HomeMy WebLinkAbout7299-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCuumANCY
No Z-25333
Date OCTOBER 23, 1997
THIS CERTIFIES that the building
Location of Property 2205 DIEDRICKS RD.
House No.
County Tax Map No. 1000 Section 1E
Subdivision
ADDITION
ORIENT, NEW YO~K
Street
Block 3 Lot
Filed Map No. Lot No.
Hamlet
2
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 29, 1974 pursuant to which
Building Permit No. 7299-Z dated JUNE 3, 1974
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 GARAGE ADDITION WITH DECK ON TOP TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to BRAD HESS & ORS.
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N-424609 - J~LY 2, 1997
N/A
Rev. 1/81
FO~M NO. 2
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)
7299 Z
Date ......................... .~ ~[1,~R ....... _~ ........... , 19.~?..h:..
Permission is hereby granted to:
~..,.......~.z...~.~.o. ~.~...~.,...,..,. .....................................
7......~.s,.~..t,,~., ................................. ~~ ..................... ~'~.
...... Z ...... ; ........................... : ................................................ :'~ ................... ~
ut p 'ses ocated at ..~t.i~.t~.q.....J~J~...~d~t...~.~...~..~,{~ ...............................................
........................................ l~L~.1~t..~,~,, ...........................................................................................
pursuant to application dated ........................¥~.....2.c~ ............... , 19~.Lk..., and approved by the
Building Inspector.
Building Inspector[,
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPART~MENT
TOWN HALL
765-1802
Bette . Jeatme Town~n~d
29 Woodblaw A~nue
Stony Bnn~, NY 11790
APPLICATION FOR CERTIFICATE OF OCCUP.~MCY ~ ~P q ~/~
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. S.ubmit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
Vpre-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 dwelling $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-~xistinR Buildin~ - $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 ..... I.~ :. ~9. :.~-~· .......................
Location of Property.. ~..~ .......... -Di~I..~. ~ .............. G~-~ ~ ...........
House No. Street Ham]et
Onwer or O ers of Property. k Z.q . · ,.
County Z~ ~p No 1000, Seotion...l.~ ........ ~loc~....~-. .......... not..
Subdivision .................................... Filed Map ............ Lot ......................
~q~ ....... Applicant ~.~- ~ ~~
Permit No ............... Date Of Permit ......... ~ ...............
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Finai Certicate...~.......
Fee Submitted: $...~.:0~.. ..................
· ............
Examined
Approved
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
19.Z~. Permit No....?......~...Z..?......"~.... .....
App"ca.on No..Z..
APPLICATION FOR BUILDING PERMIT
....................... . ....
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of Iot and of buildings on premises, relationship to adjoining premises or public streets o~
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this 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 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 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 buildings for necessary inspections.
.............................
(Signatu~of a~pplicant, or name, if o corporation)
................................ ............................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Ou ut:
If applicant is a corporate, 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 ...............................................
Mc '
1. Location of land on whichproposed work will b~'done, p No.: ..............................Lot No ...............
Street and Number
Municipality
2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction:
a. Exisiting use and occupancy
b. Intended use and occupancy ~--~'c:~'o~-~ ~ ~)~--~-~C ..............
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration
Repair .................. Removal .................. Demolition .................... Other Work ~C.~.....~...~ ...............
4 / 0~ O 0 ~/,~.__,_~ (Description)
4. Estimated Cost Ce ..........................................................................................
(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 ......... I¢,,/!?./. ...................... Rear .......~../ .................
Depth ............. ;5...~. ............. Height.. .......... ~..Number of Stories..~..~..t....~.
8. Dimensions of entire new construction: Front ......... ../...'~... ................... Rear ........ ./....~.. ........ · ..... Depth ...~.....~. ...............
Height .................... Number of Stories ...... ~..~....~....~.-...E...?.....~.~.;..V'..,~..~.. .....................................................................
9. Size of lot: Front ......... /...~...~...'~...[ ................................ Rear ........ /...~...~.~.~ ..................... Depth ...../....~..~.../. ..............
10. Date of Purchase .............~'...T....~...?....~...~.~. .................. Name of Former Owner .../..~.~.,~..~........./~....~..~...~..,,,~/.J'.. ..............
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 ....~.....:..~...r.?..~.~,~.~.~....~..:....~.../.~ ....... Address ~..~..~T.4'...~...~..~k-.~..... Phone No. ~,/.Y..'.~...~.~.?.].~..~
.~~ ./VF,~U¢ ...~.:.?:.. Phone No .......................
Name of Architect /~..,l~ ................................. Address ............ .).~.~
Name of Contractor .................... /, .................................... Address Phone No .......................
PLOT DIAGRAM
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 comer lot.
(
STATE OF NEWMORK, , I ¢ c
COUNTY .CF .../~..~,.Z/~ .z. Z~../z....~...../. f ~. ~
/5.,
......................................................................................... being duly swam, deposes and says that he is the applicanl
(Name of individual signing contract~}
above named.
He i~ }he .................... .O....d.~..~?.~...~..'' .......................................................................................................................................
(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 and belief; and
that the work will be performed in the manner set fo~h in the application filed therewith.
....... ............. ............ ,