HomeMy WebLinkAbout29092-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29201 Date: 01/16/03
THIS CERTIFIES that the building ADDITION
Location of Property: 520 PEQUASH AVE CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 103 Block 11 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 7, 2002 pursuant to which
Building Permit No. 29092-Z dated JANUARY 10, 2003
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 RYAN SPRINGER
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF BEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Authorized Signa re
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. 29092 Z Date JANUARY 10 , 2003
Permission is hereby granted to:
RYAN SPRINGER
520 PEQUASH AVE
CUTCHOGUE,NY 11935
for .
CONSTRUCTION OF AN AS BUILT DECK ADDITION AS APPLIED FOR
at premises located at 520 PEQUASH AVE CUTCHOGUE
County Tax Map No. 473889 Section 103 Block 0011 Lot No. 002
pursuant to application dated NOVEMBER 7 , 2002 and approved by the
Building Inspector to expire on JULY 10 00
Fee $ 300 . 00
f
Aut ied Signatur
ORIGINAL
Rev. 5/8/02
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$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
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial $15.00
Date. Jan. 16, 2003
New Construction: a Old or Pre-existing Building: (check one)
Location of Property: 520 PEQUASH AVE. CUTCHOGUE, N.Y.
House No. Street Hamlet
Owner or Owners of Property: RYAN SPRINGER
Suffolk County Tax Map No 1000, Section 103 Block 11 Lot 2
Subdivision Filed Map. Lot:
Permit No. 29092—Z Date of Permit. JAN. 10,2003 Applicant: RYAN SPRINGER
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: %X (check one)
Fee Submitted: $ 25.00
?39 Applicant Signature
co2:a9aoi
-2 TOWN OF SOUTHOLD PROPERTY RECORD CARD
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l LAWRENCE M. TUTHILL � 29092
PROFESSIONAL ENGINEER
P.O. BOX 162
GREENPORT, N.Y. 11944
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(631) 477-1652
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ODUCAVON LAW.
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BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: /A/s
APPLICANT: 1 DATE SUBMITTED:/x/02
SCTM#DISTRICT: 1.000, SECTION: — BLOCK: __[t, LOT:
STREET ADDRESS: C� CITY: .SUBDIVISIONL
11(1
PROJECT DESCRIPTION: " 11
ESTIMATED PROJECT COST: ARCHITEC GINE �11,6'11 t_L FAST TRACK? �y
SINGLE & SEPARATE CERTIFICATION-REQUIRED? 'Uo NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN1997 100-25.Merger.(A nonconforming at any time after 7/1/83
ZONING DISTRICT: CONFORMING? !JO
REQ. LOT SIZ O 13 ACT. LOT SIZE: I p REQ. LOT COV. �
. A ACT. LOT COV.
REQ. FRONT 3� PROP. FRONT REQ SIDE ACT. SIDE o 5
REQ. REAR 3 J PROP. REAR / REQ. HE HT PROP. HEIGHT
WATER FRONT? No DESCRIPTION:
PANEL #: FLOOD ZONE:_,
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH T: YES or (BED #): DTE:—/_/ PERMIT #:R10-
TOWN SEPTIC RECEIPT: Y
NEW YORK STATE DEC: PRE-DEC 9/1/75 YES o
SOUTHOLD TOWN TRUSTEES: YES or
TOWN ZONING BOARD APPROVAL: YES o
TOWN PLAN. BOARD APPROVAL: YES
TOWN HISTORICAL PRE (SPLIA): YES o O
NYS ENERGY: YES OR NO
EGRESS (18 H min.?4 sqtotal) ENT (SQ. FT. x 4%)-- LIGHT(SQ. FT. x 8%) .v
BUILDING PERMITS OPEN D. BP -Z/ C/0 Z- ,
HAVE PRE CO'S : Y OR N BP -Z/C/o Z- ,
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: SF FEE F
1. SF)- ( SF)= $
SFX $ _ +$ +$ _$ .
2. ( SF)- ( SF)= SFX$ =$ +$ +$ _$
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ j FRAMING KFINAL
[ j FIREPLACE & CHIMNEY
REMARKS: M meo-- e
DATE !/303 INSPECTOR ,
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BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:/ `
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DATE moo{ INSPECTOR
FIELD INSPECTION REPORT DATE
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FOUNDATION(1ST) at
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FOUNDATION(2ND)
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ROUGH FRAMING&
PLUMBING
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INSULATION PER N.Y.
STATE ENERGY CODE
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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 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631)765-9502 Survey
www. northfork.net/Southold/ PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined t / '� ,20 3 Contact:
Approved l C, 20 7 Mail to:
Disapproved a/c
JJJ Phone:
Expiration_,20 � f
Building Inspector
A"'P LICATION FOR BUILDING PERMIT
Date ff—y , 20 OL
INSTRUCTIONS
a. This pplication 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 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 inspections.
(Signature of applicant or name,if a corporation)
PC-61(449Jd APS CkAC)f4e A,1Y
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
D4.s ht
Name of owner of premises &-t h -S ✓�h
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.
1. Location of land on which proposed work will be done:
House Number Street ` Hamlet
County Tax Map No. 1000 Section l Block
Subdivision Filed Map No. t'' L6t` a
(Name) .... ,. . ., . . ,
2. 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 j Cie � G� x,
3. Nature of work(check which applicable): New Building Addition__XAlteration
Repair Removal Demolition Other Work
(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 Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear 75- Depth LOO
10. Date of Purchase 9 f oo Name of Former Owner k417 d}Er.'1Ju"
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO r°
13. Will lot be re-graded? YES NO r Will excess fill be removed from premises? YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES &b.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.
STATE OF NEW YORK)
SS:
COUNTY OF )
Ayn L+ being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the d W h e '--
(Contractor,
(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 /'
day of /4/O&E^4 20 6
otary Public Signature of Applicant
ELIZABETH A STATHIS
NOTARY PUBLIC,Slate of New York
No.01 ST6008173,Suffolk
Tenn Expires June 8,20;Q6
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NOTI BUILDING EPART 3 w w 3
765.1802 9 AM TO S PM FOR THE
FOLLOWING INSPECTIONS: o a o
1. FOUNDATION • TWO REQUIRED
FOR POURED CONCRETE
2 ROUGH • FRAMING A PLUMBING
& INSULATION
4 FINAL - CONSTRUCTION MUST W
BE COMPLETE FOR C.O. I W }
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE Ill Q Z
STATE CONSTRUCTIONS ENERGY ❑ = W
CODES. NOT RESPONSIBLE FOR Y 1n
DESIGN OR CONSTRUCTION ERRORS U W Q U'
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OCCUPANCY OR a v
USE IS UNLAWFUL
WITHOUT CERTIFICATE
2-2x8 PT GIRDER I, 1 OF OCCUPANCY D
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