Loading...
HomeMy WebLinkAbout11069-zPORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25695 Date: 05/01/98 THIS CERTIFIES that the building ADDITION Location of Property: 745 HAYWATERS ROAD (HOUSE NO.) (STREET} County Tax Map No. 473889 Section 111 Block 4 CUTCHOGUE (HAMLET) Lot 9.2 Subdivision Filed Map No. __Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 13, 1981 pursuant to which Building Permit No. 11069-Z dated MARCH 24, 1981 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 SCREENED ENCLOSED PATIO ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES E. & EVELYN M. REBMAN of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 FOI~ ~0. ~ TOWN OF SOUTHOLD TOWN HALL SOUTHOLD, N. Y. BUILDING F~ER~IT (THIS PERMIT MUST BE KEPT ON THE PP~EMI~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~1 0 {~ ~ Z Date ........ ~..~z~.~.~./.. ........ tl~..~... ........ , Permission is hereby granted to: ........... ~.~.~.~.~ .. £.,...../.C~? ~¢~........~. . . to ......... ~.~.~.-r. ~..~.Wc~. ~ ~. ....... ~. £. ~--~-~. ~.... ~. ~2z~c~.z~ .~....~.~..;~. ~ .................. ~L?Z'ZY..r..~.~.~.....r.~....~.---~.,:.~..~,,.~....~.~.,,~Z/.,'.",.~,;::__ .............. : ......................................... at premises located at ..Z.~...~../~.... ~./.~...~ ~... ~/...4z..: ............................... r.....~,.,.~ .................. County Tax Map No. 1000 Section , ///. Block ....... Lot No.~.~-~.~.£,~'.~z~ pursuant ;~o application dated ..~.~.e~lC./~......,/. ....................... , 19,~.'~.., and approved by the Building Inspector. Fee $.../...~.. ................ Building Inspector Rev. 6/30/80 Form No. 6 TOW OF SOOTHO= 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 fr~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. 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. 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 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 ate . ..................... Old or Pre- isting House-- -- No. ~ Street /Hamlet County Tax Map No , Section. . ock ............ Lot ............. Subdivision................ ................. ... Filer Map .......... .. Lot ...................... Permit N Dat Of Permit Applicant · Health Dept. Approval...~..%~.V~7.2 ............. Underwriters Approval..~..o~.~/.~./.~ ....... Planning Board Approval ........................ Request for: Temporary Certificate ........ Fee Submitted: $ ..... ~ .... ~- ........ · .: Final Certicate ........... APPLitCANT FOUNDATION (1st) FOUNDATZON (2nd) 2o ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE EN,ERGY cogE FZNAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] ROUGH PLBG. [ ] INS~L~TION [ ~'FINAL FIREPLACE & CHIMNEY ] FOUNDATION 1ST ] FOUNDATION 2ND ] FRAMING INSPECTOR , , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 ~isapproved a/c ..................................... (Bffilding Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. Date r'c_ I "g 19 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ;ation. c. The work covered by this application may not be commenced before issuance of Building Pevnit. d. Upon approval of this application, the Bnilding Inspector will issue a Building Permit to the applicant. Such permit ,hall 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 &all 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 'luilding 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. ['he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ;dmit authorized inspectors on premises and in buildings for necessar)f inspections. ./~..~,sa~4..c,.. a~.~.f,,~,u~4~.. :-:. ........... /' (Signature of applicant, or name, if a corporation) /)/ (Mailing address ofapph'caofft) * 3tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~ .l .