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HomeMy WebLinkAbout16742-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17588 Date DECEMBER 13~ 1988 THIS CERTIFIES that the building ALTERATION Location of Property 800 COUNTRY CLUB DRIVE House No. Street County Tax Map No. 1000 Section 109 Block 03 Subdivision COUNTRY CLUB EST. Filed Map No. 6736 CUTCHOGUE Hamlet Lot 002.11 Lot No. 24 conforms substantially to the Application for Building Permit heretofore filed in this office dated FEB. 4, 1988 ~ursuant to which Building Permit No. 16742Z dated FEB. 17, 1988 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 INSTALL SECOND STORY BATHROOM. The certificate is issued to RITA A. POWER (owner, XXXXXXXXXXXXXXXX) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HFJtLTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N043171 NOV. 1, 1988 JOSEPH S. DONATO NOV. 13~ 1988 TOYVN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_]6742 Z pursuant to application doted .... ~.~..~., ............................ , Building Inspector. 19 ........ , and approved by the Re~ 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OC( instructions A. This application must be filled in typewriter OR ink, and submitted m"...------, to the Building Inspec- tor with the following; for new buildings 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 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-cdnforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual 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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling. $ I00.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 /.//y.~./~ 5.Updated C.O. $ 50.00 Date .. .~, ............. New Cons truct ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ~..O.O. ............ ~.~ .O.o..~.~e.t~...d I¥.~. ..... ~...~.. ..... House No. Ham/er Owner or Owners of Property .~..~ .'r?f. ; .... ~.o. ??..c_;~ .(~. .............................. County Tax Map No. 1000 Section ./.o..~' Block .Q.'~. ,. Lot Subdivision . .~..ogtO~..~....~tO~ .. ~../.~'...~cS'.Filed Map No. ~72~ ~ .Lot No. ~."/ .............................. Permit No..~ Date of Permit .::~//. y~'.6;.Applicant. 7~.¥.c~..'(t.~...,~..c~..?r./.. (?. I;T..~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~<~. .................. Fee Subm tted $ ............ Construction on above described building and permit mee~able co~J,~an<~u lations. /_~ App cant....'h-...~.....~.... .......(~ .~...'~..'/?...~..~ Rev. 10,10-7a TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. (' Uplease print) Plu~er ~],~ ~, (plbase print) I certify that the solder used contains less than 2/10 of 1% lead. in the water supply system Sworn to before me this I5+h day of NOI; bcL Notary Public, ~V~01 }< ./ Notary Public County £o! £$ .J SURVEY FOR AT CUTCHO~U£ TOWN 04~ SOU~HOtD YOUNG ~, YOIJNG RIVERHEAO~ ~EW YORK Ilst) FOUNDATION (2nd) ROUGH FRAME .?LUMBIN~Z INSULATION PER N. STATE ENERGY ,CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST ]~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FINAL FRAMING REMARKS: DATE ~ wasexarninedon and~°undt°beinc°rnPllanCewlththerequ~rements°~this~°~rd' L THOMAS MIRANDA 29 SMITH I.ANE HUNT. STAT., NY, 11746 Approved .......... Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS 0:~.,... 'FORM NO. 1 SURVEY .... ~ ..... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT S~PTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N,Y. 11971 CALL .... -~- - - - ~-~- .... MAlL TO: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~) Tiffs 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. ¢. The work covered by tiffs 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 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 building for necessaw instructions. · f..'.(:( ....' (Mailing address of applicant) /~-~' State whether applicant is owner, lessee, agent, architect, engineer,~_~a~contrac~o~, electrician, plumber or builder. Name of owner of premises .......................................................................... (as on the tax roi1 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S HUS~f. BE SUKFOLK COUNTY LICENSED Builder's License No.././/. ~.J?. 7../~.~... ......... Plumber's License No. [.~.~. :~ ?..~> Electrician's License No. ') ~ / (o-~ Other Trade's License No ...................... 1. Location of land on which proposed work will be donm ................................................. House Number Street Hamlet County Tax Map No. i000 Section ....... Subdivision Coo~C~ ~ ~ 5~rff% Filed Map No. ~ ~ Lot ~.~. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... b, l~te~ded use and occupancy ................................. ~,, ,~<~,,,~,,,~, ,¢¢~;~ · ~- ..... '... 3. Nature of work (check which appilicable): New Buildihg ... ' ' . .... Addition .......... Alteration ......... ,,... Repair,....._ ......... Re~movai ........ Demohtmn .......... Other Work ..: ~ ~ ','. ; i ,,~ - ,, ttJescnpI~0n) 4. Estimated Cost ..... ~ .~. ...................... Fee ................... ',!ibt]...[r~... i'. .... i ~' (to be paid on filing this applicatio~) 5. If dwelling number of dwelling uhits ........ Number of dwelling units on each floor ...... ' '~' ".... If garage, number of cars ! · ' . ' ' '~'i ' ' ~ 6. If business, commercial or mtxed ioccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuresI if any: Front ............... Rear .............. Depth ............... Height ............... Numt~er 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 ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ............ j .......... Rear ...................... Depth ...................... 10. Date of Purchase ............ i ................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violalte any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises .... : ................ Address ................... Phone No ................ Name of Architect ........... i ................ Address ................... Phone No ................ Name of Contractor .......... ! ................ Address ................... Phone No ................ 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. i 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 ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. , l--/4 0H//~5 ~ O~ ~-- i being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................. ~. . i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui), authorized to perform or have performed the said work and to make and file this application; that all statements contained m thru apphcatmn are true to the best of his knowledge and belief; and that the work will be performed in the manneriset forth in the application filed therewith. Sworn to before me this ..... ~ ............ '~'I .... d~.,~f !..-~.~.~..t'~. · .Prfl~. · ........ 19 .~..~ $otaryi Pubhc ...... ~.~./~Z ./. * ~ .~,'-, .......... County //) ,_ : , .... ..... ~fi~..--,4~.-~ -'~ , ' (Signature of applicant) ! [ Qualified In Nesesu County (*9. ! [ Commi~ion Expires JUne ./2 '0 1: ~.'X~¥" ,~ld'o c W/ AONYaFiO30 JO 3ffOlJll~133 lflOHilM lflJM~qNfl SI 359 ~JO AONYaPO30 ';lDO0 .~0 _,=.LVOI~IJE~O 6'&,Od3,~ lN..91N03 QV-,='1 NO NOg V31:tll,~t~3 Iq oT F° THOMAS D. REI LLY PoE. IJILFfE CHECKED BY I DRAWN BY E~Ly4 Lo~' IDRAWING NO.