Loading...
HomeMy WebLinkAbout9175-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23035 Date JUNE 13, 1994 THIS CERTIFIES that the building. Location of Property 405 PIERCE DRIVE County Tax Map No. 1000 Section 136 Subdivision ADDITIONS Block Filed Map No. CUT~HOGUE, N.Y. Street Hamlet Lot 7.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 8, 1977 pursuant to which Building Permit No. 9175-Z dated APRIL S, 1977 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 TWO CAR GARAGE & DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to (owners) of the aforesaid building, SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED EBWARD & JOAN HINDERMANN N/a N-312721 - MAY 5, 1994 N/A 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? 9175 Z Permission is hereby granted to: ........ ~.~.~:.....~ ~,~...~F:.: ............. ......... ~1~.~~.~.~....:..~.. ...... · ~.~;j;....;....;~.~Z ............................ z .................................................. at premises located at .........~(:'~ ....... '"~ .............. ~:'"~' ......... ZD ........................................................ . ~.~ ~ ... . . . ~ ~ . . . . . ~ : ~. ~ ~: ~c . . ] JJ~¢ : ~ : f :~ ...... pursuant to apphcat,on dated ...~......~.~C.~....~ ............. , 19.~ and approved by the Building Inspector. .............. Buildin~ In~ector 765~[802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ? IN~U~LATION~ FRAMING [ ~ FINAL DATE ~/~~/~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 11,85077 BUREAU OF ELECTRICITY ~--- B5 JOHN STREET NEW YORK NEW ~ORK 1OO31B Date H~W ~5 ~ ~ g94 Application No. on file o~y the ~c trical equipment ~ ~serib~ bs~w a~ int~uced by t~ ~ppli~nt ~med on the a~ve application number in the prorates of EDW~D ~, HINDEf~N, 405 in the foltowing locatlo.; ~ Basement ~ Ist FL ~ 2nd FL G~/A~iC/O[~? Section Bilk Lot APRIL 28,1,994 ~s exami.ed on and found t0 be in compliamce with the N~onal Elect~cal Code. ~T K.W, O1[ H P GAS ~,P ~T NO. AW.G, SPECIALREC'PT rlME~CLOCK$ BELL~J jUNITHEATERS MULTI-OUTLET DIMMRRS SERVI~ DI~ONNECT ~. OF S R V I C E ~ ~wo, NO O~.~U',~S A.W.O DEFECT~3 REM.~]I) A~3 PER ROSLAK ELECTRIC Lie, #3677-E P.O~ BOX 164 j~ CUT ~HOG~, NY, 1t93o GENEIIAL MANA~RR J~ This ce~ificote must not be altered in any manner return to the office of ~he ~ard i{ incbrrect nspect~rs may be idenfif ed by the r credent a s ~O~Y FOR'BUILDING DEP~RTMENT. THIS CORY i ~QT~E;~[TERED iN ANY MANNER Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 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 b~ilding, 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. Bo 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 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-existing Buildinz - $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 ~i5.00 / ............................ New Construction ........... Old Or Pre-existing 'lding .............. ... Location of Property ...... --~' .,.~:~. ,~. p,.- ......................... ~ .......... House No. Street Hamlet Onwer or Owners of Property...~.f~.~.~..~...~.~Y~..4~... i ....................... County Tax Map No 1000, Section ......... Block ............. Lot.© " S nb d iv i s ion ~F~ ~-Y~. ............... F~led Map ........ ~.7 L o t. ~. ~.~ ~.~.~ .~.~r .~/. ~.. Permit No...~ ~ ~...~. .... Date Of Permit...~.Z.~/~.7 .... Xpplican~~. '/.~..~..~.~. ~ Health Dept Approval ~/./~ . Underwriters Approval ........... Planning Board Approval...~ ............... Request for: Temporary Certificate ......... .. Final Certi~te./...~.. ..... Fee Submztted. $.~'~. ...................... 'r'~C, / ....... .y y .............................. Co -D30 3 ..s,'·. lt~O~ NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN ~LERK'S OFFIGE ~UTHOLD, N, Y. ........ ~v~ ........................................ , ~ ........~ ~o .............................. ~a~oved ~/~ ....................... '.~Z'. ............. ~ ................................................... .................... {Buildin~ App.co.on ........... APPLICATION FOR nUILDING DERMITDote ...~.~, ~/2~.,~., (~. -]9..