~. ~. x..) .......................................................... qame of owner of premises .~.~'./.'~,~', 2~..~. · · .~.-'. ~'~..}(.z~.. ~. ,~.~.'9./Pdt,/~. .......................... (as on the tax roll or latest deed) ;f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ~./gd. ~'~/~ ............ Plumber's License No ......................... Electrician's License No. .. t~.-e, q. e~..c~ .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ~.4~f.--Ay~./ff./~'/~, .2~,e~./~../~/fi......~ff~:.6:f/3'~..~. ~.--~ ...... .......................... 7. ~ .-/f House Number Street Hamlet County Tax Map No. 1000 Section ..... tr././. ........ Block .....e~. 3:/. ......... Lot~..~..~...~..i~...~.~.. .... Subdivision--J.~. ~.~.~.~.../'~.<~ .~/~. ~.. ~.~..~p... ........ Filed ~ap No.../&4..-- '..~'L~t...?../.V. ....... '"' (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .g.~ ./.'/~A".~.. ~.~./. ¥t~,./.~/~;...,f?. ~.~...~./. ~V'~.-- ..................... b. Intended use and occupancy . .. O~fY-~q,~...k'~./..~¢~' .,Z~)-. ,~../.~¢.., ............................... 3. Nature of work (check whicl, applicable): New Building .......... Addition..g..-.r~.. .... Alteration l, Repair ............. Removal .............. Demolition .............. Other Work ............... ...~.~. ~.~,~ .~/.~.~. (Description) i Estimated Cost ................... Fe .a ~ ................ ¢ .... . ....... '": ~., (to be paid on f~ing this application) If dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixed 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 ...................... Height ........... ;, .......... Number of Stories .............. >. ..... Dimensions of entire new construction: Front.,./, .~.. ....... Rear ..... ~. ........ Depth .../.~. ..... Height ............... Number of Stories ....................................................... Size of lot: Front ...................... Rear ...................... Depth ..................... Date of Purchase ............................. Name of FOlmer Owner ..................... ; ...... Zone or use district in which premises are situated .................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..... /M~. ..................... Will lot be regraded ............................ Will excess fill be removed from premises; Yes No 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 ~operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. TATE OF NE)JC~'ORK, 'OUNTY OK.~ ...... ~'~ ......... ~. ~_~. ~.~ being duly sworn, deposes and (Name of~dividual signing contract) hove named. says that he is the applicant [e is the ~c~rT~. ' (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained, in this application are true to the best of his knowledge and belief; and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to before me this ........ /~-~rg ....... day of ..... '.~..F.)¢~c~ .... , 19 ~./. [otarv Public, ...... .~. ..... '-' "~...~.. County ........ , j~ ~LIZA~H AN~ N~lttE · · '~~'~ ' ~o. 52-81~850, ~uffolk COu~ Tem rx~/res ~arch 30, I~ 't A~:P~A~T SHM~L~ :? '~ 2 :T2 :: ' Tc~ FeO~,T L~U~ ¢tX4- ./~PPROVF'D ~$ :NOTED ~. NOTIFY BUILDING DEPAI~TMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS' L FO~)NDATION - ~NO REQUIRED ~E REQLJ[RE&"~NT~ OF T[~ ~AT~ CONSTRUCTION & CODES, NOT RESPO~f~E~' _,.~C4L~ .' I/4'~ I ~- 0 ' ZL,4M //4"= I'-0" /V~w %o ~K PL4g Dc4L =~ : of: i Y4"~l;o" SLAB OCCU; CV OR · I~ "TO k4ATCN //4 l/= /;O'l 4~42 14-I- O 'j / j4~4- 4~4~ APPR©~D AS 'N~TED DATE: ~./~.Z ~,,/~ B p. '.-~ ~ F~E:~ ~ ~Y: NOTi~ BUlLiNG DEPARtmeNT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING 1. FOUNDATIOH - TWO REQUIREO FOR POURED CONCDCTE 2. ROUGH - FPA~,ff'G & PLUMBING 3. INSULAT[ 2.R 4. E[NAL - c .... ~" ,;'~N MUST ALL CONS'JRUC~3}I SHA!.L MEE~ ffHE REQUIREMEN-rs STATE CONSTRUCT[ON & CODES. NOT RESPONSIBLE 'I PLA/4 15/9 5c4te: '/4"= 1'- o"