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Home My WebLink About27985-ZFORM NO. 4 TOWN OF SOUTROLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28535 Date: 06/21/02 THIS CERTIFIES tt~at the building ADDITION aka 4! Sunset Laue Location of Property: 475 SUI~SET LA GREENPORT (ROUSE NO.) (STREET) (H3~MLET) County Tax Map No. 473889 Section 33 Block 4 Lot 52 Sulx~ivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 2, 2001 pursuant to which Building Permit No. 27985-Z dated JANUARY 2, 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 ENCLOSED PORCH ADDITION TO AN EXISTING ONE FA24ILY DWELLING AS APPLIED FOR. ·"ne certificate is issued to DIANE MITCHELL of the aforesaid building. ( OWNER ) SUFFOLK COUNTY DEPARTMENT OF ~KALTH APPROVAL ELEt-£~ICAL CERTIFICATE NO. PLI~WBERS CERTIFICATION DA'£~U3 N/A N/A N/A 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. 27985 Z Date JANUARY 2, 2002 Permission is hereby granted to: for : DIANE MITCHELL 41 SUNSET LANE GREENPORT,NY 11944 CONSTRUCTION OF A PORCH ADDITION ENCLOSURE) AS APPLIED FOR at premises located at 475 SUNSET LA County Tax Map No. 473889 Section 033 Block 0004 Lot No. 052 pursuant to application dated NOVEMBER 2, 2001 and approved by the Building Inspector. Fee $ 150.00 GREENPORT Autho~i zed Signature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUP Y 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. 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 of0ccupaney - $ 0.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. A~t~ I{I (check one) Hew Construeti°n: Po ~ d. I~ Old or Pre-existing Building: LoeationofProPerty: q ] .~'Oa.-~"~ ttt~ House No. Street Owner or Owners ofProperW: ~ I?~,~- .002/ Hamlet · Suffolk County Tax Map No 1000, Section Subdivision aoae; ,,2-" &gce .fo, 1'" PermitNo. 2 7q ~- Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fe~ Submitted: $ ~.~" ~ 0 ::~ DateofPermit. TA4- 2_ t o 2- Applicant: ~1,'~,~ Underwriters Approval: Block O ~ Lot ~'- 2. Filed Map. qO 2 [ Lot: 14 { Final Certificate: '~,. (check one) Applicant S"/'gnature NEW YORK STATE INSURANCE FUND 199 CHURCH STREET. NEW YORK, N.Y. 10007-1100 1-888-997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ALLIED SAFETY MANAGEMENT INC 390 NORTH BROADWAY JERICHO NY 11753 POLICY NUMBER C 828 671-8 DATE 8/15/2001 CERTIFICATE NUMBER 070-698 POLICYHOLDER PHILIP ROSS INDUSTRIES INC 200 LONG ISLAND AVE WYANDANCH NY. 11798 CERTIFICATE HOLDER TOWN OF SOUTHOLD TOWN HALL 53095 MAIN ROAD SOUTHOLD NY 11971 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURAMCE FUND UNDER POLICY NO. 828 671-8 UNTIL 12/01/2002 , COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/01/2002 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGUL~LR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. 8L~(~.DEPT. U-26.3 THE STATE INSURANCE FUND DIRECTOR, INSURANCE FUND UNDERWRITING OWNER FORMER OWNER TOWN OF SOUTHOLD PROPERTY RECORD CARD IVILLAGE ACR~ SUB. LOT LAND IMP. AGE SEAS. VL. ~r/ FARM COMM. TYPE OF BUILDING CB. MISC. Mkt. Value TOTAL DATE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable 1 ' Tillable 2 tillable 3 Noodland ~wampland FRONTAGE ON WATER 3rushland FRONTAGE ON ROAD -louse Plot DEPTH BULKH~D %tal ~ ~'~ D~K BUILDING PERMIT EXAMINER CHECK LIST ~PmCANTNA~~ kX.'