HomeMy WebLinkAbout28569-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28649
Date: 08/06/02
T~IS C~/~TIFIES that the building ACCESSORY
Location of Property: 400 SPRING LA PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 86 Block 5 Lot 5
Sutx~ivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 16, 2002 pursuant to which
Building Permit No. 28569-Z dated JULY 17, 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 ACCESSORY 16' X 10' ACCESSORY STORAGE SHED AS APPLIED FOR."AS BUILT"
The certificate is issued to EDWARD J CAPOBIANCO
(OWNER)
of the aforesaid building.
SUFFOLK COU~I~fDEPART~TOFltF~%LTH;%PPRO~rAL
ELECTRICAL CERTIFICATE NO.
PLI~BERS CERTIFICATION DAT~
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. 28569 Z
Date JULY
17, 2002
Permission is hereby granted to:
EDWARD J & ORS CAPOBIANCO
310 SPRING LANE
PECONIC,NY 11958
for :
CONSTRUCTION OF AN "AS BUILT', 160 SQUARE FOOT ACCESSORY SHED AS
APPLIED FOR
at premises located at 400
County Tax Map No. 473889 Section 086
pursuant to application dated JULY
Building Inspector to expire on JANUARY
SPRING LA PECONIC
Block 0005 Lot No. 005
16, 2002 and approved by the
17, 2004.
Fee $ 150.00
~ -- ~thor~nature
Rev. 5/8/02 ORIGINAL
Form No 6 ~ ~. n q~ ~, --_'~
TOWN OF SOUTHOLD llV]f~'*z-.-,..?..~__, !., ~
BUILDING DEP~TMENTII t ...... w ! li i
TOWNH~L !~ I 5 ?nnp
765-1802 ! k '~' L";I
APPLICATION FOR CERTIFICATE OF,~~y' - ~.~,~ :~ ]
This application must be filled in by t~ewriter or i~ and submitted to the Building Depa~ment with the following:
A. For new building or new use:
l. Final su~ey of property with accurate location of all buildings, prope~y lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 fo~).
3. Approval of electrical installatio~ from ~oard o~Fire URde~ters.
4. Sworn statement from plumber ce~i~ing that the solder used in system contains less than 2/10 of 1% lead.
5. Co~ercial building, iRdustrial b~ilding, ~u]tip]e rgsidences and si~lar buildings and installations, a ce~i~cat~
of Cod~ Compliance from ~chitcct or engineer responsible for the building.
6. Sub~t Pla~ng Board Approval of completed site pla~ requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildiags aad "pre-existing" laud uses:
1. Accurate su~ey ofpropeAy showing all prope~y lines, streets, building and unusual natural or topographic
feat~es.
2. A properly completed application and consent to inspect si~d by the applicaRt. Ifa C~Aificate of Occupancy is
denied, the Building ~spector shall state the reasons therefor in writing to the applicant.
C. Fees 1. Ce~ificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swi~ng pool $25.00, Accesso~ building $25.00, Additions to accesso~ building $25.00, Businesses $50.00.
2. Ce~ificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Ce~i~cate of Occupancy - $25.00
4. Updated CeAificate of Occupancy- $50.00
5. Tempora~ Ce~ificate of Occupancy - Residential $15.00, Co~ercial $15.00
New Construction:
Location of Property:
House No.
Owner or Owners of Property:
Date.
Old or Pre-existing Building:
Street
(check one)
Hamlet
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No.
Health Dept. Approval:
Planning Board Approval:
Request tbr:
Date of Permit.
Temporary Certificate
Block
Filed Map.
Applicant:
Underwriters Approval:
Lot
Lot:
Final Certificate:
(check one)
Fee Submitted: $
A~ant ~fg~nature
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS:
[ ] ROUGH PLBG.
[ ] ~ATION
[ ~]~FINAL
DATE ~/~?/0/~~ INSPECTOR _~~~~
FOUNDATION (1ST)
' ~SD~TION PER N. Y.
STATE E~RGy CODE
'~~ ~~ ~
TOVUN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
Examined ,20 '
Approxed "~/I "} ,-20 ~
Disapproved aJc
Expiration
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
PERMIT NO.O~q ~ --
"~'ff~ding Inspector
Board of Health
3 sets of Building Plans
Planning Board approval
Survey.
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
Phone:
APPLICATION FOR BUILDING PERMIT
Date ,20
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
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 the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
?tPPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perrmt pursuant to
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. Tt~e
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.
( ignatu~,~f appliCatOr name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises ~'~)IX/,X}-F~) 7 {7'/il']°O,C,,]fis/h[CO
(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.
Plumbers License No.
Electricians License No.
Other Trade's License No.
Location of land on which p[oposed work will be done:
House Number Street
Hamlet
County Tax Map No. 1000 Section
Subdivision
(Name)
Block , f" ~'~;~r~ c:'~¥.' ~e;X.*
Filed Map No. .:,~'~ ."jv~ ~ot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy(
Nature of work (check which applicable): New Building
Repair Removal Demolition
Estimated Cost
If dwelling, number of dwelling units
If garage, number of cars
Addition Alteration
Other Work
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 Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Dimensions of entire new construction: Front /iD ~ Rear /62 t
Height / 0 / Number of Stones /
Depth.
Rear
Size of lot: Front Rear Depth
Date of Purchase Name of Former Owner
11.
12.
13.
14.
Zone or use district in which premises are situated
Does proposed construction violate any zoning law, ordinance or regulation? YES
Will lot be re-graded? YES
Names of Owner of premises
Name of Architect
Name of Contractor
__ NO '//Will excess fill be removed from premises? YES
~C ff~-,F- Address Phone No.
Address Phone No
Address Phone No.
NO /¸
15 a. ls this property within 100 feet of a tidal wetland or a freshwater wetland? *YES
* 1F 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.
NO J
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
L-bW/ckP a- CAPORI/vgJco beingdulyswom, deposesandsaysthat(s)heistheapplicant
(Name of individual signing contract) above named,
( S~,~ s 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
__/~'-~,. day of '--.~/..4 l~.4cjt' 20 0~
~otaw ~ublic --
~F. OAL~!
#13'13~¥~ ~'ATE OF NEW vne,,,
NO ~,,4624771
~ ~~COUN-I" ~
J~OjIJ8810~ EJ~aIRE8 NOV 30, 20_O~
Sij~'~re o 7k~'licant -
400 OSTRANDER AVENUE. RIvJ~I:~EAD~~ J -~ i
SURVD FOR: -
JOHN J. SHELLY ~ JO~NN 8. SHELLY ~
AT
GUARANT~D TO:
P E C 0 N I C SOUTHOLD S~WNGS
TOWN OF AMERICAN TI~ INSU~NCE CO.
SOUTHOLD
aY .