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HomeMy WebLinkAbout8777-zFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF O(~UPANCY No Z-25317 Date OCTOBER 17, 1997 THIS CERTIFIES that the building. DWELLING Location of Property 965 MILL C~EEK DRIVE House No. Street County Tax Map No. 1000 Section 135 Block 3 Subdivision Filed Map No. BOUTHOLD, N.Y. Hamlet Lot 38 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated J%VLy 3, 1976 ~ursuant to which Building Permit No. 8777-Z dated J~-LY 3, 1976 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 ONE FAMILY DWELLING WITH ATTACHED DECK * UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED THIS UPDATES CO Z-9119 DATED J~LY 20, 1978 The certificate is issued to '£~LMA JOHNSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 6-SO-46-JULY 20, 1978 N-360767 N/A Rev. 1/81 ding Inspector lvO~,M NO. 4 TOWN OF SOUTHOLD BUILBING DEPARTI~,NT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupency No... Z~t139 .... Date ......ffu].y .... 20 ........... , 19..7.8 THIS CERTIFIES that the building located at . .965. Mill..Creek .Dr, .....Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .....Ju~y. N .......... , 19.7~ pursuant to which Building Permit No ....8.~.7Z dated .....Ju~y..~ ........... , 19..7.6, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Private. C~e. Family. DwellL-~ ............................... The certificate is issued to ........ .V&rg~.nta. ~c~e¢~er ............................ (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ... 6-S0--/~6 ..... JuXy..20,..197/~ ... UNDERWRITERS CERTIFICATE No .... .N3607/~7 ................................ HOUSE NUMBER ... 9/;5 ....... Street ........//~.12..Creek .Dx' ................... ............................................... Sou.~,hold~,..New..York ........... ...... .... ....... Building Inspector FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8777 Z Date ......................... ~ .......................... , Permission is hereby granted to: b~ild new one famlll~ dwelling at premises located at S/S Mill C~eek Drive Southold pursuant to application dated .......................... .,T..~.....~.O.. .......... , 19..~..~.., and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of all budd,ngs, property lines, streets, and unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage dispcsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Mulhple Residences and similar buildings and installations, a cerhficate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buddings and "pre-existing" land uses: l. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspechon of buildings or premises, or other pertinent in- formation required to prepare a certificate. ' C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ..... ~ .......... Old or Pre-exmting Building ............................ V~cant Lend ............................ Subdivision ................................................................ Lot No ............. Block. No .......... ;,. House No ............. Health Dept. Approval ..~.~.~.~.,: .....~.~..~....Labor Dept. Approval Underwriters Approval y~.~. .......... ~y/_z~.~.~;..~,.,..Planning Board Approyal ........................................ / Request For Temporary Certificate ........................................ Final Cert f cate ....~...... .............................. Fee Submitted $ .................................... Construction on above described building and permit meets all applicable .... ...... Sworn to before me this ctary ........... EL)ZAB~H ANN N~IL~ NOTARY ~BLIC. State of New York .o. 52-8125~0, Su~fo,k1~C~ Term ~plres March 30. codes and regulations, (stomp or seal) TOWN OF SOUTHOLD TOWN ~LL 765-1802 A~'PLICATION 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 wafer 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 Flanning Board Approval of completed site plan re~Uirements. 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 I. Certificate of Occupancy - New dwelling $25.00, Additionsl to dwelling Alterations to dwelling $25.00, Swimming pool $25.00, Acc!essory building $25.00, Additions tp accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ......... ff2 ...................... New Construction ........... Old Or Pre~existing Building .... ~ ......... 965 Mill Creek Driv~ Southold Location of Property .............................................. I ........................... House No. Street / ~a~tlet Thelma Johnson Onwer or Owners of Property ....................................... ] ........................... 135 00 .' .Lot.. County Tax Map No 1000, Section ...... ' ..... Block .... 03.00 038.000 Subdivision .................................... Filed Map .......... I..Lot ...................... Permit No ................ Date Of Permit ................ Applicant..I ........................... Health Dept. Approval.' ......................... Underwriters Approv Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicat6..~. Fee Submitted: $..~q, PS ...................... Town Hall, 53095 Ma~n Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516} 765-1802 April 29, 1998 Dolores Alexander 965 Mill Creek Dr. Southold, New York OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD 11971 RE: Premises located at 965 Mill Creek Rd., Southold Suff. Co. Tax Map ~1000-135-3-38 Dear Ms. Alexander: It has been brought to the attention of the Building Department that a shed has been constructed without firstlobtaining a Building Permit. According to the Code of the Town of Southold, is required before any construction can be und, Please contact this office as soon as possible can be resolved. I thank you for your anticipated cooperation. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Edward Forrester Director of Code Enforcement a Building Permit ~rtaken. so this matter (Cert. Mail) EF/cs COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES July 21, 1976 MARY C. McLAUGHLIN, M,D., M.P.H. Mr. Alfred Goldsmith South Harbor Lane Southold, New York 11971 Dear Mr. Goldsmith: Re: Virginia Schector Property e/s Mill Creek Drive, Arshamomoque, Southold Town At the hearing held on April 27, 1976, in t.he office of the Suffolk County Department of Health Services, H. Lee Dennison Executive Office Building, Veterans Memorial Highway, Hauppaugel, New York, you had an opportunity to present your appeal of the department's ruling on the subject application. In accordance with the provisions of subdivision (c), Section ?, Article I of the Suffolk County Sanitary Code, the determination of t~e-Board of Review is as follows: ~ -Based on the information submitted that thi approved, subject to the following: 1. The applicant's sewaqe disposal system De a~inimum of 50 feet from the ordinary high water Pond and 65 feet from each of the wells located on t? application be be located so as to mark of Arshamomoque e abutting lots. 2. The applicant's well is to be located toward Mill Creek 1)ri~e at the maximum distance from the existing sewaoe disposal systems. 3. The applicant's well is to be driven t~rough the existing layer of clay to as deep a depth as possible while still obtaining potable water. Since the determination of the Board of ReView submitted to the Commissioner's office on July 16, 1976, has not 6een reversed or modified by her, it is therefore deemed to be the determination of the Commissioner. i Very truly yours,. H.W. Davids, P.E.i Chief Bureau of Environmental Health HWP/gph cc/Board of Review File '/Mr. Ernest Robinson ~ Southold (T) Bldg. Dept. ' V}I:ZGIN]A ~CNECTEI~, FOB,M NO, TOWN CLERK'S Dote .................... ............. INSTRUCTIONS a. 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 lot and of buildings on premises, relat onsh p to adjo ning premises or public streets or 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. APPLI~^TION 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~j admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of oppii~nt, '~r na~e, if a corporation) .................. ....... ............. .... (,~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... · ......... ............................................................ Name of owner of premises .. ~.(x~./. .~--~ If applicant is a corporate, signature of duly authorized officer. ........ ~'/(Name and title of corporate officer) ...... Builder's License No ..... /~..~......~../~.....-~.. ........ Electrician's License No. .. ~Z-- Other Zrade's License No ............................................... Location of land on which proposed work will be done. M~p No.: ........................................ Lot No ......................... Street and Numb~ .~-/~..~.~-~..~,~&9-~.-?. .................. ¢~'....~'~'~.~Jz~'J.~../~.~,~Z....Z.~.//./~...~... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ .~.~.~..~.~ ..... b. Intended use and occupancy ....... ~'..,.~..~).~--'/~.. ......................................... 3. Nature of work (check which applicable): New Building....r~.. ......... Addition .................. Alteration ....~...: ........ Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... 4. Estimated Cost ............~..~.~..~...~?.. .......................... Fee ~-~ ~ (Description) (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 ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~.~,.~ ................ Rear ......... :~...~..: .......... Depth .....~...~..' ............. ~ Height ....~'.~..~ ........ Number of Stories ....... ~..~ ......................................................................... ~). ............... ~ ...... 9. Size of lot: Front .......... ~.-.~.,.,~.~..: ............................. Rear ..... ~.~t~.:...~:.. ..................... Depth ,~......~T.......,~.7...o. ...... 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 (X) No 14. Name of Owner of premises ..~J.~-Z~'~/ ........ ~..~.~.¢/~"~... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~.~,~k~t.!.~....~./~..~....~.,.... Address ...~/.4~.~/~t ....... Phone No. ~h.~..?...'~..~..~ 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 a~d indicate whether interior or corner lot. STATE OF NEW v--~Rl~_.~n t ~-' COUNTY OF ..... ..~..t .¢- .!..~... :.,....~ ... f, ~ \' / ," .~~......~.~.~..t~.c:!. ................................ being duly sworn, deposes and says that he is the applicom (Name of individual signing contracf) above named. . He is the ........... ~.~.....~.~..F/:..~.~.~.~...~Z~.~ .................. ' ............................................................... (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. Sworn to before me this ........ ~.~..:J..... day of ................. ~.).Z~..~L,~., 19....?. -TT, '. ..... ............ .......... :5'"7 ......... · ............... )7 .......... ig ' 'a'gVE;g'g "g giigg ib' ............................. .o s~.~s~so, s~.o,~ coO_ CONSENT TO INSPECTION .. THELMA JOHNSON , . . , the undersigned, Owner(~) Name~) do(es) hereby state: That the unders~ned (is) (~a) the owner(x) of the premises in ~he Town of Southold located at 965 Mill Creek Drive~ S. ou.th.p.ld.,.. New York · which is shown and designated on the Suffolk County tax map as District 1000, Section 135 , Block 3 .., Lot 38 . That the unders~ned (has) ~1~ fined, 'or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: , . U_p. dated Certificate of 0ccuRa~cy. to ~u.c, lude the deck on the rear portion of the house which was constructed at the same time but omitted from Certificate of. Occupancy No. Z9119 dated July 20, 1978. That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described ,property, tncl.uding any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws. ordinances, rules and regulations of the Town of Southold. The unde.rsigned, in consenting to such inspections, do(es) so with the knowledge and understandin~ that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the law~, ordinances, rules or regulations of thee Town of Southold. ,' (signature) / / Thelma Jg~nson ..... (prin~ name) (siRnature) name)' '1