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HomeMy WebLinkAbout16456-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDAT~u CERTIFICATE OF OCCUPANCY No E-23328 Date NOVEMBER 4, 1994 THIS CERTIFIES that the buildin~ MODULAR DWRTW.ING Location of Property 65400 COUNTY ROAD ~48 GREENPORT, N.Y. House NO. Street Hamlet County Tax Map No. 1000 Section 40 Block 3 Lot 10.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in th~s office dated 1/10/86 & 9/11/87 pursuant to which 14498-Z & Building Permit No. 16456--Z dated 1/10/86 & 9/11/87 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 MODULAR DWNLLINGWITHHANDI--CAPPND RAMP * The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ESTATE OF DANIEL G. CONKLIN N/A N-001922 -- JANUARY 7~ 1988 N/A *THIS UPDATES CO Z-16603 DATED 1/21/1988 & CO Z-17730 DA'rEm 1/31/89 Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERAA. IT A,4us-r BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne_ 16456 z Perrnissmn is hereby granted to. . .... /~..~-.~.~.......m...~ ~ :... ,o ......... ""'" .~-" -" ' - ~ - -'~ ~' ~,~.;~ 0~' ~.m.a_~,~._ ..~.... .... LX..~ .~ ~ ~.. ~....L.~.,a ........... at premises located at ....V~...P. ....... Y..?. ........... .~.~ ,.FT~.t........~T..~.e~... ........................... County Tox Map No. 1000 Section .... (~)..~...b ..... Block ....... ..<~.,...~.. ..... Lot No..~...~...:..~, ..... pursuont to oppltcotion doted ..~'~r.~..![ ........... , 19..~.1., Budding Inspector. and approved by the Building Inspector Rev 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Budding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z- 16603 January 21, 1988 No ...... Date ................. THIS CERTIFIES that the buridmg CONSTRUCT O.NE. FAMILY. .. MODULAR. . . .DWELLING.. Location of Property 65400 North R. oad. ..... 9re. e.n. por. t., .pe.w.'~.o.r.k ...... House No Street Ham/et County Tax Map No. 1000 Section 0.~0. Block . 0.3 ...... Lot .. 10:.3 ........ Subdlvmlon ~/o Emil Cobbs Est... .. Fried Map No ..... Lot No 3 conforms substantially to the Apphcatlon for Building Pertmt heretofore filed in thru office dated September 11, 1987 16456 Z pursuant to winch Braiding Permit No ................. dated September 11, 1987 .......... was msued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for winch tins certificate m issued is ....... ONE FAMILY MODULAR DWELLING AS APPLIED FOR The cemficate m issued to of the aforesaid budding. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO PLUMBERS CERT][FICATION DATED: DANIEL G. CONKLIN ............ N001922 N/A Building Inspector Rev 1/81 TOWN OF SOUTHOLD OFFICE OF BU1LDING INSPECTOR P.O BOX 728 TOWN HALL SOU"I'IIOLD, N.Y. 11971 TEL 765-1802 To Whom This May Concern, We are unable ro complete your Certificate of Occupancy because of the following reasons. /5/ An application for Certificate of Occupancy is not on f~le. /?~ No Underwriters Certificate on file. /5/ The check is(outdated/not on file.) /~/ No }lealth Dept. Approval on /5/ No final xnspectlon has been made. Please contact our office on this matter. Thank you for your cooperatzon. Building Dept. ***/~/ No Plumber solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) 1. FOUNDATION ( ls t) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION ?ER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: Form No. 6 TOWN OF SOUTHOLD BUILDING DEPAiITME~NT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewrzter OR ink and submmtted to the building inspector wzth the following: for new buildmng or new use: 1. Final survey of property with accurate locatmon of all bumldzngs, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-dmsposal(S-9 form). 3. Approval of electrical znstallation from Board of Fmre Underwriters. 4. Sworn statement from plumber certifying that the solder used mn system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple reszdences and similar buildings and installations, a certificate of Code Compliance from archztect or engineer responsible for the building. 6. Submmt Planning Board Approval of completed site plan requirements. For exzstmng bumldings (prior to Aprml 9, 1957) non-conformzng uses, or bumldings and "pre-exmsting" land uses: 1. Accurate survey of property showzng all property lines, streets, buzldmng and unusual natural or topographic features. 