HomeMy WebLinkAbout15713-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19285
Date AUGUST 10~ 1990
THIS CERTIFIES that the building.
Location of Property 310 SPRING LANE
House No.
County Tax Map No. 1000 Section 86
Subdivision
ADDITIONS
PECONICr N.Y.
Street Hamlet
Block 5 Lot 4
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 26, 1987 pursuant to which
Building Permit No. 15713-Z dated FEBRUARY 27r 1987
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 ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DW~TW.ING.
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-131701 - MAY 30r 1990
PLUMBERS CERTIFICATION DATED N/A
Building InSpector
Rev. 1/81
FORM NO. 0
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~ ~5713
Z
Date .................................
Permission is hereby granted to:
...... ....................
..~.....~....~....,:t..,.....L L.~...s.'L.'Z. .................
..................... x ..... ~' ';:.7'".'"-':' ........ ;~'" ~ ......... ~":' .... ~"? ............................
at premises located at ..m~.L.~......~..~.~.t..~J..r~.~......~..:..~ ..................................
Count, Tox M,,,~ ~o. lOOO s,,-,ion ..... .g.~.~. ....... B,ock .... .~..~,.'. ........ Lo, ~o ..... .~ ...........
pursuant to application dated ............................... '~~ ...~,...~. ............. , 19.~...-L, and approved by the
Building Insp~//
Fee $.....~....: ..............
Building Insl3ector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPAETMENT
TOWN HALL
SOUTHOLD, NEW YORK
765 - 1802
11971
NEW CONSTKUCTION ..... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND
Loe~t ~on o f Property. ~.~q ..... %.~a_~ .......... ..... ~ ~...,...~¢.%~H~.e ..........
HOUSE NO. STREET HAMLET
' Owner or Owners of Proper~y ..............................................
County Tax Hap No. 1000 Seerlon Block Lot
Subdivision ....................... Filed Map ........ Lot ..........
Permit No ........ te of Permit pplicant .
Health Dept. Approval .................. Underwriters Approval ..............
Planning Board Approval ................
Request for Temporary Certificate .~.. .... Final
Fee Submitted: $ .................
Certificate
APPLICANT..~~-.~
rev. 10/14/88
(~,~s. ~ 0 ~ 5,~
c o
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be filed in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
!. 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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that solder used in system contains less
than 2/10 of IZ lead.
5. Commercial buildings, industrial buildings, multiple residences and similar
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requlremen't$.
B. For existing buildlngs.flPrior to April 9, ]957~ non-conforming uses, or buildings
and "pre-exis£1ng" land uses:
I. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2o A properly completed'~appllcation, a consent to inspect signed by the applicant
and a certified abstract o£ title issued by a title company whlch shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in ~riting to the applicant.
D. FEES:
I.
CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swiping Fool, $25.00. Accessory building $I0.00
Addition to Accessory buildings, $[0.00. - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $1Oo00
4. Vacant Land Certificate of Occupancy - $20.00
5. Updated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $15.OO
'er. 10/14/88
FOUNDATIO.U
(1st)
FOUNDATION
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION FERN.
STATE ENERGY
CODE
FINAL
ADDITIOr;~L COMMENTS
~/~,/w - f'~ ~ ~ ,~
85 ~,~EW YORK. NEW YORK 10038
waz examlned o~ ~ A Y 0'/, 1~90 and found to be in co~pllance R, ith the r~uirements of th~ ~rd.
flX~U ~A~[ SWITCH~ ~ ~XTU~ j ~NGES [C~I~ ~S OVE~ m~ W~S ~HAUST FANS
I~ACK I
PECI)NIC, NY,
P~r
This certificate m~st not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identifiedl~' the~' credentials.
COPY FOR BIJILDIHG DEPARTMEHT. THIS COPY OF CERTIFICATE MUST HOT BE ALTEREli'tN ANY ~. ~ _=
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
[ ] FRAMING [~FINAL
REMARKS:~~_~~~~,
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [ ~]/~INAL - A~P ~'~ ~ ~
,,'~ARKS'* ~ ~~~
~ .
