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HomeMy WebLinkAbout13053-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24915 Date MARCH 5, 1997 THIS CERTIFIES that the building ADDITION Location of Property 665 ~a/k/a 18) MIDDL~TON RD. GR~ENPORT, N.Y. House NO. Street Hamlet County Tax Map Ho. 1000 Section 48 Block 5 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 17, 1984 ~ursuant to which Building permit No. 13053-Z dated APRIL 18, 1984 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 FIBERGLASS ROOF OVER SCREENED DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS A~PLIED FOR. The certificate is issued to EILEEN KISKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A H-053930 - FEBRUARy 25, 1997 N/A //lding~ Inspector Rev. 1/81 I~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13053 Z Dote ..?. Permission is hereby granted to: ...... ................ ~~~":'"~':!! ....... ~.~...~..~.!.t ........ ~ ,o... ,__~,.. .................. .; ............................. .~ ............................ , ................ '1 ........ ~.~1.%..~.~ ........ ~......~~...~..~. .................................................. at premises located at ......~....~.....~.......~....~.~...~....~....'~....~ ............ ...~.~~ .............. cou.~ vo× Mop No. ,000 Sec,on ..~..~ ........... B,ock ....... .~. ........ Lot No ....... L.~ ........... pursuant to application doted ..... ~....L...~.. ....................... 19.~....~.,, and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 rasponsible 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 '!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 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-existin~ Buildinz - $i00.00 3. Copy of Certificate of Occupancy - · .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 March 3, 1997 Date New Construction ........... Old Or Pre-existing Building ................. Location of Property ..... ~. ~/g/~. J~).~P~%P~..R~..· House No. Street Hamlet EILEEN KISKI 0nwer or Owners of Property County Tax Map No 1000, Section...6D ......... Block...~ ........... Lot .... ~6 ................ Subdivision .................................... Filed Map ............ Lot ...................... Permit No..J3D53Z ........ Date Of Permit. ~.IB~B~ ........ Applicant..RP, BBO~I$EI~-$R~ ........... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate.3i~ Fee Submitted: $ .... .2.5 ...0.0 .............. ' ...... ~ .................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NY 10038 Date THIS CE;IFIES THAT o~y the el~tr~ ~ipme~t ~ ~eri~ be~w a~ intr~oc~ by t~ appl~ant ~med on the a~ve appl~ation number in the prem~es of in the following h)cation; was examined on · [~ B~,~m~,t [] ~,t Ft. [] 2nd FI. ©[J'l' Section Block and found to be in compliattce with the National Electrical Code. ~ECEPTACLES SWITCHES Lot FIXTURES OVENS EXMAUS~ FANS 4 OTHER NCANDE$CENT FLUGI~ESCE NT DRYERS MULTI.OUTLET SYSTEMS /,Ia. OF FEET OTHER APPARATUS: ¢ NO OF HI-LEG· NO OFNEUTRA[$ },ILl, N Iil'~l{J' C~I~INI, II~OR'I', ~Y, t t 944 ~RAL ~AGIR [his certificate must ~t ~e altered in any manner; return to the office of the ~ard if incorrect. Inspector~ may be identified by their credentials. COpY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE :MUST NOT BE ~LTERED ~IN ANY MANNER. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 8, 1997 Mrs. Eileen Kiski 665 Middleton Rd. Greenport, N.Y. 11944 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) XX No Underwriters Certificate on file. XX The check is (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 # 13053-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FIELD I N S F,~C T I~DN FOUNDATION FOUNDATIOU 2. ROUGH FRAME & PLUMBING 3. INSULATION PER STATE ENERGY C,ODE No YJ COMMENTS FINAL ADDITIONAL COMMENTS: TOWN OF $OUTIIOLD OI;FICH OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-~ ~02 This is to advise you that the job under building permit no. 13053Z issued to Bruno Kiski Jr on ~4/18/84 for ~ddition is completed and a final inspection has ( ) has not ( x ) been done. In order to complete this file, it is necessary that a Certificate of Occupaacy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00payoble to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. Plesse help us to clear up this mstter so that legal action does ~tot have to be taken. Thank you for yot~r prompt attention. Very truly you~, Victor Lessard Executive Administrator VL:gar cncl . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 , , TEL.: 76~1802 .......... ~a~3 ~ Approved . ! x~ , 192 ~.. Permit No. t .~. r ....... Disapproved a/c ..................................... ~ppiida0vn Nfl. ................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~../.7. .... 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 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 application lnay not be commenced before issuance of Building Permit. · d. Upon .approval of this application, the Building Inspector will issue a Building Permit to the applicaflt. 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 O¢capahcy 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 necessa~ inspections. / ~, - admit authorized inspectors on premises and in buildings for .... .r7 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. t~WN.~. ~ ........................... j3rev,vv .................. Name of owner of premises ..................................................... (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 ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............................................... ..... . ...... 4 ..... Oo tgr. o. ff . . . se ............ .W. .Oqe .................... House Number Street Hamlet ' c~ianty Tax Map No. 1000 Section . ..~../~..O. .......... Block .... ~.-'. · · ·: ..... .... Lot.. {.~. ............ Subdivision ................ (iq'a~) ................ Filed Map No. Lot 2. State existing use and ~ccupancy ~f premises and inten~ed use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy...'~-- ~/.2..~.~.1(~../~...'~. · .~- .~--. ............................................... b. Intended use and occupancy ................................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition ·. j ........... OtherWork ~.4~.O.*~.. ~.~.~;/.~, ~ 5 ~/ '-' t - (Description) 4. Estimated Cost .... .~. ...... ~ ........................ Fee.. ......... /~: ............... (to be paid on ~ this application) 5. If dwelling, number of dwelling ~nits ............... 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 ................... · ~ ' pth 7. Dimensions of existing structure~, if any Front ............... Rear .............. De ............ 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 ( .~. t Depth ./~;~./ Height ............... Number of Stories .................................................... 9. Size of lot: Front ........... ........... Rear ...................... Depth .................. 10. Date of Purchase ........... i .................. Name of Former Owner ......................... 11. Zone or use district in which premises are situated .................................................. 12. Does p~oposed 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 ...i ................. Address ................... Phone No ................ Name of Architect .......... ................. Address ................... Phone No ................ Name of Contractor ......... !..; .............. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from property iiaes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. - t A-" ,- ~ AS NO7ED NO~F~, '~(~C6-i'NG DEPARTMENT At 765.180~ 9 AM TO 4 PM FOR THE FOLI, 1. FOU~ATION ' TWo[REQUiRED STATE ~ ~3Y~ cou~¢~ - 9,q~'ST¢?cT~ MUST ....... X~,;CON~:[~T[O~..s~AL~2 ~.5[~ .......... being duly sworn, deposes ~d says that he is the applicant .......... ~ Co~ST~UCT~O~ ~ ~O~,cc ~,~ pcconNglBl. E FOR m is the ' ......................................................... ..... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file application; that all statements contorted ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~r set forth ~ the application filed therewith. Sworn to before me this .......... ........ .... .......... , 19~.~ No. 470ZSZS, Suffolk County lmm Ezp,c-s~amh 30,