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HomeMy WebLinkAbout16047-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF O~CUPANCY No Z-24464 Date JUNE 26, 1996 THIS CERTIFIES that the building ADDITION Location of Property 1040 FO~3~DERS PATH SO~THOLD, N.Y. House No. Street Hamlet County Tax Map NO. 1000 Section 64 Block 2 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 6, 1987 ~ursuant to which Building Permit No. 16047-Z dated JUNE 10, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PETER T. & IRENE DEMETRIOU N/A N/A ld~ng ~nspector Rev. 1/81 I~ORM NO. o TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH HALL $OUTHOLD, N. Y. BUILDING PERMIT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ ~l:~),~f Z Permission is hereby granted to: ..... .... /..~.....~...../....~...../..,,m4 . / County Tax Mop No. 1000 Section .... ~.....~... ....... Block ......... ~.., Lot No ...... ./..~ .... pursuant to application dated ....... ~.....& ............ , lg..~..,~and approved by the Building Inspector. Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 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 fro~ Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% 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: 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 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 Buildinm - $100.00 3. Copy of Certificate of Occupancy - % .~5~. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Consgruction ........... Old Or Pr~-exist%ng Buildi~ ............... ,.. Location of Property ..... L.O..~..~.....~.~.~)..YI.4.~ .... .~.~..~,. ..... ~.~-' ................ House No. Street 0, o,,,, o, ..... ..... ..... Counry Tmx ~ap ~o 1000, SecrSon ..... ~ ........ B~ock ................ Lo¢ .................. Subd~Ss~on .......................... ~ ......... F~ed ~ap ............ Lo~ ...................... ~rm~ uo ..... ~ ~7~ ~ o~ ,~ ................ pp ~,~...0~ ~. g.C ............. Healeh Dept. Approual ....... ~.~ ............. Unde~rS~ar* Approva~ ....... ~.~ ............ Planning Board Approvai ..... ~. ~ Requese ~or: Temporary CerrS~caCe ........... 'ELD ,UNDBTION ~ (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: i~\!i JUN 5!~1 ~, Examined ........ ¢.tJ. ~ 19~ 7 Approved~..l ~.., 19~Pemit No. Disapproved a/c ..................................... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8.OUTHOLD, N.Y. 11971 TEL.: 765-180:] 3 SETS OF ~ANS · CHECK - - SEPTIC FORM ............. : CALL - · - ~,- .... MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 i ~oectiqRs. ~ ~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ! ..... hr. .................................................. Name of owner of premises ... ~ .~.p- "[. ~¥te ~1.t~ (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 ........ '~ "~'~v~",.; ........ ,Plumber's License No ......................... Electrician's License No ........................ LICENSED Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................. d. ' ,'. o '1.. ...... /..Ctf.~.. ~.a~ '~..e..r..~ .... ~...,, ........................................... House Number Street Hamlet County Tax Map No. 1000 Section ...... ~...~. ...... Block .... ~ ......... Lot../..-~.-~ ..: .......... Subdivision ................ (~,/'a~) ...... i~ ........ Flied Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~stmg use and occupancy ................... ~ ............................................. b. Intended use and occupancy C2 .~. (-t . · .~1..I~.~ · ·~. .................. 3. Nature of work (check which applicable): New Building .....' ..... Addition ....... Alteration .......... Repair .............. Removal .............. Demolition .............. O~her Work ............... i ~,,j (Descrip~tion) 4. Estimated Cost .... L U.v~ ~.~..w....C ¢.~}~.:...[, .O.gy. ...... Fee. 7.,~..~,..~/~. ........................ I " (to be paid on filing this application) 5. If dwelling number of dwelling iumts ............... Number of dwelling units on each floor ................ If garage, number of cars .... 2 ................................................................... 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.... ............ Height Number of Stories : Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i · · Height .......... Numbe?c~of Stories ....... Dimensions of entire new construction: Front i, iiiii ?.'~/i i . . . Rear .... {-- .......... Depth ii Height ............... Number of Stories ........................................................ 9. olze of lot Front .......... ; ....... . ....Rear ...... : ...'~ ........... Depth ...................... 10. Date of Purchase ........ 4/.'% ~Q ............... Name of Former Owner .... ~A'LO.C:.~.e..k'. .......... 11 Z di iti wh' hp' ' ' d · one or use str c n lc remlses are situate ..................................................... 12. Does proposed construction violate any zoning law ordinance or regulation .................. 13. Will lot be regraded ........ ~,, ./fir<..O.....-~ ..... , .... Will excess fill be removed f. rom premises: ~Yes 14. Nmne of Owner of premises .~'.~e~.. .i?~m~ .~.'.~ddress .;a ~/~ ,-~'unc/~rr ~":?f, Phone No '7~, ~[~.~ Name of Architect ......... } ................. Address ................... Phone No ................ Name of Contractor ........ i ................. Address .... : .............. Phone No 15. Is this property located'iwithin 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Trustees Permit maybe required. ~ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. NOTIFY BJJ[I_DING DEPP~RTMFN'F .~'r 765-1809. 19 AM TO 4 PM F©R .' ,n FeLl .O\A/II ,~G INSPECTIONS: I. FOUNE FOR P( 2. ROUGk 3. INSUI / 4. FINAl BE: tTM ALL CC)N THE R FC"l~ 4'~F,~TS STATr: C~e'rRI JCTIC3N CONES. [~ ~'-'r R~qp~h,c',~, DESIGN 'fr~k~ ' ,- - 'TWO REOUII¥'r) RED CONCRETE FRAMING & pi ON t,~( J," r',,3N !,4, F~R C. O -, , -~ , ~u b · ,4, ~';i I.f'~ ~ (!Ill . ' g ~ ~2,~ ~;~[~g ~he is the ap~cant (Name of individual sitting contract) above named. He is the ..................... .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly 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 : .............. ~ ........ day elf ..... Notary Public,. ..... ~..~.,...U.~../~...~..~... County NOT~IW ~IC, ~t~ of ~w Y~k (Signature of applicant) i No. 4707878, Suffolk T~m Expires March ~t0,19 9./ '