DAT~
iNSpIrcTOR !) ~ (/') ~
FOB~ NO. ~
TO~N 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)
12800 Z
Permission is hereby gronted to:
~.~.....~..~..O.~f..~.~.
..~..~.~.....~.~...~ .........................
.... !. ~..~.~...,....~.......~..: .................................
,o ..~....~:.~.~...~.~....~.~.....~...~.~ .............
..~..~....~....~..~..: ....... .~ ........ ..'. .................. :. ................ ! ..............
o, premises located at ....~.../..~....~'...~....~...~..?....~-.~....]..~.,.~...~.........~..'...~.; ................
County Tax Mop No. 1000 Section ..... ..~..~....~. ...... Block ....?.......~,. ......... Lot No....~...?.....~., ..........
pursuant to application doted ...~..~~ ....... .(..~ ......... , Jg..~.~, and approved by the
Building Inspector.
~e, ,.~.~.:...../... ....
Building Inspector
Rev. 6/30/80
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180:3
., 19 ?.."~-
., 19~. Permit No. ~ .~.~ ~ ~
Received .......... ,t9...
Disapproved a/c .....................................
(Boilding Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. 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.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application,/he 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
on premises and in building for necessary inspections. ~ _
admit authorized inspectors ~" ' ~~nl~,'~ ......
(Si,,nature o~plican~Sr name, if a corporation)
v' ,~"Mailing address of applicant)
State whether applicant ~see, agent, architect, engiueer, general contractor, electrician, plumber or
builder.
(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 Liceuse No ......................
~.~') Location on proposed work will be done ..................................................
of
[and
. . .?. ........................
tlouse Number Street
County -ra× Map No. 1000 Section ..... .~-)..~. ~ ....... Block .... .C'~. ,.%.'~. ......... Lot....C).O...~.. ........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
[
a. E, stin ,,se a,d ........ ................................
b. Intended use and occupancy..~ .~.. ~~~. ~.~ .......
3. Nature of work (check which applicable): New Building .......... Addition .......... ~'LIteration . .~ .....
Repair .............. Removal .............. Demolition .............. Other Work ...............
'~ .~5~'~<:~;a~:;~ (Description)
4. Estimated Cost ............ . ................. Fee ......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................
If garage, num bet o f cars ........................................................................
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 ...TEx::~ ....... Depth.. 2i~.?~:5:'. .....
Height . A.~..a'. 'i~95 ..... Number of Stories ......... ,~....'~.'~.~--> ..................................
Dimensions of same structure with alterations or additions: Front ..... ~.e.~. ..... Rear ...~,~ .o .........
Depth ...... ~ ....... Height ....... ~ ...e~... ...... Num her of Stories ..... ~- .%,M::R.J:~:~ .....
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 .............................
I 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ....... Y.A.O. ....................
13. Will lot be regraded ........................... Will excess fill be remo3~d from premises: Yes C-~lq~
~ Nan~e of Owner of premises cgr~A~. ~ 0,.~X~Address ~0~C~.~A,~(.~co4Ar,, Phone No ................
Name of Architect ........................... Address ................... Phone No ................
Name of Contractor .......................... Address ................... Phone No ................
PLOT DIAGRAM
Locate cle~ly 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.
being duly sworn, deposes and says that he is the applicant
al signing contract)
above named.
tie is the .......................... ~rl &~ent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application: that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
(,~.~igna'h~re of applicant)
L
js~ copper' tulmng is
for Water d
' ' / " ' NOTIEY BUILDING DEPARTMENT AT pes K or L O~ly
7~5-180~ 9 AMTO 4 PM FOR THE ' o~t? ~ "I~ 5 : r
,' ,, -' ~OLLO%dNG INSPECTIONS: - ' ' .'
~ I' ¢r~ * ~. FOUNDATION -- TWO-REQUIRED ,', r
, ' ' , FOR:POUR=UCONCR~ . ' '~ ' '
:2 ROUGH-- FRAMING & PLUMB'NG ' "---- ...... OR '