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HomeMy WebLinkAbout28142-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28585 Date: 07/11/02 THIS CERTIFIES that the building ALTERATION Location of Property: 2110 OAKLAWN AVE SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 2 Lot 25.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 4, 2002 pursuant to which Building Permit No. 28142-Z dated MARCH 6, 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 ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT B & MARY ANN SKOBLICKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED 06/28/02 TALBOT PLUMBING & HEAT /,/Ut' ized gignature Rev. 1/81 Form No.6 3} 4j TOWN OF SOUTH n ,.r P (h C BUILDING DEPART _ , TOWN HALL 765-1802 'l12 ; APPLICATION FOR CERTIFICA E O"CC.UPANCY�� This application must be filled in by typewriter or ink and submitted 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. 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 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. 7//0)0 Z. New Construction: Old or Pre-existing Building: (check one) Location of Property: 2-110 L 41O A) ( UL)e House No. /� Street Hamlet Owner or Owners of Property: �p Q% /6J Skn Q L C.1p< Suffolk County Tax Map No 1000, Section 07E) .00 Block O2 DD Lot O Subdivision Filed Map. nLot: Permit No. 2-RI 412- Z- Date of Permit. �J G ©2- Applicant: � Q7' Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ✓ (check one) Fee Submitted: $ C -)-Z- ( � A cant Signature 7=- � ! c Town Hall,53095 Main Road Fax(631)765-1823 P.O.Box 1179 y Off. Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION � 8 oZ Date: Building Permit No. 2-e>1 q Z Owne4o?-&A L/C"ej _ (please print) Plumber: ti Ca (please print) I certify that the solder used in the water supply system contains less than 21110 of 1% lead. C( flfl (Plumbers ignature) Sworn to before me this day of 20�� NotaryPublic, County KATHLEEN MARIE ALAIM0 Notary PLLJ;c,„fats of f�aw york No.E2-4797299-SuYoS<Caunfy Commission Expuss 4p 30,20 3 M-lN2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REM 5: DATE w INSPECTO FIELD INSPECTION REPORT DATE COMMENTS rr11� Y-� b FOUNDATION(1ST) �. n� y Y � ------------------------------------- FOUNDATION(2ND) z 0 ROUGH FRAMING& PLUMBING x r INSULATION PER N.Y. y STATE ENERGY CODE Y FINAL ADDITIONAL COMMENTS O z m CA 70 �a y O z x r y x d b y TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION GHECI4LIST 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: 765-1802 (� y lJ Survey PERMIT NO. Check Septic Form N.Y.S.D.E.C. / Trustees Examined 7 20 Contact: Approved t; 20 0L- Mail to: Disapproved a/c G Phone: c O �7 - 3 La(,5�, i. wilding Inspector f� { to20 }' APPLICATION FOR BUILDING PERMIT ---- Date �I�RC'_.3 L `l�" 20 0 c,, t INSTRUCTIONS ' a.Tr s 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 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 throughout 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 Occupancy 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 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 authorized inspectors on premises and in building for necessary inspections. (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 Name of owner of premises (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. p Plumbers License No. 3� 1 j 'r L{� �� i �g 1 ,�6 d �e 1=)�I AD6. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 7- 1� k 0 L-4-)-uDo SO�—t7% House Number Street Hamlet County Tax Map No. 1000 Section 010 „ ®'D Block (02..00 Lot 02.5'-, 00 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 Iks)G 12 1A,IA.) ty b. Intended use and occupancy is')-1"`-C- 3. 3. Nature of work (check which applicable): New Building Addition Alteration_ Repair Removal Demolition Other Work (Description) 4. Estimated Cost Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units___LNumber 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 Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated i t A� ►�2 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be re-graded Will excess fill be removed from premises: YES NO 14. Names of Owner of premises Address _phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15. Is this property within 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 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. STATE OF NEW YORK) SS.. COUNTY OF�L4A'Uj4--')) IAZ(2,Q j 13. �/Sa�L/C.k being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the W ,, 'cr,Y' (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 Z/- day of _ 20 Z)1-� -Z"" Notary Public Signature of Applicant Jaya Kramer NOTARY PUBLIC,Stets of New York No.01KR4668322-Sulfoflt Term EVk"Feb.28,Avv Uiobfvveti.{.LPSCERT IACATE R' Lo1r V�Oi Om--tt (!Lt� � T w ol-me -ro ' i4e SLOP AP ED AS NOTED , R'uQ Lo t•iC � W t Tt} DATE:. B.P.# NOTIFY BUILDING DEPARTT D� �- (<j E ! `jY'�' ,. 765-1802 9 AM TO 4 PM F Pe- �� _•�,.� ��.� � FOLLOWING INSPECTIONS: 1. FOt.NI7.)ATION - TWO REQUIRED FOR POURED CONCRETE PLUM13ING 2. ROUGH - FRAMING & PL ALL PLUMBING WASTE PROVIDF_ ANTI-SCAtU & INSULATION NSULATI CONSTRUCTIO M & WATER LINES NEED THERMAL SNOB NoloR • ^' RFFOE COVERING f►E{/ICES K PREY �YTItVG BE COMPLETE FOR C.O. AS TQ PART, g ALL CONSTRUCTION SHAL lip N.Y. STATE BUIPART, ( (K) THE REQUIREMENTS OFWINT DE. STATE CONSTRUCTION & CODES. NOT RESPONSIB E DESIGN OR CONSTRUCTION e ON .S Y'C,Y LoeweT w �x�sr}�� �.>�u►Np2y. �� ��Q 8>�rT�t w �t.3 Too -...mow J -� i` i +1 to .`;nJUPANCY PC) GTRIae.T LXRA Z. C1+0f..56e S if ct til1, aS used tj o "'�1+r- l'S`r'"11.3 C-� � �"1 01 f= r 1 f , she!' TE. ? 4TittTyol BUILDING PERMIT EXAMINER CHECK LIST DATE ISSUED: / /02 DATE REVIEWED: _S_/.6 /02 APPLICANT:SP�opic DATI�•SUBMITTED: /_/02 SCTM#DISTRICT: 1,000, SECTION: _�, BLOCK:,,? ,2) STREET ADDRESS:0 CG CITYy- 6� SUBDIVISION: PROJECT DESCRIPTION: 1L "tj;pe_v ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: FAST TRACK? SINGLE & SEPARATE CERTIFICATION-REQUIRED? NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83) ZON:FRON STRICT: REQT SIZ OT SIZE: REQ. L V ACT. LOT COV. REQOP. FRONT REQ S ACT. SIDE REQPR REAR i WATER FRONT? 1 I-E -- PANEL #: FLO APPROVALS REQUIRED SUFFOLK COUNTY HEAL H DEPT: YES or NOkor (BED #): DTE:—/ / IT#:R10- TOWN SEPTIC RECEIPT: Y ortIA): NEW YORK STATE DEC: PRE SOUTHOLD TOWN TRUSTEE TOWN ZONING BOARD APP TOWN PLAN. BOARD APPR TOWN HISTORICAL PRE (S NYS ENERGY: YES OR NO : EGRESS (18 H min.? 4 sq total) VENT (SQ. FT. x 4%) LIGHT (SQ. FT. x 8%) BUILDING PERMITS OPEN/EXPIRED: BP 46 3q -Z/C/0 Z- PC?IF2 HAVE PRE CO'S : Y OR N BP -Z/C/o Z- , NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: q / SF FEE FEE FEE 1. SF)- (SF)= SFX $ =$ +$ +$ = $ 2. ( SF)- ( SF)= SFX $ =$ +$ +$ = $