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Home My WebLink About28691-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28854 Date: 09/09/02 THIS CERTIFIES that the building ADDITION Location of Property: 2195 HENRY'S LA PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax ~4ap No. 473889 Section 74 Block 1 Lot 44.2 subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26, 2002 pursuant to which Building Permit No. 28691-Z dated AUGUST 26, 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" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · ~ne certificate is issued to MARY JEAN & ROBERT WEBB (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENTOFMRALTHAPPROVAL ELECTRICAL ~TIFICATH NO. PLU)~BERS CERTIFIC~%TION DR£~u N/A N/A N/A Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PEPd~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28691 Z Date AUGUST 26, 2002 Permission is hereby granted to: MARY JEAN & ROBERT WEBB 68 LAKEBUDGE DR S KINGS PARK,NY 11754 for : CONSTRUCTION OF AN "AS BUILT" DECK ADDITION AS APPLIED FOR at pre~kises located at 2195 HENRY'S LA PECONIC County Tax Map No. 473889 Section 074 Block 0001 Lot No. 044.002 pursuant to application dated AUGUST 26, 2002 and approved by the Building Inspector to expire on FEBRUA/{Y 26, 200~4. Fee $ 300.00 ~ / ~ 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 typewriter or ink and submitted to the Building Department with the following: Bo Co 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 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. 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 New Construction: Date. Old or Pre-existing Building: Location of Property: House No. Street Owner or Owners of Property: Suffolk County Tax Map No 1000, Section /~9'J ~0' q Block Subdivision Filed Map. aermitNo. ',~ ~[ DateofPennit. ~-,~'~- OV.... Applicant: (check one) Hamlet Lot Lot: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ o~ ~ Underwriters Approval: Final Certificate: /"/ (check one) ~ ~' Applicant Signature /n ~,,)_ ?~,'-/- W, 2--TOWN OF SOUTHOLD PROPERTY, y. JlECORD CARD ... ,,~,~ ~)WNER STRI~I:I '~. / C~'~' VILLAGE DIST. SUB. LOT'~J ~/~,~/~ / ~ W ~PE OF BU~LDING R~. ~ ~ 5~5. VL. ~, FARM CO~. CB. MICS. Mkt. Value ~ND IMP. TOTAL DATE R~RKS Tillable FRONTAGE ON WATER W~land FRONTAGE ON ROAD Meadowl~d DEPTH Hou~ Plot BULKH~D Total, Extension Porch Porch Breezeway Garage Patio 117:/1:-- /~/ COLOR Foundation Basement Bath 'Floors Interior Finish Ext. Walls Fire Place Heat Type Roof Rooms 1st Floor Recreation Room Rooms 2nd Floor Driveway O. B. Total Dormer TRIM OCCUP^NC¥ CR USEIS U~LA~::UL WITHOUT CERI~FtCATE OF OCCUPANCY APPRO)/ED AS NOTED NOTIFY BUILDING ~EPARTMENT AT ~ /'~t~1~02 ~J~M TO 4 PM FOR THE * FOLLOWING INSPECTIONS: --~'"--'-"" FOR PC RED CONCRETE ~ 2. ROUG, ;o~iRAMING & PLUMBING · 3. INSUL~ 4. FINAL CONSTRUCTION MUST BE COlt 'LETE FOR C.O. ' ALL CON rR~CTION SHALL MEET STAT.E,.,C~JSTIII~TION & ENERGY CODEa. ~i~RESPONSIBLE FOR DESIGN O~Ig*ON~TRUCTION ERRORS 08×16/2002 ST IOHNLAND ~ 4226~84 NO.971 ~002 13:41 LAWRENCE M. TUTHILL PROFESSIONAL ENGINEER P.O. BOX 162 GREENPORT, N.Y. 11944 (631) 477-1652 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION2ND [ ]I~NSULATION [ ]FRAMING ['//]~ FINAL [ ]FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING " INSULATION PER N. Y. STATE ENERGY CODE ~D~ION~ CO~ENTS m TOWN OF. SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined ~/~:~t'L'_ ,20 ~ Approved _ -- ,20,~ Disapproved aJe Expiration ,200 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the followihg~ before applying? Board of Health 3 sets of Building plans planning Board approval Survey. Cheek Septic Form N.Y.S.D.E.C. Trustees Contact: Mail ~;~ , ....ff~ ~. ~','~'2 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date o~- ~.o ,200 ~-- 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 or areas, and watenvays. 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 pemfit 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. 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. ~~ of a~licant or name, ff a co. option) (Mall~g address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~aT' ~. ~ ~zy ~ (.~bb' (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 proposed work will be done: House Number Street 7'/-(: qq. County Tax M~No. 1000 Section ~,~/9 7 Subdivision t'~ Con, ,¢ A/A~ o ^~ ~ (Name) Hamlet Block Filed Map No. Lot ~/ State ~xistin~ use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ffo~ b. Intended use and occupancy. 3. Nature of work (check which applicable): New Bu/lding Addition Repair Removal Demolition Other Work Estimated Cost ~c,' ~ If dwelling, number of dwelling units If garage, number of cars Fee Alteration (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 ~7,z Height, o Dimensions of same structure with alterations or additions: Front Depth Height Dimensions of entire new construction: Front Height Number of Stories 9. Size of lot: Front 10. Date of Purchase Number of Stories Rear Rear /$/- b ( Depth Name of Former Owner 11. Zone or use district in which premises are situated Depth Rear Depth 12. Does proposed construction violate any zoning law, ordinance or regulation? YES 13. Will lot be re-graded? YES 14. Names of Owner of premises Name of Architect Name of Contractor __ NO V/ Will excess fill be removed from premises? YES NO t,/ NO Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * IF 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 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 ) /~ ¢',~ f--- "~/'g t~ /'~ ~ being duly sworn, deposes and says that (s)he is the applicant ('Nme of individual signing contract) above named, (s)m the (Co~tractor, 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 apphcation; 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 [J_,,e,t~. 200__~ /(J Not~y Publi~ ~ M. ~IN8 · e~ ~ires June ~2, / ' c/ Signature of Applicant