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HomeMy WebLinkAbout4398-zFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. UPDATED c~RTIFI~ATE OF OCCUPANCY No Z-23442 Date JANUARY 5, 1994 THIS CERTIFIES that the building Location of Property 155 PINEWOOD ROAD House No. County Tax Map No. 1000 Section 110 Subdivision ADDITION CU'J.'CI{OG'~, N.Y. Street Hamlet Block 3 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated O~LY 15, 1969 pursuant to which Building Permit No. 4398-Z dated J~LY 28, 1969 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 ENCLOSED PORCH ADDITION TO EXISTING ONE FAMILY DWRT~.ING * The certificate is issued to SANFORD FRI~MANN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A *NOTE: THIS UPDATES CO Z-3716 ISSUED ON DEC. 31, 1969. ~lding fnspector Rev. 1/81 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4398 Z Permission is hereby granted to: .............. .g~t~ ........................................... to ....... il~t~t ..~u. a~t l.Lt on..o~ .~Lu Jzl~.t,l~ ..O.m~l,U-'tl..ll~.U,m..wAih..~t~.. reef) at premises located at .............. .~.~.....JJ~JIIIl~aolL.~.OlJlJ. J. ................. Jl~lR~l.~l..~.g.ql]~. .................... .................................................. Gut,,e~e,j,~ ......... lt,~.e ..................................................................... pursuant to application dated ............................... ~'~......~.~ ......... , 19...6~J, and approved by the Building Inspector. Fee $...~.~.~ ........... ~' Building Inspector FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy No. ~..~.7!~ .... Date ............. .D. eee!~e? ~., 19. THIS CERTIFIES that the building located at . P~evood. Road ........... Street Map No. Fleet~a.. Block No ........... Lot No.. ~ ..... C=t~o~..~.~. ...... conforms subst~tially to the Application for Build~g Permit heretofore filed in this office dated ........ ~y ..... 1 ~.., 19 69. p~suant to which Building Permit No .... dated ......... ~y ..... ~, 19.69, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is ... P.~i~.te. o~ .fa~ ly. dwelli~ .................................... The certificate is issued to . .8~. ~!~ ....... ~ ...................... (owner, lessee or ten,t) of the afores~d building. Suffolk County Dep~tment of Health Approval ... ~.*.R~ ............................ 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 inspector with the following: 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. 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 a 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 dwellin~ $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-existinR Buildinm - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..l~! ............................... New Construction ...... . . ... Old Or Pre-existing Building..../.. ........... Location of Property House No. Street Hamlet Onwer or Owners of Property..... ...................................................... .... . . . County Tax Map No 1000, Section. .. !l? ....... Block .... .~. ..... Lot.....'~.. ........ Subdivision ............................. Permit No..~.~.~.~ ...... Date Of Permit. Health Dept. Approval ................... ....... Filed Map ............ Lot .................. .... ............... ~ppiican~ ............................. Underwriters Approval ........... Planning Board Approval ................. Request for: Temporary Certificate ..... Fee Submitted: S f~. .................... ...... Final Certicate......~..... \ -~i;-~ -=---,,o.,--.,.'-. :'~ ,..~,.,,~ .51 ,.~. /, R It n/, r ~~ o~.,.. ~o,.,, ..4 ~c / ~~. ? I,/,-/d'~ /I .~ ., ~'"" ~ / ,'/ ,f. I I.? /"'" LOT_- KRAUSE: LAND SUFtVI='¥ORS ~ MAI'OF. ~/'" o ~ ~ ~' t~Jj." N. ¥.~.. LI(:. Stile I N.¥.I. LIe. 4~74~ J ~,^i,,,.o,o_.-,:-.,,.,,,..,...~,.., r,.,~ ~..,.,,,,,,,' ' ~'~-o~__~.....,,.. I -,,. '""' '""=','.'*,..,-,=.4 .,~ ,~.,~,. d'q,,..:.,.,~.~,6 ./',-6,., ~ .~. -'.- ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE /~ ,,~ SOUTHOLD, N. Y. Examined ~ ~ ................ .,, ...... ; A ved. .............................. ........ Pe ,, No. Disapproved a/c ............................................................................................. APPLICATION FOR BUILDING PERMI'~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 POrt of thie application. 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 permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building sh~ll be occupied or used in whole or in part for any p~ll>ose wl~atever until a Certificate of Occupancy shall hove been granted by the Building Inspector. 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 Sauthold, 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, budding code, housing cod~ end regulations. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~..~....,~..~..~....~...:i......~..........~.../~....~?.~..,~... .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will he done. Map No.: ........................................ Lot No.: ........................ Street and Number .................................................... .../.....::..~ ................................ Munlc~puhty . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... ..~....~..~..~..~.....~..-~/..~....~. .......... .T. ...... .~....,~.....~...~....~/..~....'~. ................................. b. Intended use and occupancy ........ ..~.../'c....?/.~.. ............... , ....... .--.........~'~.......~:g.~_..~...~ .......................................... 10. 11. 12 13. Nature of work (check which applicable): New Building .................. Addition J" Alterotion Repair .................. Removal .......... Demolition .................. Other Work (Describe) ........................................ Estimated Cost ............... ~"~.~. .................................. Fee ..~.... ................................................................................ (to be paid on filing this application) If dwelling, number of dwelling units ..... ~..Nurnber of dwelling units on each floor ............................ If garage, number of cors ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with olterations or additions: Front ................................... Rear ............................ Depth ................................ Height ................. ..~...-Nul~ber 'of Stories ......... /~e~ ' ~" Dimensions o~. entire new construction: Front ................. ... ................ Rear ............................ epth ........................ Height .....?. ............. ~l~r~er of Stories ................ .~./..~.. ........................................................................................ / P, ear / ~(~ De th Size of lot: Front ..: ............................................................ P .............................. Date of Purchase ........................................................ Nol~of Former Owner ............................................. ;~. ........ Zone or u~e, di~trJct in which premises are situated .......... ~ ............................. ~.., ...................................................... Do~s' Drop':o~6d constructiOn violate any zoning law, ordinance or rgg.ulet'io~ ..'~..:~...~....{~...: .................... ; ................ Nar~'e of Owner of premises ?.:.......~..'.:~.~....~...~.. ............. Address ............................................ ~-none No .......... ;; ......... Narr~ of Architect ......................... ..~'..~....~....~-'. ............... Address ............... ,,~',~'~...~...~.. ................ Phone No ..................... Name' Of Contractor ........................ ..~...~...~....~-.~.. ............. Address ................. ~,~...~.....~.. ............ Phone No ..................... PLOT DIAGRAM Locate clearly~ a~d distinctly all buildings, whether existing Qr,pr. eposed, and indicate ~11 set-bock cJirnq~s!ons from property lines. Give street and block number or description according to deed, and show street names 'tied indicate whether interior or corner lot. .,~_ - STATE OF couN ........ ~'~...~...~.~....~.~ ............................................ be,rig duly sworn, d&poses and says thor he is the applicant (Name of individual signing c~olicatio_n) · , h " above named. He's t · .............................................................................. ,~.....~ ................................................................. (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 contoined in this application are true to the best of his knowledge and belief; and that the work will be performe~the manner set forth in the application filed/~herewith. / Sworn to before me this ...........-- dayof ........ .................. · NS" - .~ ............ g'"".': ....................................