HomeMy WebLinkAbout34863-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34136 Date: 12/14/09
r
THIS CERTIFIES that the building ADDITION
Location of Property: 2155 JOCKEY CREEK DR SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No_ 473889 Section 70 Block 2 Lot 28
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 14, 2009 pursuant to which
Building Permit No. 34863-Z dated JULY 14, 2009
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 ADDITION WITH LANDING TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to MARGARET A.TONYES
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 829102 08/25/87
PLUMBERS CERTIFICATION DATED 07/20/09 BURTS RELIABLE INC
r
AuZiorized Signature
Rev. 1/81
• Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802 ® E C E V E
APPLICATION FOR CERTIFICATE OF OCCUP
DEC 14 2009
This application must be filled in by typewriter or ink and submitted to the Building Der artnict with the following:
A. For new building or new use: BLDG.DEPI
TOWN OF OUTNOLD
1. Final survey of property with accurate location of all buildings,property lines, s ,
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
I. 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$50.60.
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: (check one)
Location of Property:
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section '762 Block Lot
Subdivision 'J Filed Map. Lot:
Permit No. 7 ��o Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval: �o���7
Planning Board Approval:
.Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
G �'� J' Applicant Signature
�oSVFFocKoo
To ,i Hall. 53095 Main 110.3J 2 Fax (516 705 F:
P O. Boy. 1179 y0 Telepnone (51G) ''G'
So�lr,old, New York 1 1(j71
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I. F I C A T I 0 N
Date: ao
ioq .
Building Permit No. -3
Owner: YYl(S f AI-ganf
( lease-print)
Plumber: 2)Ur--s tgoia.b!2 Inc.
(please print)
I certify that the solder used in the water supply system contain Less
than 2/10 of 1% lead.
(plumbers signature
Sworn to before me this
day of 200_ C ,v,,adB�-c
Notary Public, �'J f-y1 K County /VO*v+ f,
BERNADME L.TAPLIN
NOTARY PUBLIC#4844893
State of New York
pR�idijg Psi Suffolk County
Comms�,ti LAB rEs NQ 7/o�v0 l
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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. 34863 Z Date JULY 14 , 2009
Permission is hereby granted to:
MARGARET A.TONYES
2155 JOCKEY CREEK DRIVE
SOUTHOLD,NY 11971
for
CONSTRUCT AN ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR. THIS PERMIT REPLACES EXPIRED BP # 15647
at premises located at 2155 JOCKEY CREEK DR SOUTHOLD
County Tax Map No. 473889 Section 070 Block 0002 Lot No. 028
pursuant to application dated JULY 14, 2009 and approved by the
Building Inspector to expire on JANUARY 14, 2011 .
Fee $ 50 . 00
Authorized Signature
ORIGINAL
Rev. 5/8/02
FORM NO. L
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
J SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 15647 Z Date - ......a , 19 .7
.. .. ..................... . ..
Permission is hereby granted to:
. . �s -.. . .. : .: ..-...............
.................. ................... ......Y*1.1...........
to .. ........... ....... `..�.... ..G-�:�.... ..... -�,....... ....:....:.:.... .. ...��........'....
.................... ....*....ve- .......................................
at premises located at .. -�.............. ... .....J. .K..................................... ............
.................................................................................................................................................................
.................................................................................................................................................................
County Tax Map No. 1000 Section .....o.�R....... Block ....... Lot No. .... -.............
pursuant to application dated ...... .... . ............ .....�.%............. 19.2.7., and approved by the
Building Inspector.
Fee $.. .:./....
.......................... . ................................. ..........
Building Inspector
Rev. 6/30/80
SOUryolo
courm,��'Q
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING VXFINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:
f '
t.� okV, /
/-5 a 7
DATE INSPECTOR
6<7 M-1802
BUILDING DEFT.
�W3 INSPECTION '
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[//J FRAMING [ ] FINAL
REMARKS: � d�
G
DATE-, INSPECTORS
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROU H PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE .� 6 � INSPECTOR
ass-1802
BUILDING DEFT.
INSPECTION -
� OUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
i
DATE INSPECTOMICS---
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OUNDATIO 1CIO
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OUNDATION ( 2nd ) r
z
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�, 6u;. ';:? �;; g,;•,,, ,^.r, '�;• 3 SETS OF PLANS�1a+ e�e�ca0.<�
baFa�r4'i +.'s`fsi:kr, FORM NO. 1 SURVEY C Qa 4, Q Aad�
TOWN OF SOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971
TEL.: 7651802 CALL ��-� rz �
MAIL TO :a��� � uJ wa:04
Examined 101 . 3 f
Approved . . . . . ., 19 . . . Permit Nod.S . . . . .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . . . . . . . . . . . . . . . . . .. 19 . . .
INSTRUCTIONS
a. This application 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit ursuant to the
Building,Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicab aws%Ordinances or
Regulations, for the construction of buildings, additions or alteratio or removal o moli o s herein described.
The applicant agrees to comply with all applicable laws, ordinance build' code, ho sing o e and regu tions, and to
admit authorized inspectors on premises and in building for necessary ' spect' ns.
(Signa e f applicant, r name, if a rporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
OCufv !Q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises I�GU//(�` R O !YES • ./�t9i (. .. �. . ... uY . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
Builder's License No. . . . . . . . . . . . . . . ... . . . . . . . . .
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's 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 . . .7.�. . . . . . . . . . . . Block . . . . . . . . . . . . . . . . Lot . . . g. . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . . . .' :5.�.--? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . Alteration . . .. . . . . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . ... . .
(Description)
4. Estimated Cost . . . . So D .�. . . . . . . . . . . . . . . . . . . . . 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 .a.9.•. . . . . . . . . . . . . . . . . . Height . . . . . : . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . .
-$. Dimensions of entire.new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . ... .
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: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regraded-_..... . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No
14. Name of Owner of,premises . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . ... . . . . . .
Name of Architect . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . ... . . . . . . . . . . .
Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . .. . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . .
15. Is this property located within 300 feet of a tidal wetland? *Yes . . . . . No . . . . .
*If yes, Southold Town Trustees Permit ma be required.
AM
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NE YORK S.S
COUNTY OF . . . . . . . . . . .
G=,D �.v • �• • . .r<J.N. Y S . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Heis the . . . . . . . . . . . . . . . . . . . . . . . . . . . . !i. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(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,,andjh�liefi.and that the
work will be performed in the manner set forth in the application filed therewith. .d
Sworn to before me this
. . . . . . 3/`( . . . . . . . .day of. Gam: . . . . . . ., 19 .
Notary Public, . . County
ryUNbD'�AJ COOPER (Signature applican
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Ton� yes,Margaret A' Roll Year: 2010INextYr 1 Family,Res Land AV: 1,300
2155 Jockey.Creek D r and,Size:0.56 acres T otal AV: 7.200
Parcel 70.2 2B Owner ,Tax Bill Mailing'Address 3rd Party Address Bank
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5 G EN PORT, N.Y. If 944
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