Loading...
HomeMy WebLinkAbout28676-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28768 Date: 08/23/02 THIS CERTIFIES that the building ADDITION Location of Property: CRESCENT AVE FISHERS ISL~/qD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 6 Block 7 Lot 16.2 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 5, 1989 pursuant to which Building Permit No. 28676-Z dated AUGUST 22, 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 12' X 20' SCREEN PORCH ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. ·"ne certificate is issued to MARY MEYER of the aforesaid building. ( OWNER ) ~uFFOLK COb/Tl"f DEPARTMENT OF HEALTH APPROVAL ELECrRICAL C]LRTIFICA~q~ NO. PLUMBERS CERTIFICATION DA'r~u N/A N/A N/A //A~hori z ed Signature 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. 28676 Z Date AUGUST 22, 2002 Permission is hereby granted to: MARY MEYER 180 RIVERSIDE DR NEW YORK,NY 10024 for : CONSTRUCT A 12'X20' SCREEN PORCH ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. (REPLACES BP #17995-Z) at premises located at County Tax Map No. 473889 Section 006 pursuant to application dated APRIL Building Inspector to expire on FEBRUARY CRESCENT AVE FISHERS ISLAND Block 0007 Lot No. 016.002 5, 1989 and approved by the 22, 2004. Fee $ 150.00 A ' ~ '~ature Rev. 5/8/02 ORIGINAL FOUM' NO. 0 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) No- 017995 Z Dat...~~........~ .................. , 19...~..~' Permission is hereby granted to: ..../.,..~ ....... ~....~ ..... ~ ................... ,o ......... ~..~ ............. l.~...~.~.~....i.-,/,~.~..~x~_.// County Tox Mop No. 1000 Section ....... ~. ............ Block ..... ~ .......... Lot No.../~/,,...~.... pursuant to application dated ...~.~'~)...../.......~ .................. ,19.~...yand approved by the Build~, Inspector. Fee $. · · .~. · ~..r- ~-- -. -~- ~/ i~,nspector Rev. 6/30/80 Ac 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 submi t~~e building inspector 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 Upre-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 ~he reasons therefor in writing to the applicant. Fees 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-existinK Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial 415.00 -- Date ..... ;.~......~....~.....~..~...~ ........ New Construction ........... Old Or Pre-existing Building.. ~ .... Location of Property ..................... C ...... ~: ....... ~~ .' .~. ~ .~.~%. [ .~..~.~ .~. ~ House No. Street Hamlet Onwer or Owners of Property....~.~.~. .... ~''~'7' ~' ........................................ County Tax Map No 1000, Section..~. .......... Block...~. ........... Lot...l~.,.~ ........... Subdivision .................... Filed Map ....... Lot .................. 28676-Z .Date Of Permit 8/22/02 . .Applicant Permit No .... , -~ .......................................... Health Dept. mpproval..~....~..l..~. ........... '..Underwriters Approval ..... ~..~..~. ............. Planning Board Approval. . ~...i.~. ............. Request for: Temporary Certificate ...... Final Certicate.....~.. .... Fee Submitted: $ OWNER TOWN OF SOUTHOLr STREET FOR/~ER O~VN E~'~4 \ RES. p/~ S~AS. --- LAND IMP. JVL. TOTAL FARM DATE PROPERTY RECORD CARD ACR. E W F Acre Value Per Value / " Tillable 1 I J Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Plot DEPTH ,:~ ,. ~, BULKH~D ToM ~ ~' ~ ~ DOCK COMM. CB. MISC. Mkt. Value TYPE OF BUILDING Extension.. Extension~'~ Foundation ~_~. ,~ Bath 1/~ Dinette Basement Floors K. ~.-~ ~ 6 Ext. Walls Extension ' Fire Place Type Roof Porch © Porch Breezeway Garage Patio Total Recreation Room Dormer Driveway Interior Finish Heat Rooms 1st Floor Rooms 2nd Floor LR. FiN. B. -- I 08/2~/2002 09:42 FAX $31 788 7798 FITELEPHONE INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION END [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLUG. [ ] INSULA'flON 0O2 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ................. 19... o? Approved~'~f~ S 19 ~.~ermit 'q-' ~"~' .., No./. v(...7. Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: APPLICATION FOR BUILDING PERMIT 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 ~iriff:ffl&buildings on premises, relationship to adjoining premises or public streets or areas, and giving a der'ailed '~i~¢cribfihh df laYis~t of property must be drawn on the diagram which is part of this appli- cation. ~..~ ~ ;'~ ~.~' . 4~ ~.~ .... c. The work covered by this appl,catmn may not be commenced before ~ssuance of Building Permit. d. Upon approval of tl{ii'aPPllca~i.o~{~ the Btlilding Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available:fqr inspection throughout the work. e. No building shall l~e occupi~d'~ used in whole or in part for any purpose~vhatever Until a Certificate of Occupancy shall have been granted bY ~cevBu.~lding Inspecto[~ ~ APPLICATION IS HEREBY-M.AISB :to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinan6e of the ToTM °fSdUth°ld, Suffolk County, New York, and other applicabl~ 'L~iWs, 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 aplylicalSle 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'a~ii~J;)' '~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ (... & ............................................... Name of owner of premises..~/~..~..e:p..A,/....../~. ~..~. ~...~. .......................................... (/ts on t e tax roll or latest deed) If appj4cant ¢ a corjporation, signatuy, e of duly authorized officer. (N}ffgl~ and title of corporate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other *rade's License No. /. ~-~.~. q.7.-/~. -~.~. .... 1. Location of land on which proposed work will be done ...... ~Q.../(~..~.~--.e .~....~.~ .......... House Number Street Hamlet County Tax Map No. 1000 Section ........ ~. ......... Block ...... .~. .......... Lot../.~... ~.. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intendedu/~e and occupancy of proposed construction: a. Existing use and occupancy .... ~../..)~.~..//.~...'~.~..J~ .K .///... ~)~ ?t/./.~'~· .................... b. Intended use and occupancy <~ - - .~.. · - ....... : ................. 3. Nature of work (check which applicable): New Building ..... ..... Addition .../~.. ..... Alteration .......... Repair .............. Removal .............. Demolition ...~ .......... Other Work ............... ~-,~C//~-~/6/ ~-~f~_~/-t /~- )Q ~D y,... ~, _ . (Description) 4. Estimated Cost .... -~'.~, ~:~. ~..~. .... Fe~...~.../"~.: .~.. ~ ........................ (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 ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 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 ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .................. -. ......... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises,,5-,~./.~../J..../.~./ff.~...t'~'.. Address ................... Phone No.c~..~.'~7(~.'..~'.~?.~'.. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .~e~=~..~... o'~.(.d.t~ ~... Address Phone No. ,zffi~...7..~.~.~..b..~ 15. Is t:h±s propert:y located w±t:h±n 300 feet: of a t:±dal xaet:land? '~Yes ..... No~..... · If yes, Sour:hold Town Trustees Perm±t raavbe requ±red. PLOT DIAGF. AM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS NOTED NOTIFY BUILDING DER~RTIVlENI 765-1802 9 AM 1~) 4 PNI FOR THE FOLLOVVING INSPECTIONS: 1. FOUNDATION - ~ RE-f~UIRED FOR POURED COI~"RETE 2. ROUGH - I:~W~IING & IN. UMIBING 3. INSULATION 4. FINAL CON~'TI:IUCTION MU~T BE COMPLETE FOR C.O. ALL CONSTRUCTION $1~LL MEET THE REQUIREMENTS OF THE N,Y. STATE CONb~FI~UCtiON & EI~'ItGY CC~OE~. NOT RESPONSIBI~ r-ON DESIGN OR CON~TflUCllON OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, COUNTY OF ................. S.S .. .-,~... ' ..~..,ff.~.cS,,~ ~././/. .................... being duly sworn, deposes and says that he is the applicant '(Name of individual signing contract) above named. He is the...~..~..'~..~. ~ .r~.. ...... .c~...~.~. ~.....c~...~. ~.M...' .~...~-= r..d.t .~.~..~. ............... (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 ............... Q"'. ....... day of .... ~.~. ......... , 19 Notary Public ...... -~...~, . .~) g_....~.. ..... County .............. ?eml~i{?~8~l~.ScUhffa~ok.l%unty~! ,,~ ~' / (Signature of applicant)