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HomeMy WebLinkAbout28273-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28356 Date: 04/24/02 THIS CERTIFIES that the building NEW BOILER INSTALLATION Location of Property: 2740 MANHANSET & 80 FIDDLER LA GREENPORT (HOUSE NO.) (STREET) (HAMLET) County Tax Nap No. 473889 Section 43 Block 1 Lot 1 Subdivision Filed Nap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 15, 2002 pursuant to which Building Permit No. 28273-Z dated APRIL 15, 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 INSTALLATION OF NEW HEATING SYSTEM IN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARY ANNE & ALBERT SHIVICKAS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Authorized gnature 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. 28273 Z Date APRIL 15, 2002 Permission is hereby granted to: MARY ANNE & ANO SHIVICKAS 59-74 68TH STREET MASPETH,NY 11378 for INSTALLATION OF A NEW BOILER AS APPLIED FOR at premises located at 80 FIDDLER LA GREENPORT County Tax Map No. 473889 Section 043 Block 0001 Lot No. 001 pursuant to application dated APRIL 15, 2002 and approved by the Building Inspector. Fee $ 150 . 00 Author ed Signature ORIGINAL Rev. 2/19/98 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 I% 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 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. Photocopy of Certificate of Occupancy-$0.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00 Date. L4' /a d2 0 U 2- New Construction: Old or Pre-existing Building: (check one) Location of Property: 2140 M&n t4Q i1 w4- AK N th &- eCAeeA. .N�— House No. Street Hamlet Owner or Owners of Property: A l W r-f S U,v,X kU!, TCI y►n&, -7"!,4 -A n I( Mks j 14 Vty c S LI;y C Gkj? ,M,I y-T2u s+ Suffolk County Tax Map No 1000, Section 4S 3 Block I Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (c ck one) Fee Submitted: $ Applicant Signature 6 . r 6� coezag3s� aha z 3 suaoINa DE". INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION 2 [ ] FRAMING [ FINAL EY" [ ] FIREPLACE & CHIMNEY REMARKS: � Ole-� DATE � IN8PECTOR TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 ,-��., �� Survey PERMIT NO.,—)%; Check Septic Form N.Y.S.D.E.C. 11 '.5 Z Trustees Examined 120 Contact: Approved L 20 ?j Mail to: Disapproved a/c Phone: Expiration (j i 120 qInsp AS 11010 APPLICATION FOR BUILDING PERM i DA L -_2 Date QPR' 2 , 2002- v INSTRUCTIONS NOTIFY BUILDING 7Q6-1 f9pc letely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets 9 �r e according to schedule. "alio*and of buildings on premises,relationship to adjoining premises or public streets or areal*(p Ug1frwFy"ING & pLUMRft a INSUMTK*covered by this application may not be commenced before issuance of Building Permit. 4 FJNFA�ox Q' p ,the Building Inspector will issue a Building Permit to the applicant. Such a permit shallbL�P eT El G&aiIable for inspection throughout the work. A used in whole or in part for any purpose what so ever until the Building Inspector THEissu THE N.Y. NTNT e if the work authorized has not commenced within 12 months after the date of CO issuI WNW 18 months from such date. If no zoning amendments or other regulations affecting the property ave een enacte in e i ,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 c de, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. gu <4,_s (Signature of applicant or name,if a corporation) 1© 96Y 0 � _ 66,A k lj (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 1?1P&a1,C,u.11 P(um!fie1Z Name of owner of premises A(bpe+ s4;vrc(cas Fato,14 jeeyiro(o(0 (rysf a- wla y Ali A e S14,v.-cku s (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer Fam,(,(�Y rtj-, ca(otcL (Name and title of corporate officer) Builders License No. Plumbers License No. `3> S q p Electricians License No. 45 Ll (— Other Trade's License No. 1. Location of land on which proposed work will be done: A-)q<) M aA kAvtse-t A vi2 a r a.. �i-O 'F,'d d(VP_ La.wc. G-wo p g(, House Number Street Hamlet County Tax Map No. 1000 Section 41, Block Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy S'n ato ci we 11,.4 a b. Intended use and occupancy S'ny t e -{'c m.udwell„�a 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work-—1,yj Yla I( COW' 2 C1,boo B!a I°01 to r- CA S41,P-0 d , (Description) . 4. Estimated Costc�,p7 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 cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front a y. (o Rear 2S.7 Depth 30,9 Height Number of Stories o'2 Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stc ? �} q� 8. Dimensions of entire new construction: Front �' Rear """"'"""'Tei"""+""""' fl Height Number of Stories :+ 9. Size of lot: Front 1 2 t) t Rear I 0 L t Depth ft l U1 �' OT RSA 0 CORt-a8V 10. Date of Purchase Name of Former Owner Lc 11. Zone or use district in which premises are situated . 3 12. Does proposed construction violate any zoning law, ordinance or regulation7rX44-JA 13. Will lot be re-graded? YES NO Wi11 excess fill be removed from pUdliek? V19! ,1: NO 14. Names of Owner of premises Address `4a0R Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is 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. T-�+k 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. Wk N W_C� rP -ove8 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF V o h h � being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the iU f2S)(" 0-[ B Ltr-+r% 4 l,4 64, Z N L (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 belie ; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 1 Z- ", day of IQ 49�,'( 20 U 2— T1-- Not ublic Signature of Xpplicant JENNIFER B.GOULD Notary Public,State of New York No.02GO5024640—Suffolk Counttyy Commission Expire—March 14,20Q2