The URL can be used to link to this page

Home My WebLink About28453-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28522 Date: 06/17/02 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 39405 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 15 ORIENT (STREET) (HAMLET) Block 8 Lot 17 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 28, 2002 pursuant to which Building Permit No. 28453-Z dated JUNE 11, 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 "AS BUILT" ADDITION AND ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WILLID~4 A & JAMET D HANDS III (OWNER) of the aforesaid building. S~FFOLK COUNTer DEPART~4ENT OF ~RALTH ~.PPRO~L~L E~.Rt-£RICAL CERTIFICA~E NO. PLUMBERS CERTIFICATION DA'r~u N/A N/A N/A ~. A~uth~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. 28453 Z Date JUNE 11, 2002 Permission is hereby granted to: WILLIAM A III HANDS 39405 ROUTE 25 ORIENT,NY 11957 for : "AS BUILT" ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 39405 NLAIN RD ORIENT County Tax Map No. 473889 Section 015 Block 0008 Lot No. 017 pursuant to application dated MAY 28, 2002 and approved by the Building Inspector to expire on DECEMBER 11, 2003. Fees 300.00 U ~--~---~'~rizJd~ignat~re Rev. 5/8/02 COPY Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewfiter or ink and submitted to the Building Department 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 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. 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. Copy of Certificate of Occupancy - $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. ~/~"~t~/~ ~Otg~ New Construction: Location of Property: , Owner or Owners of Property: ~ ~ 7~ ~- Suffolk County Tax Map No 1000, Section /~" Block Old or Pre-existing Building: House No. Street Subdivision PermitNo. ~O~:~/-//._~3~_ DateofPermit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ (check one) Hamlet aO Lot /7 Filed Map. Lot: Applicant: ~,>/h .~','2 ,~ ...~ .,~/~/_~-~_ Unde~dters Approval: Final Certificate: / (check one) BUILDING PERMIT EXAMINER CHECK LIST DATE IS'SUED: / /02 DATE REVIEWED: x-/.e~,/02 DATI~'SUBMITTED: ~ /,z-~/02 SCTM# DISTRICT: 1,000, SECTION: ! 5" , BLOCK: ~ , LOT: STREET ADDRESS: :~.o_¢' ~'..- ?O_. CITY:t'""~t~,~ SUBDIVISION: "/a ~.... PROJECT DESCRIPTION: ~'~ -t~ .... ('~.[~_ ~ C-~,;. 0_~-'- EST~ATED PROJECT COST:~ ~ ' ~0- ~ .... ~ , S~GLE & SEP~TE CERT~ICATION-~QU~D? ~* NOTES: LOTS 40,000SF -100-24. Lot reco~ition.(CREATED before June 30, 1983), ~DERSIZED LOTS FROM JAN.1997 100-25. Merger.(A nonconforming at any time after 7/1/8: ZO~G DIST~CT: ~-~ COlOr. G? ~Q. LOT S=~: ~,~ ACT. LOT S=~:7*,t,~ ~Q. LOT COV. 2~ ~O-FRONT~ PROP. FRONT_ /_~ Sm~ ,r~ ACT. S~ ~Q. ~ ~ PROP. ~ / WATER FRONT? 8'o DESCRIPTION: PANEL #: FLOOD ZONE: , APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or~(BED #): TOWN SEPTIC RECEIPT: Y ori~ NEW YORK STATE DEC: ra~-DeC 9/1/75 YES OIt~ SOUTHOLD TOWN TRUSTEES: YES orS~ · zo o APP.OVA : TOWN PLAN. BOARD APPROVAL: YES TOWN HISTORICAL PRE (SPLIA): ~r NO DTE: / / PERMIT #:RI0- NYS ENERGY: YES OR NO : ~ EGRESS (18 H rain2 4 sq total) .,...-~VENT (SQ. FT. x 4%). BUILDING PERMITS OPEN/EXPIRED: BP _P~lq ~ -Z / C/0 Z- HAVE PRE CO'S: Y ORN ,_~.OTES: BP /,, O0 ,AO. r. FEE STRUCTURE: FOUNDATION: FIRST FLOOR: SECOND FLOOR: OTHER: TOTAL: 1.( ql 2.( "ti SF)- ( SF)= SFX$ SFX$ SF)- ( SF)= SF SF SF SF SF =$ =$ INIT OTHER TOTAL FEE ~,,j.E~o///.. FEE +$/J'-o +$ f)~ = $ ~ X.~..~ +$ +$. = $ Telephone (516) 765-1801 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 SOUTHOLD TOWN LANDMARK PRESERVATION COMMISSION TO: Southold Town Building Department FROM: Southold Town Landmark Preservation Commission - Herb Adler DATE: June 10, 2002 Re: William & Janet D. Hands Residence - 39405 Main Rd (Rte 25) Orient Tax Map #15-8-17 SPLIA No. OR-S5 The Landmark Preservation Commission has reviewed the addition of a closet to the rear room of this residence and endorses the same. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ .] INS~_TM [ ] FRAMING [ c']'j=INAL [ ] FIREPLACE &_ C~'IIMNE, Y /~ REMARKS: ~ REPORT~l DATE ENSPECTION FOUNDATION (1ST) ROUGH F~G & ~'S~ATION PER N. Y. STA~ E~RGY CODE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 Examined ~'//[ ,20 Approved.. ~/[ ,20L.