~ o~l SCTM# DISTRICT: 1,000 SECTION: ~ BLOCK: DATE REVIEWED: / /o~ /01 .DATE SUBMITTED: II / .Z /01 LOT: CITY: ~ ('"'~e_f__.tODO~'V-SUBDIV. NAME: ARCHITECT / ENGINEER: -- ,A~ o ~ - c' .---.~ ~::~. o ~ FAST T~CK? S~GLE & SEP~TE CERT~IC~ON,~Q~D? NOTES: ~ ~,~SF -1~-24. ~t ~eo~ition.(C~TED bef~e June 30, 1983), ~DE~ED ~TS FROM J~.1997 1~-25. M~.(A n~nf~ng at any fi~ ~r 7/1~ zo~a~mcz: ~-~a co~o~, ~Q.~TS=E:~o~O ACT. LOTS=E:~,7~Q ~TCOV~ ACT. LOTy2V' /~ Z ~Q. ~om 35~ PROe. F~O~~g~ ,;,/= ~ ~Q. ~ 3 ~' PROP. ~-~ ~ / ACT. S~E/~ WATER FRO~? ~ DESC~TION: P~L ~:, ~ ~LO0~ ZOO: X , AGENCY PERMITS REQUIRED FOR REVIEW APP VALS REQUIRED: 3~_~: · _ .. / / PERMIT #:RI0- SUFFOLK COUNTY HEALTH DEPT YES , (BED #)' DTE' NEW YORK STATE DEC: PRE-DeC 9/1/75 YES j~ SOUTHOLD TOWN TRUSTEES: YES q~ 7 TOWN ZONn,4G EOARD APPROVAL: YES o~ TOWN PLAN. BOARD APPROVAL: YES oi~ TOWN HISTORICAL pRE (SPLIA): YES NYS ENERGY: YES OR~: /2~// EGRESS (18 H rain,? 4 sq total) ~ VENT (SQ. FT. x 4%) LIGHT (SQ. FT. x 8%). BUILDING PERMITS OPEN/EXPIRED: BP ,qO! ~ -Z / C/0 Z-c~ (:~), A-"/?) . HAVE pRE CO'S: Y OR N BP~-Z / C/0 Z- NOTES.: ~r~.x,~/£~_~' FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR : SF SECOND FLR : SF INIT TOTAL: 2._0 5 SF FEE 'OT(O,~°3 SF)-( SF)= - SFX$~ =$ ~ +$ /5'-o +$~ OTHER TOTAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUN~TK)NiST [ ]ROUGHPLBG. [ ~)UI~DATION2ND [ ] INS.~;~TION [~ FRAMING [~~FINA~-'-" [ ] FIREPLAC~ CHIMNEY q REMARKS: ~ /~/ ~OUCH FRAI~E & BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Examined //o~ ,20 o / Approved //.,~- ,20 ~ ~' Disapproved a/c PERMIT NO. C2.O~tS¢~,~ I~UILDIiNkj FI:NMI 1 AI"FLICA'f~ON CHECK.LIS' Do you have or need the following, before applying Board of Health 3 sets of Building Plans. Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact:. Mail to: ] tqO0 (2.~clar Dr. East Marion,NY Phone: 477-2465 Building Inspector kPPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date/~O t,/ 2- ,200 1 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 stale. Fee according to schedule. b. Plot plan showing location of lot and of building~ 0. n'premises, relationship to adjoining premises or public streets or areas, and waterways. 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 issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection througho.ut'the work. e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupan is issued 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'Cofinty, New York, and other applicable Laws, Ordinances or Regulations, for the cbnstmction of buildings, additions, orCa'Iterations or for removal or demolition as herein described. The applicant agrees to eoi-nply with all applicable laws, ordinan6es, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for neees, s~/ry inspections. (Signature of~i~plicant or name, ifa corporation) 1000 Cedar Dr., East Marion, NY (Mailingaddressofapplicant) l1939 State whether applicant is owner, lessee, agent, ~chitect, en~neer, general contractor, electrcian, plumber or builder General Contractor ' Name of owner ofpi'emises Diane Mitchell ' ',, (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... 