Loading...
HomeMy WebLinkAbout10967-zFOPaXi NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19946 Date JUNE 5, 1991 THIS CERTIFIES that the building. ADDITION Location of Property 6760 PECONIC BAY BLVD. House No. Street County Tax Map No. 1000 Section t26 Block i1 subdivision Filed Map No. LAUREL ~ N. Y. Hamlet Lot 3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 6~ 1980 pursuant to which Building Permit No. 10967-Z dated NOVEMBER 13~ 1980 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO, PLUMBERS CERTIFICATION DATED WILLIAM & DOROTHY GRANNEMAN N-515922 - APRIL 9~ 1981 // ~uilding Inspector Rev. 1/81 TOWN OF SOU, THQLD BUILDING D~P~RTMEh~~ TOWN'HALL i SOUTH'OLD, N~ Y. BUILDING p, ERJ~iTil (THIS pERMIT MUST BE K.SPT ON THE PP,~:~I$~S uNTIL ~ULL COMPLETION OF THE WORK AUTHOR(ZED) ;' N©. ~0967 Z D*te ~ ~ Per~isslofi is hereby granted to: :'~ ......... .......... ~o..~.~.~.~c~...:.~.x.~.z~ ~...~..: ...... ~.~..=..~;~...&.~ ~ at premises located at ..................................................... ~ , ~ :: ~ , Couhty T~x Map No. 1000 Section ../....~.(.: ........ ;. Block i....~.(. ............ !Lot No, ;..g.q.~. .......... pu~s~ant to application dated .......~....~..~ ........;.~'~;...~.........!;... i...:, 19~,, and approved by the BL~il~ing Ihspector. ~e~ ~ ...... .~ ............ nspect Rev, 6/30/80 , ~ , Form No. 6 TOWN OF SOUTIIOLD 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 contaios 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 archiuect or engineer responsible for the building. 6. Submi[ 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. ~ 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 Building - $i00.00 3. Copy of Certificate of Occupancy - $5,00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Connnercial $15.00 ate ...................... ew Construction ........... Old Or Pre-existing Building. .~... ocation of Property.~.~..~. ......................... i, ......... ~ ......... ~ ~.~. .......... ltouse No. Street Hamlet ewer or Owners of Property ...... ounty Tax Map No i000, Section...~.~.~ ..... Block ...... ~f ......... ? . ~bdivision .......... . ....... Filed Map ............ Lot.~.. ~rmit N°L~f~ ~ ' iii~JlJ'~'~m~il//~/~O A ' ~/zr~ ~ ~'~'~ff~'~r~-- .......... · .¥.'../ ........ pp±icant ....... fl! ........... ~ ......... App App 1 ~alth Dept. royal .................... Underwriters rove ..................... '.arming Board Approval ................ .. ... .. . ~quest for: Temporary Certificate ........... Final Certicate..~.~... Submitted: ................... I tq; ........................ ~ ~LICANT i,' FI.ELD~NSPECTION FOUNDAT ION ( ~ s t ] FOUNDATION (2nd) ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL COMMENTS ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~NAL // DATE ~-~/~,// INSPECTOR ~~-~~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING ~EPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ~..~...~.../..? .... , 1~... Permit No. ~.~. ~..~. ~..~. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.../'~ .~.~'.¢ ....... 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this appli- cation. 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. (Signature of appl'.e~fit, or name, if a corporation) __ __-~OM' '~ ,~-- (Mailing address of applicant) /'" State whether applicant is owner, les~e, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ............................................................. Name of owner of premises Pd.}.//i?~..~.. ~...~'...D..,? .r.o. ~ .¢.:..~?.?~...~..~'7~.....~.. ............................. /(as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. /.~//.. ................... Plumber's License No.. 2).o. ~./77 ............... Other Trade's License No..~.c.]..~.~.~?.~?.~ .~. :'. ..... 1. Location of land on which proposed work will be done....~:e..c.0..~.;..c../.~..~../~.../.~Sd .................... © House Number Street Hamlet County Tax Map No. 1000 Section .../.?~..~. ........... Block .... .d(' ............ Lot.../~.....'~. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~stmg use and occupancy ......... ~: .'~....~. ............... ./ ! 10. 11. 12. 13. 1~. ¥ Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remloval . . ......... Demolition .............. Other Work ............... ,~ ' ~ (D ipti ) ; escr on . Estimated Cost.. o d: ...... ; Fee (to be paid on filing this application) If dwelling, number of dwelling units / · Number of dwelling units on each floor If garage, number of cars ~ . ................................................................ If business, commercial or mix0d 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 alterations or additions: Front ................. Rear .................. Depth ................. i... Height Number of Stories . .. Dimenmons of entire new construction: Front . Rear .. . Depth .. Height ............... Nur0ber of Stories ........................................................ Size of lot: Front .......... ............ Rear ...................... Depth ...................... Date of Purchase .......... : ................... ; Name of Former Owner ............................. Zone 6r use district in which premises are mtuated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........ .................... Will excess fill be removed from premises: Yes No Name o f Owner of premises imf. ,.~t J~.,.%. ~. ~..~., .~¢'.. WA~dress . .M~/t~r~. t. ~./. ........ Phone No. ~.~. ~: .~g~.~../.... Name of Architect . o2: .~.r.'~A''. .%%v?.~ ......... Address ....Zt'-~-, w..,~..] ....... Phone No. P-.£~..~. ~t~. ~ / .... Name of Contractor ~..e.~. ~. ~.' T..e/... 'OD..~?. '& ....... Address .Z~.&;9'. t'. T.~..c/.<. ....Phone No. ¢.~. ~.-~. 4.~.-~ .... PLOT DIAGRAM Locate clearly and distinctly ali 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. NOTARY PUBLIC, State or New York No~ 52.4524771 Qualified' {n Suftolk County Commission ~xplres March 30, I98~:~ STATE OF NEW YORK. , COUNTY OF .... .~.q .//d~' ~ .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above name~d. He is the ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file ~is application; that M1 statements cont~ned M this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~n4r set for~ M the application filed therewith. Sworn to before me this ............... '/: ....... day o~ ........ 19~ , ............. (Sigmt~e of applicant)'