- Disapproved a/c BUILDING PERMIT APPLICATIO~ CH~CKLIS1 Do you have or need the following, before applYing( Board of Health 3 sets of Building Plans P~lan_n_jng Board approval Sc'phc Form N.Y.S.D.E.C. Trustees Contact: Mail to: Expiration IZ [! ,20 uilding n.qpector ':; !~I ! PLICATION FOR BUILDING PERMIT !i i 282002 Il '~-'.~i~:;~! :i:~i';:~~'~ i~' INSTRUCTIONS --T'-'-~ ---- ~ ~~ST be compl~ely fill~ ~ by ~emter or m ~ ~d s~ed to ~e Bml~g Inspector with 3 sets of plus, acc~ate plot pl~ to s~e. F~ according to schedffie. b. Plot pl~ showing lomfion of lot ~d ofb~dl.gs on pr~ses, relatio~hp to adjoining pre~ses or public streets or areas, ~d wate~ays. c. The work covered by ~s apphcahon m~y not be commenced before iss~ce ofB~lding Pe~t. d. Upon approval offs a~cafio~ ~e B~dlng ~pector will issue a Buil~g Pe~t to the applic~t. Such a pe~mr sh~l be k~r on the pre~ses av~ablc for ~fion ~o~out ~e work. e. No buil&ng shall be oe~i~ orus~ ~ whole or ~ p~ for ~y p~ose w~t so ev~ ~fil the Bml~g ~spector issues a Ce~ificate of Occup~cy. 5 Eve~ b~id~g prat ~ ~ke ff~e work auto.ed ha~ not comm~c~ ~thin 12 monks a~er ~e date of . ~ g ~ ~or ~y auto.e, ~ ~g, ~e extension of the pe~t for an addition s~x mont~. ~ere~, a n~ p~t s~ be r~ed. ~PLICATION IS ~ ~y ~E to ~e B~ Dep~ent for ~e is~ce of a B~ld~g Pe~t p~su~t to the Buil~ng Zone Orffin~ce of~e Tom of Sou$ol{ 8~o~ Co~, New Yor~ ~d.o~ app~cable Laws, Ordnances or Re~latiom, Gr the const~cfion ofb~, ad.om, or ~tmfiom or for remov~ or d~lffion as here~ deschbed. The applic~t a~ees to comply ~ ~ a~Hmble laws, ordinance, b~g code, ho~ ~de, ~d relations, ~d to a~t authohzed inspectors on pr~ses ~d ~ b~g for n~ess~ tape.iota. St~te,~he~er applic~t is o~, 1~, ag~ ~chtect, en~, g~er~ conjuror, elec~ci~, plmber or b~lder Nameofownerofpremises ~,///~,,~] ~. /~~,7)/' --~q~.~. (As on the tax roll or latest deed) I£ 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: House Number Street County Tax Map No. 1000 Section Subdivision Hamlet Block O~ t/7 Filed Map No. 2. State existing use and occupancy ofpremjs, es and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition v//' Alteration Repa/r Removal Demolition Other Work Est/mated Cost If dwelling, number of dwelling units If garage, number of cars Fee (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 !~y' Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height 8. Dimensio.ns. of entirepe, w construction: Front o~'~// Rear Height /--~',4~,~/-/t~/,¢2"/,~' Numbero~St-'~'~e~- / 9. Size of lot: Front Rear 10. Date of Purchase Name of Former Owner 11. Zone or use district in which prerni.qes are situated Number of Stodes Rea r Depth Depth 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 f~om premises? YES NO 14. Names of Owner ofpremises/llr.~, .~'f.~,//~/'~ddress ~5/~5'"/~/~, ~"t~,~t~one No. Name of Architect ,,~-,,, ('~..//~,,v/' Address .Phone No Name of Conlractor Address .Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a fi'eshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIR.ED. b. Is th/s property within 300 feet ora tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAy BE REQUII~D. 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. --' ~'~1D-*~IM0 I STATE OF NEW YORK) NOTARY PUBLIC, STATE OF NEW YORK ] SS: No. 01DA6067304 ~ COUNTy OFS~,~D [(~ ) QUALIFIED IN SUFFOLK COUNTY _~J ' MY COMMISSION EXPIRES DEC. 10, 2~1 [J,)i [[ }~q ~. ~rFLFI~S ~ being duly sworn, deposes and says that (s)he is the applicant (N~me of individual signing contract) above n~med, (S)He is the )~2qe,~'2'"' (ConL~actor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to "erform or have ---~ that all statements contained in this tmllcatlnn ~' - p~.ormed me. sma w.or~ and to make and file this application. app ...... are tree t~ 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 ~84~ day of 1~ Notary Public 20 02. · OCCUPANCY OR USE IS UNLAVdFUL WITHOUT CERTIFICATE OF OCCUPANCY I/ NOTIP( BUILDING 76S-1802 S AM TO 4 PM FOR 'THE i~u lNG INSPECTIONS4 1. FL~OUWNIDATION ' TWO REQUIRED Ft0R POURED CONCRETE 2. FIOUGH - FRAMING & PLUMBING :3. I SULATION & ~iI~iL~L . CONSTRUCTION MUST ~IE COMPL.~TE FOR C.O. AL CONSTRUCTION SHALL MEET TH REQUIREMENTS OF THE N.Y. Si~TE CONSTRUCTION & EHERGY CC:DES. NOT RESPONSIBLE FOR DE SiGN OR CONSTRUCTION ERRORS