HomeMy WebLinkAbout41819-Z �gUFFot TOWN OF SOUTHOLD
moo �Gy BUILDING DEPARTMENT Vo I
y 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#: 41819 Date: 7/18/2017
Permission is hereby granted to:
Mazurowski, Florence
PO BOX 383
East Marion, NY 11939
To: install accessory above-ground swimming pool, fenced to code, as applied for.
At premises located at:
11005 Route 25, East Marion
SCTM # 473889
Sec/Block/Lot# 31.4-29
Pursuant to application dated 7/11/2017 and approved by the Building Inspector.
To expire on 1/17/2019.
Fees:
SWIMMING POOLS -ABOVE-GROUND WITH REQUIRED FENCING $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Building 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. -7
New Construction: Old or Pre-existing Building: (check one)
Location of Property: S — ✓
House No. Street ' Hamlet
Owner or Owners of Property: � �"L�%'yKz j�
AL Suffolk County Tax Map No 1000, Section 31 Block Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: �,// (check one)
Fee Submitted: $
Applicant Signat re
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(IST)
------------------------------------
FOUNDATION(2ND)
9
ROUGH FRAMING& y
PLUMBING
0
r
INSULATION PER N.Y: y
STATE ENERGY CODE •
i
FINAL
ADDITIONAL COMMENTS
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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 4 sets of Building Plans
TEL: (631) 765-1802 'IV
Planning Board approval
FAX: (631) 765-9502 V Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application_'
R
Flood Permit
Examined ,20� Single&Separate_;
DStorm-Water Assessment Form
-711qZ JUL 1 0 2017 Contact:
Approved ,20 �
Disapproved a/c BUII.DIN t;EQ4 :d TOWNOFLD Phone: 6 /-F7 91�
Expiration ,20
Buil to pector
APPLICATION FOR BUILDING PERMIT
Date '� — j , 20��
INSTRUCTIONS
a.This application MUST be 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 Insp�ctor 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 6 name,if a corporation)
(Mailing address of applicant) 3 4
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
(Aso 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:
11U(55 o'Ac S CaS+ KAcm+on
House Number Street :;s. iHamlet.
County Tax Map No. 1000 Section Block Lot
i
Subdivision Filed Map No. Lot
i
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy /L/ 14D
b. Intended use and occupancy
3. Nature of work (check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work(kbM� 'noy_�- J
0(Description)
4. Estimated Cost
i w __-(To'b'6paid on filing this application)
' '' n nit 5. If dwelling, number of dwelling units .. ; , Number of dwelling u s on each floor
If garage, number of cars °
6. If business, commercial or mixed occupancy, specify nature and extent each type of use.
7. Dimensions of existing structures, if any: Front 4 ='�-'`r A'-'"°�`' °'-Re'ar'``` f Depth
Height Number of Stories
j
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
I
9. Size of lot: Front Rear Depth I
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 NO
13. Will lot be re-graded? YES NO Will excess fill be removed fro 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&D.E.C. PERMITS MAY B 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.
I
STATE OF NEW YORK)
COUNTY Of j� SS:
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the (�Loofg
(Contractor,Agent, Corporate Officer, etc.)
'
of said owner or owners, and is duly authorized to perform or have performed the sa I id 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.
i
Sworn to before me this
day of 20 _
i
TRACEY L. DIAIYER
ARY PUBLIC STATE OF NEW
otary Public NO. Signature nature of aplicant
QUALIFIED IN SUFFOLK COUNTY
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APPRO ED AS NOTED
DATE: B.P.#
FEE: BY:
NOTIFY BUILDING DEPAR NT AT
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1. FOUNDATION - TWO REQUIRED GLI
FOR POURED CONCRETE GLI Above Ground POOL Fence Add-On Kit B (35ect)
2. ROUGH - FRAMING & PLUMBING 66 customer reviews 1 75 answered questions
3. INSULATION
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NEW YO R KC8cVhTc@ e&eT9)WN t0lDES This item's packaging will indicate what is inside and cannot be hidden.
AS REQUIRED AND CONDITIONS OF
OCCUPANCY OR ELECTRICAL
o USE IS UNLAWFUL INSPECTION REQUIRED
ULUMNUMWITHOUT CERTIFICATE RETAIN STORM WATER RUNOFF
OF OCCUPANCY PURSUANT TO CHAPTER 236
OF THE TOWN CODE..
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Intex
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