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HomeMy WebLinkAbout16138-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22650 Date OCTOBER 8~ 1993 THIS CERTIFIES that the building Location of Property 305 BAY HAVEN LANE House No. County Tax Nap No. 1000 Section 88 Block 4 Subdivision Filed Map No. ADDITION SOUTHOLD~ N.Y. Street Hamlet Lot 29 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 15, 1987 pursuant to which Building Permit No. 16138-Z dated JUNE 26~ 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 TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to PATRICIA RYAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-023180 - JULY 25, 1988 Rev. 1/81 /~uil~ing Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALl. SOUTHOLD, N.I Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE P!REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZE ~,1 ~ ~ '5~ z Permission is hereby granted to: ..... ....~..~.~.LLX .............................................. ....~.~......o...-.' :L:....t~.~.~.~ ..... ~t premis, ,o~ated at ..~...0..~......~......~....~.~....0...~.:....~.......................... ~ ~~~ ~&~ , ............... co~t., Tox ~op No. ,000 Sec.o,, ...... .~..~.~. ..... ~,o¢~ ...... ~.~ ........ Lot No...~.~ .............. / pursuant to application dated ....... ....~.~..~...~... ................ , 19.~...'2., and approved by the Building inspector. Fee $..,.~..~)..?....~ ~ ~.~.~i~l~~ ........... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 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 Cod~'Compliance from architect or engineer responsible for the building. 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 i. 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 Date .... ..... . ............... . ......... New Construction ........... Old Or Pre-existing Building ................ . Location of Property ............. ~. o a House No. Street Hamlet Onwer or Owners of Property ..... f~r?.~l.~('.~ .... .~.:...~.~/~. ........................... County Tax Map No i000 Section Block '-- ' Lot Subdivision ...... ~.Y../~.~.~.~ .~. ............... FiledMap . .~ ?./.~. ........ Lot .~.~ ..... ........... Permit No /~'/--~ ?. .... Date Of Permit ....... Applicant .... I.~l~.,.~.~.~...7.. .d~ Health Dept. Approval ...................... Underwriters Approval.l~.% ~..~ ~..~ I~.~. Planning Board Approval ........................ / ¥.. Request for: Temporary Certificate ........... Final Certicate ..... Fee Submitted: $...~;.0.0. ................... ','.. , , i .... BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~INAL DATE INSPECTOR.~ ]'65-~1802 BUILDING DEPT. INSPECTION [j/] /F~UNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE 76S-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND[] INSULATION FRAMING [] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [/~INSULATION [ ] FRAMING [ ] FINAL REMARKS DATE _~ .... INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined . .".'q...,&.4/~4...., 19 ..1 Permit Approved. Disapproved a/c ..................................... (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. Thc 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 ~n, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housin~ co~, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectior~., '~ / ..... : .... .... tj.k ............. " (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. ................................... ........................................... Name of owner of premises ...... 'i/.t4 .~,~.~:. ! .~..L~....i.~..~..~..~. ·· ...................... ' · (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...|..'~..~.~..~...~..I. .......... Plumber's License No. '?~'~ k{. ~. Electrician's License No ..... .'~..~..~?..t':~.-7. ........ Other Trade's License No ...................... 1. Location of land on which proposed work will be done .............. .7. .................................. ...... .'ze..e .................. a..-t ...... .V~.,e.....a...o..~. ........... .~..o..w..~. ~ ................ House Nmnber Street Hamlet County Tax Map No. 1000 Section ........ ~...~. ...... Block ....... k/, ......... Lot .... '~' '7 ........... Subdivision..~..~. ? .0.?.~ .~ ...... ~.t..~. ~ ........ Filed Map No..~'....I. ? ....... Lot....~..o. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... !.....~f~...~.~.~ ...... ~ ........................................... b. Intended use and occupancy ..................................... .-. 10. I1. 12. 13. 14. Nature of work (check which ~pplicable): New Building ..... ' .....'Addition . ff~.[6...:...~ ,atteratLo_n _ Mi] ..... Repair .............. Re~ ~ovai .............. Demolition .......... [!~..~' ~ ,] ~' ~ ..... "' (to be paid On filin~ -~h{s ai~1311~ation) If dwelling, number of dwelling units ...... ( ........ Number of dwelling units on each floor. If garage, number of cars .. If business, commercial or mi~ed occupancy, specify nature and extent of each type of use ..... --. ................ Dimensions of existing structures, if any: Front .... .~'.~. ~ ~ .... Rear ....t...~. ~ .'t. ....Depth ......... ~.~ ~o '~. ...... . Dimensions of same structure with alterations or additions: ~.'¢ --~ _ "1 Front ................. Rear .................. Depth .... ~..'l '~ ~ ,. Height ! .7...., ~ ~. . .. Number of Stories.. l Dimensions of entire new construction: Front ...t...~. ?.~..'r. .... Rear ...'I..'>".'7.0. ~ ..... Depth . ~ ~ ~ ...... Height .. ~..'2r ?. ~ ..... Ndmber of Stories ...... .t ................................................. Size of lot: Front I-,.~-o Rear .t'Lq'~o Depth ~ Date of Purchase" Name of Former Owner Z d' ' ' wh' hp ' 't d one or use lstnct in lc rem~ses are si uate ..................................................... Does proposed construction v~olate any zoning law, ordinance or regulation: ~ ~O ? ' . Will lot be regraded ..... ~ q ....... ~ ........... Will ~xcess fill be remoyed' from premises: _Yes No Name of Owner of premises~'./l.~.~.'?.,.~. . i(.."f.~ ~ .... Address~..'/· .~/.'~q...l~...~?~..~?.~, Phone No.."1.(...~.: U.?'~ ..... Name of Architect ........ t'7. ~ .............. Address .......... Phone No ................ Name of Contractor ...~.....I.%. ~..,~..,-~. ........... Address '.~. .',.q 9. {~,~'~ .~."~' ' ' Phone No.'l~-.~.'.?-~.q'l.$ .... Locate clearly and distinctly ~ property lines. Give street and bloc interior or corner lot. PLOT DIAGRAM " 11 buildings, whether existing or proposed, and. indicate all set-back dimensions from k number or description according to deed, and show street names and indicate whether STATE OF NEWjfO,R,K, ,, ' S S COUNTY OF .,~...i ' ' ....... .~. ~..~.¢..'~..~m."~-. _. { .~. ? t'41i'.-~ ~. ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ~ ~ r~. (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 statelnents 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 ............. 19 N~o!ary P ~ublic~~"'~'3c~ °--7' ~ ........... ~ ........ County Notary Publlo, State of New ~ t,// (Signature of applicant) No. 48226113, Suffolk Cou ~f~ty irerm Expires De~ember 31, lS .. _ ?