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HomeMy WebLinkAbout10804-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OC~JPANCY No Z-23268 Date OCTOBER 7, 1994 THIS CERTIFIES that the building ADDITION Location of Property 375 GOOSE CREEK LAN~ EXT. House No. Street County Tax Map NO. 1000 Section 78 Block 8 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 20 Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 24, 1980 pursuant to which Building Permit No. 10804-Z dated J%FLY 29, 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 GARAGE ADDITION TO EXISTING ONE F~ILY 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 JOSEPH & JULIA VIDDLICH H-042888 - OCTOBER 4, 1994 ding Inspector Rev. 1/81 (THIS PERMIT MUST BE KEPT ON '~H,E PRE/~IS~S COMPLETION OF THE WORK AUTHORIZED) N°. 10804 Z rate ........... UNTIL FULL Permission is hereby granted to: ~0 ........ ~ ................ ~ ......... ' ', ........................ ............................................................... , ~. at premises ~ocatea at ...... ~. .................. ~ ................................... · ............... ,, ................................... Tax Ma No 1000 Sect on Coun~ p . ~ · . ................. .%':'~'~k~.~ .~,~.~ ............... '-~L°tan-aN° ......................... roved b the pgmUOnt to opp cation dated ..............................~.,.: ......... ;... ~;. .... lY,....f.., 0 PP Y Building Inspector. ~, ........ L~..~. : ~ . 'Sullding~l~tor ~. IIL~G. DEPT, '~ ~ OF $OUTHOLD. ..... Form No. 6 TO[~N OF SOUTHOLD BUILDING DEPARTMENT TOWN }[ALL 765-1802 ~PLICATION FOR CERTIFICATE OF OCCUPANCY A. 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. B. 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 I. 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 Buildin~ - $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 .................. New Construction...~ ...... Old Or Pre-existing Building ................. Location of Pronert,,.~7~ House No. Street Hamlet 0Dwer or Owners of Property.~.~[.~. ~..~.~.. ~.l,~.%J ....... County Tax Map No lO00, Section.. ~... Block. .<~. ..... Lot =~Q .~. ~Subdivision ............................... Filed Map ............ Lot ...................... .............. Applicant ............................. [ealth . Approval ....................... Underwriters Approval ...................... Dept . .. 'lanning Board Approval ............... <equest for: Temporary Certificate .... Final Certicate ...... ee Submitted: $...~.~ .................... s ( .................... ~ ' A PLICANT~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ao~ ~ ~(~;~] 9 BUREAU OF ELECTRICITY ~ fY~'"Y~ '[9~ JOHN STREET, NEW YORK, NEW YORK 10038 THI~ CERTIFIE~ THAT o~ly t~ e~tr~ equlp~t ~ ~scri~d be~o~ ~ i~tr~uc~ by 1~ oppJlca~t ~m~ on the a~ve application number i~ t~ prorates o~ n thefollowlng location; ~ Bmsement ~ 1st Fl. ~ 2nd FI. (¢~/OIVI* ,~ection Bilk Lot ~sexamlnedon {~}J }:IT}ii'II }~ R 29,1994 and found W be in compli~ce with the Na~onal Elect~cal Code. SERVIC~ DISCONNECT NO. OF ( _ $ E R V -. C -- A~T A~P TYPE .~.l~[j'' j 1 .~ 2W 1 .~ 3W 3.3W 3 .~ 4W NO Oi~ERCC~COND OF '~C~ND NO OF HItEG ~[~O ~NO OF NEUTRAL${ O~U~AL / l OTHER APPARATUS- Per ~ ~his ~ifltol~ m~s~ no~ b~ ~lt~r~d in ony man~r r~t~rn ~o th~ ofh~ of *ho Board d meOrr~e~ Insp~rs m~y bo d~aff'~d by ~h~'r COPY FOR BUILDING DEPARTMEN~ THIS COPY OF CER~$CATE-MOS~T BEA~ED IN ANY MANNER / [ ] FOUNDATION~,ST [ ] ROUGH PLBG. / [..~ F'OUNDATION ZND [ ] INSULATION DATE 765-;[802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ .] INS~TION~ FRAMING ~-~]"FI NAL REMARKS'- / DATE Town Hall, 53095 Mare Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD September 26, 1994 Mr. & Mrs. Joseph Vidulich P.O. Box 1348 Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file. The check is (outdated/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 10804-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Ai") DITIOIx. IAL (~D~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 .