST END RD FISHERS ISLAND
County Tax Map No. 473889 Section 011 Block 0001 Lot No. 009 . 001
pursuant to application dated MARCH 18, 2002 and approved by the
Building Inspector.
Fee $ 150 . 00
Autho z d SigA7ature
ORIGINAL
Rev. 2/19/98
FORK NO.
TOWN OF SOUTHOLD d7L�'�7
BUILDING DEPARTMENT
TOWN HALL v
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 14840 Z Date ... . ... .......................... ..
Permission is hereby granted to:
...lcl� ..�Y ..................V.-
................a. �..........................
to ....................11... ......L�... ...`,~ . -..!1..�''�.�!!�.... '!\. .... IL
....... .. R...
..i2�lklraq.�..G1-a... nn--, -..........................................................................
-9 .. �aizJK�r�I
at premises located at ...rti ..re�i�r!-fA.
�. .�?..� ... . ' ,...............................................................................
County Tax Map No. 1000 Section ......0.1.1......... Block ....... ..'........ Lot No. ............
pursuant to application dated .....�."....a 7..................... 19.940, and approved by the
Building Inspector.
Fee $..5b.'../!....
..... ....................Building.inspector.........................
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT -
TOWN HALL
765-1802 i., 18 2002
APPLICATION FOR CERTIFICATE OF OCCUPAN
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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 17 lead.
5. Commercial building, industrial building, multiple residences and similar buildinf
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 an(
'"'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 a 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 - .25t.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
3/8/02
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . X . . . . . . . . . . . .
' East End Fishers I 1 Y
Location of Property. . . . s. s��c .ly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property. . , ,Daniel,and .Sarah .Gordon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. 11 . . . . . . . . . .Block. . . .1. . . . . . . . . . .Lot. 9.:1 , , , , , , , , , , , , , , ,
Subdivision. . .N/A . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . .
Permit No. . 28198Z*. . . . .Date Of Permit. . .3120102. . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . .
*Replaces BO #14849Z
Health Dept. Approval. Underwriters( 14;,SQ,-,lye ), ,Underwriters Approval. . .3./.1102. . . . . . . . . . . . . .
Planning Board Approval. . . N./.A . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. , X. . . . . . .
$. 25.00 '
Fee Submitted: . . . . . . . . . . . . . . . . . . .
a '4 �� I • • • • •
. � . .
APPLICANT Richard Strouse
a �aq(D Engineer
03/27/2002 08:44 FA% 11002
ter Of7 VhW
91
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING INAL
REMARKS%
At
DATE /�- INSPECTOR
FORM NO. 1 D
TOWN OF SOUTHOLD #027"� 7
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined . . . . . . . ., 19Received . . . . . . . . . . , 19 . . .
Approved . . . Y.r). . . . . . ., 19��. Permit No. . . . U. . .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . . .�.q . � �vrc.� . . ., 1986
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3
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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation. '
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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
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_-uth^r apd inspectors on premises and in building for necessary inspections.
Vvlw,aRao .Ar:��si c 1s ,hn.c•
. . . . .
(Signature of applicant, or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Q,rrk. "
. . .. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-t.�
Name of owner of premises .�a•+1t;t� T Sa.vwt+• �.• .6C%n-Je • , , , , , , , , • , , , , , , , , • , • , , , , , • • , • , , , ,
(as on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer.
k .
(Name d title of corporate officer)
Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . .
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . `
1. Location of land on which proposed work will be done. >R4S'f EI��, , �'1��I�s.,:S (S �.Y, , , , , , , , , ,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
House Number Street Hamlet
County Tax Map No. 1000 Section . . . PJ. . . . . . . . . . . Block . . .I. . . . . . . . . . . . . . Lo>- 9' . . . . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . .
ame) ,ry. s : iUt�ti;. . . . . . . . . . . . .
(N7 =o
2. State existing use and occupancy of premises and intended use and occupancy of pxoposeo cep structicrp:
a. Existing use and occupancy . 54►?1.1f.:7 � ' s,¢ . . . . . .0. . . . . . . . . . .
b. Intended use and occupancy S&44%L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .- . .".A'. . . . . . . . . . . . . . .
3. Nature of%York k %06 h applicable): New Building . . . . . . . . . . Addition . ✓. . . . . . . Alteration V . . . . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . Other Work .
r o • (Description)
4
Estimated Cost 5,Vao . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .
f
71% (to be paid on filing this application)
S. I dwe%41 t . . . . . . . . . . .
welling units . Number of dwelling units on each floor.
Igarage,number of cars . 14
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . .
. . . . . . . . . . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .N•A.. . .
7. Dimensions of existing structures,if any: Front 3'•9: . . . . . . . . . . Rear . Al Depth .�4:I. ' • ' . . . .
Height . . . . . . . . . . Number of Stories ?. . . . . . . . . . .
Z.a .
Dimensions of same structure with alterations or gdditions: Front 39•. . . ' , . • Rear . 3'l . .
Depth .' 2V. . . . . . . . . . . . . . . . . Height . . . . . . . t. . . . . . . . . . . . . ...
P� • �� • 1 . • . . . . . . . . . . . Number of Stories .?-. . . .
8. Dimensions of entire new construction: Front . 33. Rear . .33.., . Depth . .1. ' . ' '
Height . .I.g . . . . . . . �. Number of Stories . .2• "
9. Size of lot: Front . .1?r4 . . . . . . . Rear .3 I I .�. . . . . . . . . . . . . . . . . .Depth 299 'i . . . . . . . . . . . . . . . .
10. Date of Purchase . . . . . . . .1.9,8 3 , . Name of Former Owner Kr f tA4vs; Alh4-!l,Gro;-,ler , •
11. Zone or use district in which premises are situated . .fts14":k1f :- G9,.nr4, ,,.,f. ' ' '
12. Does proposed construction violate any zoning g law, ordinance or regulation: :t Q • ' ' ' '
13. Will lot be regraded . Will excess fill be removed from premises: Yes Qo
14. Name of Owner of premises DAN44 ArOT rlorj• , . . Address 4�5, hd M't11 Rk• . . :Phone No.?c!l! k,S,•+,t�}3,�!f: .
Name of Architect lvl�CSV.- gh !/4KJ+tk�FJI;►,�., Address7K&'v4 '"��s�enA4APhone No.4(It 4C-1.74P .
Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . .
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
ekr
1 PON-04
ISS SETpSAGK � EyytTING .
LIrFG 1 HC
1
1 ue►a RmF "
1 �FGK,
�aT LIF-Lll= �
SV"O-K.co.TAx MAP 1
/ I-OTolocCo 011 •1 9.1
�i..�T4 Ps{.ocic.'s5
COUNTY OF S.S
. .JAVAge �t �1�9. . . . . . . . . . . . . . . . . . . . . being duly sworn,deposes and says that lie is the applicant
(Name of individual signing contract)
above named. '
f, t• ,
lieis 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.
Sworn to before me this
Notary Publi •�/�ou�sex
Y
3 ;7 . . . ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature of ap �
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4, FINAL. Cf"'IRTRUCTION MUST.
5 BALUSTF--&-S DETW. EA.FoS'�' BC COUPI ETE FOR C.O. 11
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