12988 HI Plumbers License No. Electricians License No. Other Trade's License No. County Tax Map No. 1000 Section Subdivision Eastern Shores (Name) Location of land on which proposed work will be done: 41 Sunset La, -.. House Number Street Greenport .'-2:!.~T C-'..~ ~'7'~' '."7 ,-' 33 '' Block 04 Cot ' ~ $ Gree~po.rf~ Filed Map No. ,~n? l Lot 41 ~tate ex~st~ng use ano'occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy__:, Single family residence b. Intended use and occupancy_ Same ~. Nature of work (check which applicable): New Building_ Repair Removal Demolition 1. Estimated Cost $ 2000.00 Fee ;. If dwelling, number of dwelling units 1 If garage, number of cars Addition Alteration Other Work_.qo r~on pal"ah -- (Description) (to be paid on filing this application) Number of dwelling units on each floor If business, commercial or mixed occupancy, specify nature and extent of each type of use. Rear Dimensions of existing structures, if any: Front Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth .q A Mlh'l.. ' Rear Depth Height. Dimensions of entire new construction: Front SAME Rear Height Number of Stories Size of lot: Front 75 ' Rear 75.06 ' Depth 115.2 0. Date of Purchase .Name of Former Owner 1. Zone or use district in which premises are situated ~> - q (~ 2. Does proposed construction violate any zoning law, ordinance or regulation: ~o 3. Will lot be re-graded NO Will excess fill be removed from premises: 4. Names of Owner ofpremisesx~i ~n,=, Mi 'l-.r',h~=] '[Addres~_l Sunset La Name of Architect Address Name ofContractorglm D~z~nkow.qkl Address East l',larion 5. Is this property within 100 feet cfa tidal wetland? *YES NO · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 6. Provide survey, to scale, with accurate foundation plan and distances to property lines. 7. If elevation at any point on property is at I 0 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: :OUNTY OF ) Number of StOries '~: DePth YES Phone No. 4 7 7- 4 01 6 Phone No Phone No. _4 7 7- 2 4 6 5 ~i '"' ~" - n~=n~'n*r:~i being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, ¢)He is the Contractor (Contractor, Agent, Corporate Officer, etc.) /'said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; mt all statements contained in this application are true to the best of his knowled e and belief:. ~rformed in the manner ~h ;~ ,~.~ oppU~,:on filed therewith, g . and that the work will be set fo.,., ,,, worn to before me this ,~ / ELIZABETH A STATHI8 NOTARY PUBUC, State of New York No. 01ST6008173, Suffolk County Term Expires June 8, ~ ~ gnature of Apl/~ant 0 _~ O U N D ~RI VE .lop PAUL E. MELLAS ~ OOROT.¥ M. MELL,,S 22.4 ' /'/'z ~tory 8.62' 2 I' 30 "W.~ ~/o/F Jori~ P. ,OWHES ~, K'~THLEE~ "OW,ES 112. 17' ZS. ~- ' o 0 SURVEY FOR DIANE MITCHELL AT GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY. N,Y. I'000 - 33 - 04 52 SCALE I" ' 20' ~ JAN. I0, 1986 CERTIFIED TO: TICOR TITLE GUARANTEE GREENPOINT SAVINGS BANK DIANE MITCHELL , ,~ ~ z, ~ N.Y.S. LIC. NO. 49615 PECONIC SURVEYORS, P.C. [515J 765 - 50,20 P.O. 80X ,909 MAIN ROAD $OUTHOLD, N,Y. 11971 85 - 445 ..g(..^L.E; -' I ~AF S N-I~C4. a$ UNDERWRITEF REQU .L ~-I Svv~F_..'F LA', I ( II ~ 100 ~.. llOUOll ,. & INIUI~Tlml & IqNAi.. llU.( 8HALL OF THE & fA'[ lo I I/ [:)c~o 31 pcTo i cgdA. t. P.. ;