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Home My WebLink About28626-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28866 Date: 09/12/02 1~{IS C~I~TIFIES that the building ADDITION Location of Property: 875 HENRY'S LA PECONIC (HOUSE NO. ) (STREET) (H3kMLET) County Tax Map No. 473889 Section 74 Block 1 Lot 15 Subdivision Filed ~4ap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 5, 2002 pursuant to which Building Permit No. 28626-Z dated AUGUST 5, 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 FIREPLACE ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · ~me certificate is issued to JOH/q M & LAUR3k C HELF, SR (OWNER) of the aforesaid building. SQFFOLKCOUNTYDEPART~ENTOFH]~%L~{APPROV~J~ ELEt-£RICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'i'F~U N/A N/A N/A Autaor ' Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~]ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28626 Z Date AUGUST 5, 2002 Permission is hereby granted to: JOHN M SR & LAURA C HELF 875 HENRYS LA PECONIC,NY 11958 for : CONSTRUCTION OF A FIREPLACE AS APPLIED FOR. THIS PERMIT REPLACES EXPIRED PERMIT #20410 at premises located at 875 County Tax Map No. 473889 Section 074 pursuant to application dated AUGUST Building Inspector to expire on FEBRUARY Fee $ 150.00 HENRY' S LA PECONIC Block 0001 Lot No. 015 5, 2002 and approved by the 5, 2004 . Rev. 5/8/02 ORIGINAL ~v~ NO. ~ TO~N O~ $OUTNOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 20410 Z Date ~?/..... 19Z..~.. Permission is hereby granted to: at premises located at ................. .?....~...5~.. .... ./~....~ County Tax Map No. 1000 Section ...... .?...~... .......... Block ....... ../.. ........... Lot No. ....... · ./-/.~....~--. ................................ , 19..~...~., and approved by the pursuant to application dated Building Inspector. Fee $......0~...~..~...~.. ....... Building Inspector ....... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCy: ! d · ~ .Ji~. L This application must be filled in by typewriter or ink and submitted to the Building Depart~t_h 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 o f electrical installation from Board of Fire Underwriters. 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. Bo 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. 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: Location of Property: ' Old or Pre-existing Building: (check one) House No. Street i Hamlet Subdivision Permit No. o~6~2~ ~_ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Filed Map. Lot: DateofPermit. J/A~/~-2_ Applicant: ~-'~/'~ ! ~J~ /~2~'~ Underwriters Approval: Final Certificate: ~"' (check one) Fee Submitte~i $~ ,~O ~ t/c,c-- / 5..,__ 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ]INSULATION ]FRAMING [ ~J"FINAL ~/~~~ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR FOUNDATION ( 1 s t ) FOUNDATION (2nd) 2. ~OUGH FRAME & -PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .../.~..~.~. ........ 19 ..~. Approved .... . ......19.f..';:Permit No...,~.0. ~!..,~... Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF' HVAL. TH 3 SETS OF PLA~I$ .......... SURVF'Y ................... CIIECK SEPTIC F 0 R,'I .............. NOTIFY ~ CALL HAIL TO: INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 Location of land on which proposed work ~vill be done. ....' .......... ilouse Number ....... /' ...................... 4. ~Vq.~. ~ ......... Street Hamlqt County TaxblapNo. lO00Section ~ /--/~ Block ...~Z~Y~ff ...... ' Lot..>...: ............ ................ O~s ~/o ~z~- . ~ · Subdivision ~/~ ~ ............... Filed Map No. (Name) .............. Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... , o - "" .......... ..... b. Intended use and occupancy (Name and title of corporate officer) · , · Budder s Lmense No ........ Other Trade s License No. ~ ................... ¢'OLLOWIT,~G INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. ~NSULATION 4 FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O ., ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y, STATE CONSTRUCTION & ENERGY' COGES. NOT RESPONSIBLE 'FOR DESIGN OR CONSTRUCTION ERRORS :ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit .hall 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 whatever until a Certificate of Occupancy · hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or {egulations. for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. :~i~PaPultit~;~htzea~r. ees to. comply wi/.!~ aU ap.p. iic, abJ,e ia,vs, ortlznances, building code, h/~usil3g code, and regulations, and to ' inspectors on premises ana mounding for necessarf~ s. .... .. ............... ,.... .... ' /~a~t;r-e- fap~l~cant~or name, ifa corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ......................................................... ~ PPRgV-TJi~ ~oe 2~0I~.. Xameofownerofpremises ~/_~'_ ? ~./~./~/] ~,~ ~,~TE' /."'" ." BE# ( s on the t3x roll or late~}[}.(~rled) ",'i, - BY:-~,, · o ' ;,,O'r FY B, i,-O,NG DEPARTMENT AT If applicant is a corporation, sz~nature of duly authorized officer· · 7-35-1802 ~) AM TO 4 PM FOR THE 3. Nature of ork (check which a--':~-~- ........ .~/~x..~ ~:1/-/~~'/'~'0~c~*c' -P-u~um~: i~ew guflaing .......... AddiSon ~ '. ...... ~n ......... Re~r .............. Removal .............. Demolition .....~. :< .... ~~ ...... · ·. 4. Estimated Cost ~ (Deschption) ................................. Fee (to be paid on filing this application) 5. IfdweIlino nu~ ........ o, ,.ucr oi oweumg units N · If garage, number of c~s dwelhno units on each floor ...... . ' .............. umber of ' , . 6. If business, commercial or mixed occupancy, specify ~ure and extent of each ty~e of use .................. 7. Dimensions of sxisting structures, if any. Front ~ Hei- ' ...... ~ht ~.~ .......... NumberofS~-~- '"~ ........... Rear ..~ ......... Depth ~ .... ~ensions of same st~cture with alterations or additions: Front Depth .................... HeiSt ................. Rear ............... 8. Dimensions ofent' ' · ' ..................... Number of Stories .......... ' ' ~re new const~ctmn: Front ........ Rear Depth ............. Height x~u ............... '] moer oi ~tofies . ' ................. ' ..... ~[ .... 9. Size of lot: Front . . .~.~... ~ ....... '.'.~. ~ ....................... 10. Date of Purchase ..... ~5 .......... Kear.,~;g~ .............. Depth .~' ?~''~ .......... I I. . · · . ' .... . ...... : .... ..... *,amc of Foyer O,vner ..~4/.~ ~:~ ...... Zone or use d~stnct m wtuch premises are s~tuated ................. . .... , ...................... 12. ' ............... Does proposed construction violate any zoning law, ordinance or regulation. ~ .................. 13. Will lot be regraded ..... (~ ..... 14. N~e of Owner of premises'~ ¥ ~ -~. ·wm excess~l~ ~e removed from premises: Yes ~2: :~ ~:~ir~;;; '~~7 ....... ~. Address .~8 ~2~ff~. 4 .( ~ Phone No r'~ '~ · ~~ddress. ~ey/e; .~-Zf(m. Phone Noj, j~j j j ....... 15. Is thxs property within 300 feet of a ~h~d~ah~',' ' ;;:; ......... :rhone No ......... · ....... · If yes, Sourhold Town Trustees Permit may be required. · ... PLOT DIAG~ Locate clearly and distinctly MI bulldogs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y Hnes. Give street ~d block number or description accord~g to deed, and show street nines and ~dicate whether interior or comer lot. ~6~ TATE OF NEW YORK. &S ~~. <au~v oF ..... .,;. i ........ ..... .............................. being dul wo (Name of individual signing contract) , es and says that he is the applicant ~ove named. ..... ........ ........................... (Contractor, age~orporate officer, etc.) ....... said owner or owners, and is duly authorized to perform or have performed the said work and to m~e and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be perfomed in the m~nerset forth in the application flied therewith. om to before me this ............. ~ ..... yor..~<~~ ..... ,~o .7.~ ~1~ 8mt~ ~ ~ Vo~ · · .~. 7 'g ture of applicant) ............................. OF FOUNP, WAI. I.. II I/4" °1'0" IO,:~,OI " I~V, 12~,01 PI,E~IO 1~.51~N~ ~ ~LI~VAflON