HomeMy WebLinkAbout40849-Z ��o�s�FFotq•�oG� Town of Southold 5/16/2018
0
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39575 Date: 5/16/2018
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 30 Tucker Ln, Southold
SCTM#: 473889 Sec/Block/Lot: 63.-5-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/20/2016 pursuant to which Building Permit No. 40849 dated 7/22/2016
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"WINDOW REPLACEMENT TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
Note: Correction for application date
The certificate is issued to Zukowski,Janet
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
uth rite i ature
Town of Southold
3/27/2018
0
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39575 Date: 3/27/2018
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 30 Tucker Ln, Southold
SCTM#: 473889 Sec/Block/Lot: 63.-5-7
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/1/1900 pursuant to which Building Permit No. 40849 dated 7/22/2016
was issued; n conforms to all of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
"AS BUILT"WINDOW REPLACEMENT TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Zukowski,Janet
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
u ho ' Signature
�SUFFa�,r�oTOWN OF SOUTHOLD
moo �y� BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o . SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 40849 Date: 7/22/2016
Permission is hereby granted,to:
Zukowski, Janet
PO BOX 1616
Southold, NY 11971
To: legalize "as built" window replacements as applied for.
At premises located at:
30 Tucker Ln
SCTM # 473889
Sec/Block/Lot# 63.-5-7
Pursuant to application dated 1/1/1900 and approved by the Building Inspector.
To expire on 1/21/2018.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00
CO -ALTERATION TO DWELLING $50.00
Total: $450.00
B ilding ector
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. 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.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date.
New Construction: Old or Pre-existing Building: -Y-,, (ch ck one)
1
Location of Property: n l '2
House No. Street Hamlet
Luffolk
wner or Owners of Property: 01
��
County Tax Map No 1000, Section & 2) Block 5 Lot
Subdivision Filed Map. Lot:
Permit No.�a � Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: d/ (check one)
Fee Submitted:$
pplicant Signa re
l 019 q SOUT'yo
N o
ply 0 lm,�c�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] SULATION
[ ] FRAMING / STRAPPING [ FINAL O/A' A�
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
�I ve-
w Icve,
DATE INSPECTOR
1, •Y! � _ ;
FIELD TNSPEAl
C3N FLE 'OR� AA2T Coivx� '
FOUNDA=ON (1ST) -Al
................».. _ ....--- .
FOUND�TTQN'(2N13) �
ROUGF!FPJI-M`Q&
PLUMBING '
INSULATION•PEA N.Y.
STATE ENER:GrY CODB
to l �
FINAL
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 G Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit ,
Examined j 20 Single& Separate
Storm-Water Assessment Form
Contact:
Approved '20 moo: '7n
Disapproved a/c i fs
Phone:89 Z��S 17d
Expiration ,20�
7
D L� Building Inspector
(5 t!
PLICATION FOR BUILDING PERMIT -
JUL 2 0 20
Date , 2016
BUILDING D INSTRUCTIONS
a. T M19Tattkli'iVIL'JS e completely filled-in by typewriter or in ink and submitted to the Building Inspector with 4
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 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.
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 inspection
(Signa e of ap ' ant or name, if a corpora-16
ion)
( aiing address o applicant) // 7/
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
(As on the tax roll or 1 est 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.
1. Location of land on which proposed work'will'be-`d1oh6--85,-"
;r!?
House Number Street __ :-:V : .,F ;f ;f s ,';E ,✓ ;Hamlet
County Tax Map No. 1000 Section r/p Block �''� Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended and o ccupa cy of proposed construction:
--- a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work dC6P
(Description)
4. Estimated Cost Fee
' _ (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 'ar
Depth Height Number o r rim` �" d 5" � ? (2M7
7,
8. Dimensions of entire new construction: Front Rear , Depth
Height Number of Stories 41,01 0 A1111
9. Size of lot: Front Rear Depth 6CkM�qtj"'!—F ,� _;�'4W��yhj 3 °
�` d(iiK d.6 i e`r.d f ''td 7b`Y k d5
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? YES NOX"'
13. Will lot be re-graded? YES NOXWill excess fill be removed from premises? YES NO
14. Names of Owner of premisez, 4Phone No.
Name of Architect Address Phone No
Name of Contractor A,12tfe--, Address Phone No.
15 a. Is this property within 100 feet of tidal wetland or a freshwater wetland? *YES NO
* 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.
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.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY O&Ak
J1 being duly sworn, deposes and says that(s)he is the applicant
(Name of indivi ual signing contract) above named,
(S)He is the e we
(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.
TRACEY L. DWYER
Sworn to before me this NOTARY PUBLIC,STATE OF NEW YORK
;W'L day of 20_L NO.OIDW6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2QL
A
Notary Pillic Si ure of App]icant
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AS REQU IREZ A - ' WITH ERTIFICAT�Eo R G E F $� C A`�'H RYN M. E PATH
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DATE: - 2'"', B.P. `�. , �, ` • = tRoN Pipc
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FE_: BY:
NOTIFY BUILDING DEPARTMENT AT �4v��
765-1802 8 AMT 4 PM FOR THE
-FOLLOWING INSP CTIONS:
I. FOUNDATION - TWO REQUIRED,-
FOR POURED 0NCRETE j 'S�st• �p�•
?. ROUGH - FRAI ING'& PLUMBING � do
3. INSULATION i b�d GUARANTEED TO LN�tTER-CouHrQ 7iTLt 6utiRANTY
4. FINAL -_ CONS RUCTION:MUST MO K-re.Arar CO. AS suavav lro MAY 9, 194-3.
eL
"r BE COMPLET FOR C.O.- y:t� 14%Ir
4TTo W. VAN 'tL Y4. 4. SO N
ALL CONSTRI7�
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REQUIREMENTS OF THE CONS BLE FO
YORK STATErtWa- .4k .ANE LIGEetSEA LAsto Suitvevoes
JDESIC�N OR,'CONSTRUCTION ERROR G¢e f<N ro iGT N
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i FULLVIEW FIXED OR '/z LITE INTERCHANGEABLE
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ENERGY PERFORMANCE RATINGS
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ADDITIONAL PERFORMANCE RATINGS
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i AAt%,-W1A/C8A 101/IS21A440-08 Class LC-PG30 45.8 X 76.9
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