HomeMy WebLinkAbout15787-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z19498 Date NOV. 13~ 1990
THIS CERTIFIES that the building.
ONE FAMILY DWELLING
Location of Property 260 FLINT STREET GREENPORT
House No. Street Hamlet
County Tax Map No. 1000 Section 048 Block 002 Lot 025
Subdivision GPT. DRIVING PARK Filed Map Noo 369 Lot No. 81
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 17, 1987 pursuant to which
Building Permit No. i5787Z dated MARCH 21r 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 ONE FAMILY DWELLING, AMENDED TO INCLUDE 2ND FLOOR.
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
FLINT STREET CORP.
87-SO-46 MARCH 1, 1990
N002756 JANUARY 21, 1988
PAUL DINIZIO JUNE 20, 1990
Rev. 1/81
I~OE,~[ NO. 1~
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~ 15757 Z
Date .........I ............................................. ' '
Permission is hereby granted to:
..............................................
at premises located at .~....~....~.......~..~...o~ ....... ..,~..~.~ .................
County Tax Map No. 1000 Section ..... ..(~... ............. ~;~ Block (~ ~ Lot No. a~. ~
· .....~ / 19.?..~...., approved by the
pursuant to application dated ......... ~....C.~ ......... .~. .......... , .. and
Building Inspector.
Fee $. ,~,,.,~, .,~.. ° ?. ~)
Rev. 6/30/80
Form No. 6 7~o____~
TOWN OF SOUTHOLD
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 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
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
"pre-existing" land uses:
i. 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-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
iI~ Y":'?~
Date ................................ . .
Jew Construction.....~. ..... Old Or Pre-existin~
Building
ocation of Fro e t,, ............
House No. Street Hamlet
o n rs o,
;ounry Tax ~ap ~o [000, Section .......... B~ock ......... ... . . *~ot ................ ......
;ubdivision ....................... .. . ..........Filed Map ......... ... Lot ......................
'ermit No...~ '. ..Date Of Permit. An~lic~r A/
[ealth Dept. Approval ...Underwriters Approval
lanning Board Approval ....................... .
equest for: Temporary Certificate ........... Final Certicate...%. ....
eeSubmitted: $~ ....... J~.~.~.~.~- ............ i ...~.'.~-.g( ..~..~..~?~7.~ .;~'.~..~..J
~'~'~ ~,,~,fl~. ~o z/~ , . ............ , .........
APPLICANTv
TOWN OF SOUTIEOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No._/~7~7 2.
(please prl~t) ,
Plum~er ....
(please print)
I certify that the solder used
contains less than 2/10 of 1% lead.
in the water supply system
Sworn to befor~ me this
19~
NOtary Public,
County
(plumber's sig~ture)
Notary Public
No._4707878,.Suffdk._C~nly~.
Expires M~mh 30, J-~ ;';
OU~IDATION {l~t)
OUNDATION (2nd)
OUGH FRAME¥//
PLUMBINd
iNSULATION PER N.
STATE ENERGY
CODE
FI~IAL
· ADDITIO~I~L MMEN[
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION ZND [ ] INSULATION
[ ] FRAMING--
FINAL
DATE
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND ~/INSULATION
FRAMING
FINAL
REMARKS:
DATE
INsP?C??R-/~
"._.~BBU765'1802
ILDING DEPT.
INSPECTION
[ ],~FOUNDATION 1ST [ ]
ROUGH PLBG.
[ ] FOUNDATION AND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
765-1802
BUILDING DEPT.
INSPECTION
[ F//OUNDATION] IST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] F~RAMING [ ] FINAL
DATE _ INSPE~C_TO
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [~ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
/~/FRAMING [ ] FINAL
DATE
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
gOUTHOLD, N,Y. 11971
· TEL.: 765-1802
Approved .}/'~ O-~cg-~O & / 19~.?. Permit No /
Disapproved a/c .....................................
...................................................5'~ ........ Ooze
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received. ........... ,19...
