HomeMy WebLinkAbout37948-Z ��q�c�UFFOI,�COG Town of Southold Annex 8/28/2013
P.O.Box 1179
54375 Main Road
cy Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 36469 Date: 8/28/2013
THIS CERTIFIES that the building DECK
Location of Property: 200 Maple Ln, Greenport,
SCTM#: 473889 Sec/Block/Lot: 35.-5-5.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
4/10/2013 pursuant to which Building Permit No. 37948 dated 4/17/2013
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 an existing single family dwelling as applied for.
The certificate is issued to VanCleef,Ann Marie&VanCleef,Robert
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
)g6pl!Lzed S' ature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y x 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#: 37948 Date: 4/17/2013
Permission is hereby granted to:
VanCleef, Ann Marie &VanCleef, Robert
PO BOX 368
Orient, NY 11957
To: construct a deck addition to an existing single family dwelling as applied for
At premises located at:
200 Maple Ln, Greenport
SCTM # 473889
Sec/Block/Lot# 35.-5-5.1
Pursuant to application dated 4/10/2013 and approved by the Building Inspector.
To expire on 10/17/2014.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $392.00
CO -ADDITION TO DWELLING $50.00
Total: $442.00
Building Inspector
Form No.6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPA-NCB'
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new buildipg or new. .use:
1. Final survey of property with accurate-location of all buildings,property lines,streets,and unusual naturat 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 2l1 U 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 epmpleted 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-$50.00, Additions.to accessory building$S0.00, 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 `� — i!
New Construction: Old or Pre-existing Building:' V . (check one)
Location of Property: A le-
House oL�in,e�
No. treet Hamlet
Owner or Owners of Property: f7 r)
Suffolk County Tax Map No 1000., Section S Block 37 Lot
Subdivision u Filed Map. Lot:
Permit No. / Date of Permit. 7 — 7' /3 Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate- (check one)
B'0
Fee Submitted: $ 5-0
Applica It Signature
soUryolo
��y�OUNTV,N�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ FOUNDATION.IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: G
c
DATE INSPECTOR
9
h o
�O
coulm,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPEC PON
[ ] FOUNDATION 1ST [ ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRIC GH) [ ] ELECTRICAL (FINAL)
REMARKS: Gf Posrs- 7-6 i
DATE INSPECTOR
pF SOUr�o
C/
0V
TOWN OF SOUTHOLD BUILDING. DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULATION
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
IF
DATE INSPECTOR ` A-lift
�OF SOUTy
�o
couto,� Q
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLB
[ ] FOUNDATION 2ND [ ] IN�
[ ] FRAMING /STRAPPING [ F AL & ,_
[ ] FIREPLACE & CHIMNEY [ ] FIR SPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: A-S/ l
A
DATE INSPECTOR
OF SO�jyo�o
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROU PLBG.=
[ ] FOUNDATION 2ND [ ] I SUL N
[ ] FRAMING /STRAPPING [ FIN
[ ] FIREPLACE & CHIMNEY [ ] FIRE INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
No
DAT e7z LIJ INSPECTOR
Comlymms
rm PM IN
PLUMING
IN&ULATIONPEAN.Y.
_
STATE ENERGY • 1
1 I� ka 1 -c r . '
i 11 •NAL CMMNTS
_..
R.•
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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 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. 3 7q Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood Pen-nit
Examined ,20 Single&Separate
® C EH vnf] E Storm-Water Assessment Form
v1 Contact:
Approved ! ,20]_3 Mail to:
Disapproved a/c
BLDG. DEPT. Phone:
TOWN OF SOUTHOLD
Expiration ,20_L_�
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date bo , 20 13
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)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor,,electrician, plumber or builder
Name of owner of premises A4M
(As 4n 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 w rk will be done:
Pi Gar, ell e—
House.Number Str t Hai et
County Tax Map No. 1000 Section .3 S Block Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 1�
b. Intended use and occupancy �,v►�q 1�... i+n vim, /z -�-�
3. Nature of work (check which applicable): New Building Addition V Alteration
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, specci y nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front SS Rear . Depth
Height Number of Stories 4
Dimensions of same structure with alterations or additions: Front Rear
Depth -15-A Heights Number of Stories
8. Dimensions of entire new construction: Front Rear 30 Depth A
Height Number of Stories o
9. Size of lot: Front Rear d.5-o Depth
10. Date of Purchase Name of Fortner Owner
11. Zone or use district in which premises are situated /
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO v
13. Will lot be re-graded? YES NO V Will excess fill be removed from premises? ES NO
14. Names of Owner of remises & "'Job r Address fr4 It 1'. Phone No.
Name of Architect 0 b-er✓t T'a-r w- 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? a_ 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)
I SS:
COUNTY OF II
A11 n V d rl 0 -Q,e°C being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(Contractor, Agent, Corporate Ofticer, etc.)
of said owner or owners,and is duly authorized to perform or have performed the said wort: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 20
not
I Pub!c 1�OTM
190696
Notary Public U596 �y Si •iature of Applicant
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