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HomeMy WebLinkAbout15873-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20738 Date MAY 19~ 1992 THIS CERTIFIES that the building. ACCESSORY Location of Property 840 PINE TREE ROAD CUTCHOGUE~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 104 Block 1 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 18~ 1987 pursuant to which Building Permit No. 15873-Z dated APRIL 4, 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 ACCESSORY STORAGE SHE~ AS ~PLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ROGER & MADELYN STOUTENBURGH //uil~ing Inspector Rev. 1/81 I~OR~ NO. ~ TOWN 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) N~ 15873 Z Permission is hereby granted to: ..~ .......... :~ .......... .t.~.: ...... ~-~ ~ ~ .... ~ . .. of premises I~oted at .............................................. I~uildlng Inspector. Building Inspector Rev. 6/30/80 Form No. 6 BUILDING DEPARTMENT · 76511802 APPLICATION FOR CERTIFICATE OF OCCUPANCY "~'~' " A. 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: Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). Approval of electrical installation from Board of Fire Underwriters. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. ~ - ~. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. . ~. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-c~nforming uses, or buildings and 'Tpre-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 applicator. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessor~y building $25.00, Additions to accessory building $25.00. Businesses $50.~0. 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 Date .................................. Jew Construction ........... Old Or Pre-existing Building ................. IIouse No. Street Hamlet )nwer or Owners of Property. .~... . .... 'ounty Tax Map No 1000, Section...~..~.~. .... Block.~..~.~). ...... Lot .... /../., .............. uhdivislon .............. Filed Map ...... Lot.../ ~ ....... ermit No ............. Date Of Permit ..... Applicant ........ ealth Dept. Approval ........... ............... Underwriters Approval ....................... lanning Board Approval ........................ -~qumst for: ~e Submitted- $ .......... Final Certicate ........... Temporary Certificate . APPLICA~NT INSPECTORS Victor Lessard Principal Building I~spector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone.(516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD 1~¥ 15, 1992 SCO'I'I' L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 ROGBR STOUTENBURGI~ 840 PINg TREE ROAD ClYrCROGI3R, ~ 11935 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xxx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. 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 ~ 15873-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TO%~N BUILDING DEPT. ]65-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION FRAMING REMARKS: ROUGH PLBG. 2ND I- *1 INSU~_.~N [~FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND ~ FRAMING REMARKS: ROUGH PLBG. INSULATION FINAL 0 UN D;, T I 0.~; ~ OU~DATION (2nd 1 OUGH FRAME & PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIO~;A'L COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 .TEL.: 765-1803 ., ., 197..7: Permit No. /.~..~.7.~-.. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) · APPLICATION FOR BUILDING PERMIT Date 21 ]'3 . 19~.7 INSTRUCTIONS a. This applicatior[4 .=,~ gte~'~ in by typewriter orin ink and submitted to the Building Inspector, with3 sets of plans, accuraq t~l~t 1519 ~ .(l~l~ccording to schedule. b. Plot plan ~ ~ .lo~ ~'c ~'d of buildings on premises, relationship to adjoining premises or public streets or areas, and ~ 'de,~ tel~ 13n of layout of property must be drawn on the diagram which is part of this appli- cation. _~.~' ~',t~,'~_~ c. Th~ c~ r~'~org ~~?EI ~'~n may not be commenced before issuance of Building Permit. d A~o~am0r~ }oft~&tl PPI~ ~q, the Building Inspector will issued a Building Permit to the applicant. Such permit shall ge~"~p~ t~h~} ~¢.~ ~.~ 'for inspection throughout the work. e. No~S~l ~ _~e_~ r%]~ie or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have be'~fgri~it~l~ t, by~ t~filding Inspector. APPLICATI~ }I~E iy MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordi{~ ke of the.Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for tjae' ~nstruction of buildings, additions or alterations, or for kemoval 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 inspectom on premises and in building for necessary ~ctions.~/~'~ ~ . · ~ /-;~ ~r~ a corporation) ........ i&iiii i' OOii&i i5 ....... State whether applicant is o~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ............................................................ Name of owner of premises ....... .~. '~' i ' ' i ' ' ~0¥~ '~' ~TFJO ......... tas on rne 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 ...................... House Number ~ Street Hamlet County Tax Map No. 1000 Section ~O Block .~ ,O O Lot ~ {} ' ~ (Name) State existing us~. and occ~?.~ncy of premises and intended use and occupancy of~s_~d construction: b. Intended use and occupancy ...~{~cn .... ~ .... ~ ............................................. 3. Nature of work (check which hpplicable): New Building .......... Addition .......... Alteration .......... Rel~air ~ .~ .... , ....... Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost . . , .... ~.~_ Fee .................... -.: ..... ! (to be paid on filing this application) 5. If dwelling, n mber of dwelli~tg units '- ~ .... Number of dwelling units on each floor... 7;. ~-. ........ If garage number of cars ' --'---- , . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use...7....~ ..-TT., .......... Dimensions of existing structfires if any: Front ....... .75. ...... Rear .... ~ ........ Depth..Ti '. e,g ............... Number of Stones ........................................................ Dimensions of same structure iwith alterations or additions: Front Rear ~ Dept .................. , ....Height ....... ~ ............. Number,of Stones - .. .......... (, 8 , ,'~Dlmenslons ~f ent'.re new cons~ruction Front /.(2 .. Rear ...l ~ ......... Depth ltd. . Height .f~ ........... Number of Stories ....... [ .................. ,. 9 Size of lot Front /~. ~. ' ,.~ Rear /'O ~ . De~th / c/, 7.7~ ........... 11 Zone or use district m which premises are s~tuated .............. ~.~ ~[O~...a cc. ~- 12 Does proposed construction violate any zoning law, ordinance or regulation: . iii. iiiiii i,~,., i 13. Will lot be regraded ....... 5 .... ./r~..O... ;--' ....... Will excess fil1 be removed from t)r,~mises: Yes Name of Architect ...... /9..O../?~7 ............ Address .... ,~ ............... Phone No ................ Name of Contractor ~ ~ ff~"fi ~ Address ~ "',. · :2'" .~ Phone No 15. Is this property locate~ withinl,O0 feet of a tidal w~tiar~d?, * Yes";..,;. Q~ ..... · If yes, Southold Town T~ustees Permit may be required. ~i,f:N "/ .. i PLOT DIAGRAM "~ ,/" .... '. ' :.. Locate clearly and distinctly all b. kuildinjLs, whether existing or l d,: in tt a3t% l set?ack dimensions from property lines. Give street and block number or description according to deedf'im,~sho~y,~tro~,t hames affd indicate whether interior or cornm lot. e ,~ ~,~ ~,' , , ~0~ STATE OF NEW YORK, ,-~4 ~F'oC/(S S COUNTY' OF. ~Sjq .%T.,ffP.c.0.... , · ..../~..Q .~.~..~... R ~..Q M TT..~.~, .~. ~..Ol..~. ~ .~... being duly sworn, deposes and says that he is the applicant (Name of individual si~ning contract) above named. He is the ...~ ~ ~ ~ ~~. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dhly autho~ed to perform or have perfomed the said work and to m~e and file this application; that all statements cootained N this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ....... ......... .......