INSTRUCTIONS
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 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 necessary inspections.
...........
(Signature of3p~licant, oA' name, if a corporation)
............ g~,...z4/.~ z'... ,..s?/ ............
.......
........ ifi~-~/ifi~' aadres~ '3~' ~licant 5
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
· .O..vo.W.4.'2. ...................................................................................
Name of owner of premises.. E/!'.'~/./. .... . .~. '. .... .~.' .0.('..~., .............................................
(as on the tax roll or latest deed)
If applicant i~.orpo~i, on, signature o f % authorized officer.
.......... ...... ........
(Name and title of 6°orporate officer)
Builder's License No ........ .~.~./.~ ............
Plumber's License No ......... ,S.'.e[ ?. ...........
Electrician's License Ne .......................
Other Trade's License No. ~'e/f
'1. Locationofland onwhich proposed work will be done .... ~L~¢... ~.¢ ........ 5..~.~,.~e,4....xix.~./..~.¢/
House Number Street Hamlet
County Tax Map No. 1000 Section ....~..? ........... Block .... ~ ........... Lot...'.~: .'~5... ..........
Subdivision ..................................... Filed Map No. Lot (Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction: .
a. Existing use and occupancy ..... . .~'.&.~.~.~../0..75.. ...............................................
b. Intended use and occupancy ~. ~&.~(
3. Natureofwork(checkwh~ch!apphcable) New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work
' '!~ ' '~ ' rD ripti )
'. ".'_ esc on
4. Estimated Cost ................................ ~..,~ .~.OO Fee ............................. -.. ......
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...... .~. ....... Number o f 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 ....................
7. Dimensions of existing struct¢res, ifany: Front ............... Rear .............. Depth ..............
Height ............... Number of Stories .......................................................
Dimensions of same stmcture~with alterations or additions: Front ................. Rear .................
Depth ................ : ....Height ..... .~ ...... Number of .Stories ....
· ' ' : ' ont ~ ~. ' Re r o2 ~ - Danth .............
8 Dnnenmon of n F
· s entire new constructlo r ..... a .
.~.0 r. Nflmber of St rie .~w.i ............. - ...............
Height o s ..................................
9. Size.of lot: Front ........ .'-~..O.,.r ......... Rear ...... .,.~-.O../ ........... Depth "'--...~.4'~'/"""""""""'~' '"~.'~t} ........
10. Date of Purchase ..... .~.~. ................. Name of Former Owner ...,J..g:p.,a.~/ .........
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..............................
13. Will lot be regraded ....... i.,~ ·. tt/~. ............. Will excess fill be remov,ed from premises: ~ No
14. Name of Owner of premises . i[':./(i~... ~...f-..~..OcP Address .~[~O.og.~..~.. <~'.,,~,.,,Phone No ~Z~-~..
Name of Architect ~¢{~...l~q~,.~...~.ot.'/~O¥-) '-q~a',~},~ddress ~,.~ z//~vv~' Phone ~,,' ~¥r .....
Name of Contractor ......... ,~./.~. ............. Address ................... Phone No .................
15. Is this property locate~ within 1100 feet of a tidal wetland? * Yes ..... No~¢~,.
· If yes, Southold Town T?ustees Permit may be required.
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 number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF N~r~/ORK,
COUNTY ~~-Y~ ~S .
....... ..........
above named.
being duly sworn, deposes and says that he is the applicalt
.e the ........................ · ..................................................
/ ~gent, corporate officer, etc.)
of said owner or owners, and is dgly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application am true to the best of his knowledge and belief; and that the
work will ¢e performed in the mantlet set forth in the application filed therewith.
Sworn to before me this i
.......... ~. · .~. ...... day6f ...... ~.. , 19 ~..~
~ ~.5~tat,,e<~_.N.e~w_.Y.o_~. ' (Signature' o f applicant )
, No. 52-8125850, Suffolk COulllP/~
' I Term Expires O~tober 31, 19 '~' '