~ ./, ~.~ ~ TEL.: 765-1803 Examined ...... x~o~.~..'.., 19... ............................... (Building Inspector) Application No .................. APPLICATION FOR BUILDING PERMIT /') ~ .... ,19 INSTRUCTIONS t/ a. Th~s apphcation must be completely filled in by typewriter or in ~nk 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 drawn on the diagram which is part of this appli- cation. c. The work covered by this apphcat~on 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. (Sigrl~tu~ of a. pp~licant, or name, if a corporation) .. aW..ehg ¢ ..... (Mailing address of apphcant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. 0.. ................................................... Name of owner of premises . .'.~..0.~..~.e./'P....~..~..~...~.[~tr~ .... .~.. !.,Q .[2~..Lr'. t..C../.~. ................... (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 ............. {~.~.b~j..~. (.~.. Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done, .................... ; ............................. House Number ~treet Hamlet County Tax Map No. 1000 Section ...... 7..~.. ..... Block ......... ~ ...... Lot .... .~.~. ......... Subdivision .................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... /. ~..~_. r.r..~ .: ................................... b. Intended use and occupancy ..... ~.'~. }~ ~~~. :~.~.~.~.0~.ct,? ............. :~ Nature of work (check which applicable): New Building .......... Addition Y.. .... Altera~jon ....... ~_~. Repair .............. Removal .............. Demolition ....... ---  i 'Other Work .C'~-z~.~t~/~. ~.. ~'2.. (Description) oo { 4. Estimated Cost ..... ' ......................... Fee .................................... (to be paid on ~ing this application) 5. If'dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, nm~nber of cars ..... ; .................................................................. 6. If business, commercial or mixedl 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 .................... i. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 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 No 14. Name of Owner of premises ...' ................. Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ 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 corner lot. STATE OF NE COUNTY OF. ~/~.. './/fZ..:. .... N/ / -/~. ~'~f~' '~'"~'~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~e is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work ~d to m~e and file this application; that all statements contained M this application are true to the best of his knowledge and belief; and that the work will be perfomed in the manner set forth M the application filed therewith. Swam to before me this ........... .... dayof ..... Not~ ~c ... ~5 ...~.~ ....... ~ff.. ~ ~ nty ~ ~lZhB~H ANN NEVILLE .?]. ......................... NOTARY PUmC,St,te p~?r~ (Signature of applicant) go. 52,812~50, .Suf~tl Term Expires M~rch~O719~ ~, ,: TE ' H.D. KEF. , ' ' . . Th~ sewage ~dlsposal and w~t~r suppl " .~ ' feel !1%105 for thlm locnt/on~have b~en - , . - ,: . <: :,..) .-. . ~:.'. ,, .: ,; ...... :~ ~ -: .. :,:--; :-' . . .,..- .. . .... ..... .... ,..,.-:. .~.:., . . . · . [ ~ ~ .' .... -.' ...: . - . . . ..:~.~ ~¢ ~ 'i.~ '.. ..... . :. ,. . - .....,,.~ ~t~ ~ ~ ..:, -. "· ~ 'g~l. ' . - _[ ~. - 5ouTNoLD 5A¥[~(-,,$ [$AI~,K 50UILIOLD 60UIMOLD r: 8Cl:~JPANC¥ OR USE IS UNLAWFUL WITHOUT CERTiFiCATE · OCCUPANCY "AEeration of this by ~n Architect or Licensed Profes, signal E~gJ~eer, is illegal". · ~- ~cfi,3a 7209, Subdivision 2, N, Y. State Education Law. AP,PRqVED AS NOTED DATE: 7f b-~B'P' :~~ FEE: ( BY: "~ Z~T NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE C~PLFTE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REOHIREMENTS OF THE N Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERROR~ Architect and Engineer's Seal ned Signature ~n¥ ~0~d for initial use of dr3w!n~ Ch~n=,es, alterations or cut A;ch~tec~ or Engineer's ~proval voids Seal and Signature on ~e.