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HomeMy WebLinkAbout36769-Z 4 TOWN OF SOUTHOLD ��OguFEo(,�c�G� o �� 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#: 36769 Date: 10/20/2011 Permission is hereby granted to: Moody, Hiram F. Jr. QPRT & Goulard Sarah R QPRT 2127 Rabbit Road, Wickenburg, AZ 85390 To: . Alterations to a Single Family Dwelling; Renovation of a 2nd Floor Bath, as applied for. G At premises located at: 128 Reservoir Road (Winthrop Drive), Fishers Island SCTM # 473889 Sec/Block/Lot# 9.-8-3.2 Pursuant to application dated 10/13/2011 and approved by the Building Inspector. To expire on 4/20/2013. Fees: SINGLE FAMILY DWELLING-ADDIT.ION OR ALTERATION $214.00 CO -ALTERATION TO DWELLING $50.00 Total: $264.00 r Building Inspector 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_ -Swum statement from plumber certifying that the solder used-in system contains less than 2110 of 1% lead. . 5_ Commercial building,industrial building, multiple residences and similar buildings and installations,a certificate of Code Compliaitce,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: I- Accurate survey of property showing all property lines,streets,building and-unusual natural or topographic features. 2. A properly eompleted 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 $1.5.00,Commercial$15.00 / Date. f©— Z6— New Construction: Old or Pre-existing Building: (check one) Location of Property: }, •U \ �— p J //.5N�fn House No. �] Street Hamlet Owner or Owners of Property: l"/DD��/ la p U L/9 Je Z� . Suffolk County Tax Map No'1000, Section 9 Block Lot 3 Subdivision Filed Map. Lot: Permit No. 3 "l(0 _Date of Permit. /0 - 010-/ 1 Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: V (check one) Fee Submitted: $ .�� u �� �s•loll � - ���� C Applicant Signatur FIELD 1NSPEeTYON REPORT DATE COMMENTS U,,, ►ti t � � FOUNDATION(1ST) 6- - - ------ - -------------- FOUNDATION(2ND) � . 00 ' ROUGH FRAMINQ& PLUMBING 'c INSULATION PER N.Y. ' STATE ENERGY CODE C) FINAL ADDITIONAL COMMENTS . rn d '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 3 �� Survey SoutholdTown.NorthFork.net PERMIT NO. / 67 Check Septic Form N.Y.S.D.E.C. Trustees ( q Flood Permit Examined ` I ,20� Storm-Water Assessment Form DO Contact: Approved ® 20 I I Mail to: Mts TpruTed a/c Pho Expiration ,20 OCT 12 2011 x t Building Inspector BLDG. DEPT. TOWN OF SOUTHOLD APPLICATION FOR BUILDING PERMIT Date Aog P- , 20 1 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 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) S3`f !^. X:r Vey. 66. ;17 O (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder vp� b,,c Name of owner of premises }--� i r'ct f bd"mil (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer C A.q u;n O (Name and title of corporate officer) Builders License No. Plumbers License No.��^^ -4 od'i V; ---r-;- a 00/Y1 P Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: I�g Pe-Selc0C) Zq- V,J . F � House Number Street Hamlet County Tax Map No. 1000 Section`? Block Lo 3, Subdivision Filed Map No. of a 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 3. Nature of work(check which applicable): New Building Addition Alteration_ Repair Removal Demolition Other Work (Description) 4. Estimated Cost iol �goD 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 ears 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 He-fight 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 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? YES NO 13. Will lot be re-graded? YES NO 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 &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 urvey. 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 OF ) `ha1►'1o�s G. QGt)l being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the 1 Owe $� I J/" �� ON IV CJ" ontractor,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 Quo *r 201l_ Notary Public /� Signature of Applicant 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 Survey SogtholdTown.NorthFork.net PERMIT NO. Check ��,,•, b`� �`" � Septic Form N.Y.S.D.E.C. 53 Trustees Flood Permit Examined ,20 Storm-Water Assessment Form PLUMBER CERTIRCAP.ON Contact:/,�/ ,l (�(�' 8� " (l0 v U 1�� Approved 20 ON CEAO'ON 'ENT BEFORE Mail to: CERTIEtCATPOF OCCUPANCY Disapproved a/c SOLDER USED�N WATER APP '` = -.5 NOTED_, SUPPLY SYSTEM CANNOT PU11111B�NVC` Pho i4LLP,L INN W.5TE 3� Expiration 20 EXCEED 2/10 OF 1%LEAD. &WATEF�UNE6N�EC. �A E__-_._____ P. - - OCT 12 2011 x TESTING BEFORE COVERING FEE �-) � v o-3,, j Buildiri Ins Inspector 1 NOT! ' ,`PARTMENT AT g p. BLDG.DEPT. rf� GJ�L1G e�C� 765 -0 d PM FOR THE TOWN OF SOUTHOLD UU FOLL IONS: APPLICATION FOR BUILDING PERMIT 9. REQUIR�Q • FGr, P- ,�h ':UNC;RET ! 4 �/ Date �� a- , 20 1 b .S�'�-�'�L-• 2. ROUGH-=RA%':vim P'_Uty18f.% STRAPPING. ELECTICAL A§QU� IIN§ cdC Gam` ' 3. INSULATION Q, 4. FINAL-CONSTRUCTIQN A ELLgfgII§,ALL (Signature of applicant or name,if a corporation) MUST BE COMPLETE IFOR ALL C.ONSTRUCT19NLLLfpjTjTWS��f IRE:QUiRBMJN1Tg OF jT{k{ff COM ff MEN � 1� (Mailing address of applicant)- 11DRKSTAi . Ib1QT1TFEMWkL f �a4w j State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ELECTRICAL (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer 9-To 0 , 0 a INSPECTION REQUIRED ?'L;na; Teuma (Name and title of corporate officer) Builders License No. • �, �ta- , Plumbers License No. (�30:/Y)p Electricians License No. E Other Trade's License No. i-f V�0 0 COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES i AS REQUIRED AND CONDITIONS OF 1. Location of land on which proposed work will be done: TOWS Plumbin and Heating SOUTHOLD TOWN ZBA :e r 0 C) Zr F. T g g 0 0 ! House Number Street Hamlet Box 534 �— _ SOUTHOLD TOWN PLANNING BOARD Fisher's Island, NY 06390 County Tax Map No. 1000 Section9 Block Lo 3i Subdivision Filed Map No. of