HomeMy WebLinkAbout16316-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southoid, N.Y.
Certificate Of Occupancy
No. Z- 170 0
Datc Sune 20, 1988
RENOVATION
THIS CERTIFIES that the building ................................................
· 2935 Peconic Lane Peconic, N.Y.
Location of Property ..............................
House NO. Street' ........................... h~r~iel
County Tax Map No. 1000 Section . , O..7.4 ....... Block . . .0.~ .......... Lot 0 1/4 '. 2
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
August: 4, 1987 pursuant to whicb Building Permit No. 16316 g
dated............................Augus t .5, 1987 was issued, and conforms to all of the requirements
of the applicable provisions of the law. Tbe occupancy for which this certificate is issued is .........
RENOVATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
....... ;,hi/~,~b' '¥6' ~'c'£Ob~' '~k' 'i6',,'2'~'/~'~ ...................................
The certificate is issued toEDWARD DART
..................... ?o¥.~;, '~=I~g~,~'X'~IO'X .....................
of the aforesaid building.
Suffolk County Department of Health Approva~ .......... .N/.A. ............................
UNDERWRITERS CERTIFICATE NO .......... .v3.~. p.!u.q' 7..6./. 6. ./.a.a. ....................
PLUMBERS CERTIFICATION DATED: May 31, 1988-Henry J. Smith & Son, Inc.
Rev. 1/81
FOR~ NO. O
TOWN OF SO~JTHOLD
BUILDING DEPARTMI~NT
TOWN HALL
SOUTHOLD, N. Y.
N_O
SmLmN~
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date .... ~,..~.......~..'~. ................ , 19'~
16316 z ~ .......
Permission is hereby granted to:
~ :.~..~~....~...~:.....n~.~ ............ .
~ ................................. ~"z'7~ ............ 7'7'? ........... ~ ............... ; ...............................
at premises I~ated at .v~ /..;~:.,.,.~...~...~.~.~....~Z~~ ............................
County Tax Map No. 1000 Sect~en~-....(~..~..~. ........ Block .......~..!i/ .., Lot No....l V ~.....~... ....
pursuant to application dated .~..~....~......~. ...................... , 19..~...~., and approved by the
Building Inspector.
Fee
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
$outhold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec-
tor with the following; for new buiJdings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic featu res.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa*
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~2operty showing all property lines, streets, buildings and unusua~ natural or
topographic features.
2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3.Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
5,oo
C. Fees: Additions $25.00 POOLS $25.00
1. Certificate of occupancy New Dwelling. $25.Q0, Accessory ,$]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50 .. 00
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 //
o.oo
5.updated C.O. $ 50.00 Date .............
Newcons t~r'uc t~±on ...... Old or Pro-existing Buildin ............ Vacant Land .............
Location of Property
House No. ~ ~ Street Ham/et
Owner or Owners of Property ..............................................
County Tax Map No. 1000 Section ..... ~-__.~-_ .... Block .......... Lot ..... J .........
Subdivision ............................. ;...Filed Map No ........... Lot No .............. /
Permit No..I.b.~'~[.~.. Date of Permit... Applicant .~{¢~. (~f~-~. ?....~ ~.'.~..
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate . . . .[,,~... ' ..............
Fee Submitted $ "~
Construction on above described building and permi~i.i.i.i.i.i.i.i~m~ets a)i applicable(~;odes and regulations,.
Applicant ...... . ................
Rev. 10-10-78
¢0 ~. 1'70 I0
HENRY J. SMITH & SON,
MAIN ROAD
SOUTHOLD, N.Y. 11971
(516) 765--3690
Inc.
CERTIFICATION
Building Permit Ne.__L6~L6Z- .......
0wner__~d~_D_~r~S ................
Plumber Henri J. Smith & Sonz_~B~
I
system
Certify that the splder used in the water supply
than 2/10 of IE i ~d.
contains less. ; '. ~~~
Sworn to before me
_~[~_day of __~a_~ .......
19 88
Notary Public,
this
ar
Suffolk County ~;0Tt,~'r ?U~,LI ,, State of ltew Yorll
765.1802
BUILDING DEPT.
~~,~ INSPECTION
FOUNDATION 1ST [Z'~~OUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[)~I~MING [ ] FINAL
REMARKS:
DATE ~/hl~ INSPECTO~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMINGs,, ~ 4~?-~'n ~AL
765-1802
BUILDING DEPT.
INSPECTION
[ ] FRAMING
REMARKS:
FOUNDATION 1ST [ ]
FOUNDATION 2ND []
[
ROUGH PLBG.
INSULATION
] FINAL
/
~.-~.~//'~ 765-1802
~~--~UILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
DATE
,'INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
: :,/'~'~, BUILDING DEPT.
::iNSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [~'FINAL
.RE:MARKS:
- ~ ~/~ ~- ~ ' _, ~ .
DATE ': INSPE~O~~,
UGH
SULATION PER N. Y.
STATE ENERGY
CODE
....... Iff'
BOARD OF HEALTH ......
3 SETS OF PLANS P';~-: -
TOWN OF $OUTHOLD CHECK ..... ~-,
BUILDING DEPARTMENT SEPTIC FORH .../~. ..... :
TOWN HALL
SOUTHOLD, N.Y, 11971 NOTIP¥ .Y.'7.'Z:.?7.1. q ....
TEL,: 765-180:~
Examined~..'~..~. ,~..., 19 .f?.
Approve~l~- ~'~'., 19~.~. Permit No. l..le..~./.g..~
Disapproved a/c .....................................
(Building Inspector)
CALL
MAIL TO:
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
19f.7
a. This application must be completely filled in by typewriter or in ink and submitted 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 may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued 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 pumuant 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 building for necessary Cspect~ns. ~,, ' ':. ~
(Signatur~i~'g~n~ant~,Jf a corporation)
·
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, gege~ral:c~ntractor,, electrician, plumber or builder.
amc or owner o[premzses .... :.s ......................... "; '~' c~' "~ ........... ' .................
(asonthe ~,~'0[l~ll~'%~s. ee~ ~ L
If apphcant ~s a corporahon s~gnature of duly authorized officer. · -' ~;..~ ,~. ~Oh~l~..,~ ~It:D~NG OEPAR1M~T AT
(Name and title of corp~r'ai~ officer) · "~6~,'~ q(.m~ vWO ~QU1RED
ALL CONTRACTOR'S MU~ToBE SIIFFOLK COUNTY LICENSED
Plumber's License No ......................... 4 [tN.~ t;O~ST~OCY~O~
g~ COMO~ fir[ ~O~ C.O.
Electrician's License No ....................... T['~ REQUirEMENTS ~ '~
Other Trade's License No ...................... C~ NOT ~I~E ~
1. Location of land on which proposed work will be done ..................................................
House Number Street Hamlet
?q .... ..........
County Tax Map No. 1000 Section .................. Block ......
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. x~stmg use and occupancy .....................................................................
b. Intended use and occupancy ........ ~ ....................................
' ppli ) ..... '... Additi .
3. Nature of work (c!]~ck which a cable: New Building .. on ..............
Repair ...... ~..~... '... Removal .............. Demolition ............ ' ' Other Work ...............
4. Estimated Cost .................. .... · ..... ... Fee..... .................................
: ' (to be paid on filing this application)
5. ~ gd::lgl}:gn~=~br eorfOcfardT;lll.n~.~l.1 . 1 t . . ................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....
7. Dimensions of existing structures, if any: Front ............... Rear .... , ...... .... Depth ...............
Number of Stories .....
Height
Dimensions'of same structure With alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
.... 8.Dimensions of entire new cons/ruction: Front .......... . ..... Rear ............... Depth ...............
Height ............... Number of Stories ...... ~ .................................................
9. Size oflot: Front .......... i ......... ... Rear ....... ........ ...... . Depth ... ...................
10 Date fP has ' Na of Form Ow
· o utc e .......... i ................... me er nar
11. Zone or use d~stnct ~n which premises are situated .............. .
12. Does proposed construct~on~)~late any zomng law, ordinance or regulation: ...... ~.i0~ ............. .........
13. Will lot be regraded .... .r~...i .................... 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:~ .~,] .............
15. Is th±s properl:y local;ed! w±i;h±n 300 feel; o£ a i;±dal wei;land? ~Yes ..... No
~Zf yes~ Sou~:hold Town Trnsi;ees Perm±i; maybe raqu±red.
PLOT DIAGRAM
Locate clearly and distinctly al.1 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.
OCCUPANCY OR
USE iS UNLAWFUL
WITHOUT CERTiFiCATE
OF OCCUPANCY
STATE OF NEW YORIC~
cou ¥
........ .... ..................
(Name of individual signing contract)
above named.
He is the...~.~~..: ...........
: (Cont
owner or owners, ~d is d41y authorized
of
application; that all statements contained ~ this
work w~l be perfo~ed in the m~n~r set forth
Sworn to before me this
........................day ... .....
H~IH EN~E~E
.... being duly sworn, deposes and says that he is the applicant
tctor, agent, corporate officer, etc.)
:o perform or have performed the said work and to make and file this
pplication are true to the best of his knowledge and belief; and that the
he application filed therewith.
hcanti
SU k'VF','"C [.)
AF
/
N. 55' 18' IO'E.
5.55'os'ao'w,
Bi_AS:i FtAC 1~,
5
139.00
CO.