~..Z. ~ INSTRUCTIONS ! o. This application must be completely filled Jn by typewriter o¢ in ink and submitted Jn triplicate to the Building~ Inspector, with 3 sete of plans, accurat~ 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 giving a detailed description of layout ofproperty must be drawn on the d ogrom which is part of this application c. The work covered by th s app cat on may not be commenced before issuance,of Building Perm t. ' 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~ sheil 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~9 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or~j Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heroin described. 'The applicant agrees to comply with all applicable laws, ordinances, ,~uJlding code, housing code, and regulations, and tog admit authorized inspectors on premises and in buildings for nece~'~'a~/y,inspections. / (Address of applicant) ~/ //' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ...~.~,¢~'.,~'....~.~~,~,~d,~l~.'~ ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) B.,der's License No. Plumber's License No ................................................. Electrician's License No. /--~?...~...~.~...~::X',~-'2-.,~X~,. Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No~:~,~'~,~. Lot Street and Number ..... .-~......~....O....~...~........~../.~...,(~.~,4~...~./~ ....................... ~ ................... .~.l.~..d.~.'~(.~.~..~.~_....~.... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............................ b. Intended use and occuponcy ,,,,,~(~,(2~.~. ........ (JfU.,'~ ...... /~./J,~.i..~/.~...~... ......... 3. Nature of work (check which appliceble): New Buifd,ng,. ................. Additi~;~r~'.~:~...~..~...?,~... Alteration ................ Repair .................. Remova~ .................. Demolition Other~work'-~A~:.,,~.. ..................................... 4. Estimated Cast ............................. ..~...,,~,....~ .......... 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 .................. ~14~..~....~ ..................................................................................................... '6. If business, commercial or mixed occupancy, specify ,nature and extent of each type of use ...... ~ ............... 7. Dimensionsco~f existing structures, if any: Front ........~....~.....Q. ....... Rear ......... ~..:.(~ ........ Depth ~,,~.~'....~.lJ~ ..... Height ...!..~........Q ....... Number of Stories ...........Q...~,.~. .......................................................................................... Dimensions of same structure with alterations or additions: Front .... ~...~....'::...Q~. .............. Rear ......... ,.~.,~].--'..O .... 8. Dimensions of entire new construction: Front ...... ~...~.....,..~. .......... Rear ...~..~..':.0.?. ....... Depth ..~.~....:Ci ..... 9. Size of lot: Front ......... ........... ...... Rear ..../...~.~.?.....~.....O.....:z~....,~,.. Depth ./.../.,..~.....~ ........... 11. Zone or u,e district in ~/hich prernises are situated ............. .,A,.. ................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .... /~...~. ......................................... 13. Will lot be regraded .....~'..~.~t~ ............ Will excess fill be removed from premises: ~L~'~), Yes ( ) No Nome of Contractor ....~...~,..I~......:T.~.-..'.~... ........... ............ Address ................................ Phone No ....................... PLOT DIAGRAM Locate cle0rly 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 corner lot "~. ~. ~. STATE OF NEW Y, ORI~,,/ ,~/7 ~ S S COUNTY, OF~~"';" J, ' ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing cataract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authdrized to perform or have performed the said work and to make and file th s application; that all statements contained n this app c?io~,)e true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the a~tlon filed therewith., Sworn to ~ore me this . ~ . r / ~) / ' . ~ JUDITH T. TERRY ~ ',,., ' [~lg~ature aT appl:cant) Not~ public, State of New York , ,, ~, 52-034~963 Suffoik 'I