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HomeMy WebLinkAbout28715-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28872 Date: 09/16/02 THIS CERTIFIES t~at the building AS BUILT DECK ADDITION Location of Property: 4370 NEW SUFFOLK RD NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 110 Block 8 Lot 29 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 23, 2002 pursuant to which Building Permit No. 28715-Z dated AUGUST 23, 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 DECK ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS BUILT". The certificate is issued to TERENCE M HIGGINS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF r~R~L.r~ APPROVAL ELEt-rKICAL u~TIFICATE NO. PLUMBERS CERTIFICATION DA'r~ N/A N/A N/A Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUIT,nING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28715 Z Date AUGUST 23, 2002 Permission is hereby granted to: TERENCE M HIGGINS BOX 221 NEW SUFFOLK,NY 11956 for : CONSTRUCTION OF AN "AS BUILT" DECK ADDITION AS APPLIED FOR at premises located at 4370 NEW SUFFOLK RD NEW SUFFOLK County Tax Map No. 473889 Section 110 Block 0008 Lot No. 029 pursuant to application dated AUGUST 23, 2002 and approved by the Building Inspector to expire on FEBRUARY 23, 2004. Fee $ 300.00 Rev. 5/S/02 ORIGINAL 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: 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. ]*or 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. Co 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. New Construction: Old or Pre-existing Building: ~'~ Location of Property: ~/~9 /[J£oC/.ffJ/4~/~'( ~o~. House No. Street, / Owner or Owners of Property: ~-~ ~'~c~/L] e ~ ,~-/',-,2 .~ Suffolk County Tax Map No 1000, Section e/~2;> rD c> 7/O Block Date of Permit. Filed Map. Applicant: Underwriters Approval: Final Certificate: Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ox (check one) Hamlet Lot ~ ~ Lot: (check one) Applicant Signature OWNER TOWN FORME~, OWNER LAND SEAS. IMP. VL TOTAL OF $OUTHOLD PROPERTY RECORD STRE~ ~L~ ~7© ~ , :ARM DATE AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre V(~lue Tillable Woodland Meadowland House Plot' Total ValUe. Per Acre CAR[ : VILLAGE DIST. ,,~/~ ~, ~ ~//( /~ TYPE OF BUILDIN COMM. CB. MICS. Mkt. 'Value :RONTAGE ON WATER/~.~ :RONTAGE ON ROAD )EPTH )OCK Q M. Bldg. ~ExtenSion Extension Extension Porch COLOR Foundation Basement Porch i Bath Floors Interior'Finish Heat Breezeway Garage Patio O.B. Total [Ext. WalKP~ $~s Fire Place Roof Recreation Room Rooms I st Floor Rooms 2nd Floor DriVeway FIN. B 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO~/H PLBG. [ ] FOUNDATION 2ND [ ~I~ULATION [ ] FRAMING [ ,~ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ' '~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INS~ DATE ~//' ~/C'~*~ INSPECTOR ~~-~ ~~ COMMENTS FIE!,I~ INSPECTION REPORT I DATE I FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE TOWN OF SOUTHOLD BUILDIN( TOWN HA SOUTHOI TEL: (631 FAX: (631 : DEPARTMENT LL D, NY 11971 765-1802 765-9502 Examined ~/~' ,20 ~. Approved [ ~/'~et5 ,20 ~. Disapproved aJc / ' Expiration )G. DEPT. ~F sgumoLo Building Inspector BUILDING PERMIT APPLICATION'CI)~C~KLIST Do you have or need the following, befor~ applying? Board of Health 3 sets of Building Plans / Planning B~.~approval Sm'vex Check ,~ ,~ 0 O, ~ Septic Form N.Y.S.D.E.C. Trustees Contact: Ma~l. to:~'O~ o?4:~ t/ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,2002 sets of plans, ,. b. Plo' areas, p_nd wat c. The d. Up( shalCbe kept o e. Nol issues a Certifi f. Eve. issuance or ha property have addition six m, APPLt Building Zone Regulations, fc applicant agree authorized ins State whether Name of owm If applicant is (Name Builders Licen Plumbers Lice Electricians Li Other Trade's 1. Location House Nun County Ta~ Subdivisio: ; application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 .ccurate plot plan to scale. Fee according to schedule. plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or ,'rways. work covered by this application may not be commenced before issuance of Building Permit. n approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit a the premises available for inspection throughout the work. ,uilding shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector gate of Occupancy. F building permit shall expire if the work authorized has not commenced within 12 months after the date of not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the ,een enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an nths. Thereafter, a new permit shall be required. CATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to the Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or r the construction of buildings, additions, or alterations or for removal or demolition as herein described. The s to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit ectors on premises and in building for necessary inspections. (Signature of~pphcant or name, if a corporation) (Mailing address of applicant) ~pplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ofpremises 7~'/F~/t/~__ ~- ~/~'./,~ j (As off flae tax roll or latest deed) corporation, signature of duly authorized officer and title of corporate officer) se No. ~se No. :ense No. Acense No. 'land on which propos~ed %or~ will be dl:kne: ~ tber Street MapNo. 1000 Section (Name) Hamlet Filed Map No. 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 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~9},~-(p O 5. If dwelling, number of dwelling units If garage, number of cars 9. Size of lot: Front 10. Date of Purchase Fee Addition k Alterati( Other Work (Descrip ~Jon) STATE OF NEW YORK) SS: COUNTY OF ) Address Address NO Phone No.~ca~'~. ~ Phone No 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 ora tidal wetland? * YES__ NO__ * IF YES, D.E.C. PER_MITS 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 NO being duly sworn, deposes and says that (s)he is the appl (Name of individual signing contract) above named, (S)He is 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 that all statements contained in this application are tree to the best of his knowledge and belief; and that the work performed in the manner set forth in the application filed therewith. Swol;q,~ before me this ~ ,~ //'~ ~ ~_~,,~ t.A day of ~"~k~t I 201~)~' Notary Public Signature of Applicant PAULA MASCIA Not~y P, ubllO, State of New ¥~1~ NO, 01MA5030507 Qualified in Suffolk ~, ~ Exptre~ July 1~, d'n°~/ his application; will be Depth 11. Zone or use district in which prenfises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO x, Will excess fill be removed from premises? YES 14. Names of Owner of premises ~. t6~/~)~)! -~ Name of Architect Name of Contractor 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 Height. Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stodes 8. Dimensions of entire new construction: Front Rear Height Number of Stories Rear Depth Name of Former Owner Rear Depth (To be paid on filing this appli, :ation) Number of dwelling units on each floor SUI~VE'r' Ot= PI~OF'F~'I-'r' S ITUA'FtE: ~H ~FFOLK TO~ OF ~UTt~LO ~FFOLK ~UN~, N~ ~VE~EO FE~. 15, 2000 ~FFOLK GOUN~ TAX ~ IOOO - ItO - 8 - 2~ i soo56, o,,e p .54 ~ ~ Wicks Road T~N~ Hl~lN~ ~ECONI~ A~ST~T ~I~ST AHE~IGAN TITL~ TITLE ~ 641 S OOgqO ~e~ = ,2~o s.~. o~ 0.2 ~ ..~.s. ~~ 36~8 F~ 3~7 ~. D:~OBS~I 11 < >