2. A properly completed applicatzon and a consent to mnspect signed by the applmcant. If a Certzficate of Occupancy is denied, the Bumlding Inspector shall state the reasons therefor mn wrztzng to the appizcant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Addmtions to dwelling $25.00, Alterations to dwelling $25.00, Swzmming pool $25.00, Accessory buildzng $25.00, Addmtmons to accessory buzldzng $25.00. Busznesses $50.00. 2. Certificate of Occupancy on Pre-exzstzng Buzldmn~ - $I00.00 3. Copy of Certlfzcate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Resmdential $15.00, Commercial $15.00 Dare ........... "~.'<~.. ~ ................... New Construction ........... Old Or Pre-existing Buzlding..~.'~.~. . ....~..~?~..'~/'~.... '~/'~;~ * Location of Property .... ~..~.~...~..~..~z~....~.~.~..~..~../ .......... House No. Street Hamlet Onwer or Owners of Property..~Tf~..~../~/t.~ff~.~..~.~/.'.~ .................... County Tax Map No I000, Section.~..~. ......... Block..~,~ ........... Lot..4~/~-..¢.~?.~. ......... Subdivision ................................. ... F~led Map ............ Lot .................. ... . Permit No ..............., Date Of Permzt ............. . . . Applicant ..................... . . . .. .. . Health Dept. Approval ....................... Underwrzters Approval ................ Plannmng Board Approval ................. Request for: Temporary Certificate ..... Fee Submitted: $ ....................... ..... Final Certicate.~... APPLICANT FORM NO. 6 TOWN OF SOUTHOLD Budding Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be fdled in typewmter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use I. Final survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topograph ~c featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, Industrial buddings, Multiple Residences and similar buildings and installa- tions, a certificate of Code comphance from the Architect or Engineer responsible for the budding. 5. Submit Planning Board approval of completed rote plan requirements where applicable. B. For existing buddings (pmor to Apml 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of p~t~perty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buddings or premises, or other perhnent ~nforma- t~on required to prepare a certificate. C. Fees: Addztlons $25.00 1. Certificate of occupancy New Dwellzng $25.00, Accessory ,$]0.00 Business $50.00 2. Certificate of~ccupancy on pre-exist~ng dwelling $ 50.00 3 Copy of certffmate of occupancy $ 5.00, over 5 years $10 00 4.Vacant Lanct C.O. $ 20.00 5.Updated C.O. $ 50 O0 Date .......................... NewConstructIon ...... Old or Pre-ex~st[ng Buddmg .~ ......... Vacant/and ............. Hamlet House No. Street Owner or Owners of Property ........ ~- .'~t'~~, ..... ,.. ....................... County Tax Map No. 1000 Sect,on ...(~.. ~ .(~ ..... Block ....~. ~.. ...... Lot . ./.(~. ;. ~ ..... Subdlv,s,on .~. ~ .~-~M~ . .F,led Map No.7~.~.[..~.T Lot No..~. ......... Perm,t No. ~. ~ .~.~. ~. Date of Permit .~.~? ~f.?.Apphcant ............................... Health Dept Approval Labor Dept Approval ..... Underwriters Approval .................... Planning Board Approval ...................... Request for Temporary Certihcate ........... Final Cert~hcate ....................... Fee Submitted $ ....................... Construction on above descmbed budding and permit meets all apphcable codes and regulations Applicant .............................................. Rev 10 10-78 765-].802 BUILDING DEPT. INSPECTION FOUNDATION ].ST FOUNDATION FRAMING REMARKS: [ ] ROUGH PLBG. 2ND [ ]/~SULATION [~/J FINAL ~/~/~ ~o DATE //////~/~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [ ]~FINAL, REMARKS: *~/e ,~~ d-~ ~--~*Y-~--~-~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [/~FOUNDATION' IST'[ ] ROUGH PLBG. FOUNDATION FRAMING REMARKS: 2ND [ ] INSULATION [ ] FINAL DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]ROUGH PLBG. ]~OUNDATION 2ND [ ]INSULATION [ ] FRAMING , [ ]FINAL REMARKS: Approve~. I 1 Disapproved a/c BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORMNO I SURVEY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARIMENT SEPTIC FORM ............. : TOWN HALL NOTIFY SOUTHOLD, N Y. 11971 TEL 765-1802 CALL ................ MAIL TO: .,19 1 , 19~.] Permit No t (~ .~'~ ~ (Bulldmg Inspector) APPLICATIO'q FOR BUILDING PERMIT , SEP- l!987 , Date ........... 19.. INSTRUCTIONS a. Ttus application must be completely filled m bi' typewnter or in ink and submitted to the Budding Inspector, with sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of bufld,ngs on premises, relationship to adjoining premises or pubhc stree or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this appl cation. c. The work covered by ttus application may not be commenced before issuance of Budding Permit. d. Upon approval of this application, the Budding Inspector will issued a Bufldmg Permit to the apphcant Such perm shall be kept on the premises available for inspection throughout the work. e. No bmldmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmldlng Permit pursuant to tl Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances, RegulatJo.s, for the construction of buddmgs addmm~s or alterations, or for removal or demolition, as hereto descnbe The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulanons, and admit authorized inspectors on premises and in bmldmg for necessary inspections ..... ...... (Signature of applicant, or name, If a corporation) '' ' (flailing a h nt-ddre~pp--ca-') ........ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlde Name o~ owner of premises . ff~-~ ff ~ (as on the tax roll or latest deed) If apphcant ~s a corporation, signature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ........ Plumber's License No Electrician's License No Other Trade's License No Location of land on winch proposed work will be done· House Number Street County Tax Map No 1000 Section (Name) · Block . O Filed Map No Hamlet .. Lot. c'c~2 J -4 ~Lot .3 ....... State ex,sting use and occupancy of premises and ~nt~nded use and occupancy of proposed construction a Exlstlng use and occupancy . ~ b. Intended use and occupancy ,x~f~ . .//7/f~. .......... 3, Nature of work tcheck whicn .a bl w u lng ...... Addit,on ...... aiteranon ...... Repmr ....... ~ ~. Demolition ....... Other Work (Descnpllon 4 Estimated Cost . . ~f.~.t~., ~ .......... Fee .......................... ' (to be paid on filing thru apphcation) 5. If dwelhng, number of dwelling umts q~. .... Number of dwelling umts on each floor ......... If garage, number of cars .... ~ .o./t~ .~- ......... 6 If business, commercial or m~xed occupancy, specify nature and extent of each tyj2e of use ...~..o..,q. ~ ...... 7. Dmaens~ons of existing structures, if any Front ....~.O .... Rear ., .q.,O. ..... Depth . 7 ,O. ] ...... Heigdat . ~, ! .... Number of Stones . .. ~ ............. ~ '. ........... Dnnenslons of same structure with alteratmns or additions Front ......... Rear ........ Depth ............. Height ............ Number of Stones ......... ~ .... 8. Danennons of entire new construction Front ...~ .~,. / .... Rear ...2' .0 ~. ..... Depth . ./..~ ..... Hemht ./q'.' . ..... Number of Stones . ~ ........................... ? C;~ze o~ ~or ,~ront Y ~'6 .o. ..... Rear . . . ~?.__ . :. Depth- .q/3~,~ I0 Date of Purchase ..................... ~ame, ot P o _r:mer O~'ne; ' I 1 Zone or use district m which premises are situated .../{~' ' 12. Does proposed construction violate any zoning law, ordinance or regulation' .. ~.~..).~.rx~- ...... 13 WflI lot be regraded . .. ~ ~O..: .... ~ >,~ 2~'/a' Wilt excess fill. be~removed f/r~m pTem~ses Yes , 14 NameofOwnerofpremises ///,~t~. J,'~.~..Address .~.. /~d ~honeNo.~.~. Name of Architect . .,~.~O?--~.E. ....... Address . c/~..o.AJ_.~ ..... Phone No. Name of Contractor . .~.. ~g~r<~ ........ Address .~ ........ Phone No. 7.~ 15. Is this property located within 300 feet of a t~dal wetland? *Yes ..... (~ ..... *If yes, $outhold Town Trustees Permit maybe required. PLO~ DIAG ~AM Locate clearly and fl~stmctly ~Jl buddings, whether ex~stmg or proposed, and. indicate ~I set-back dnnenslons fro~ property hnes, G~ve street and block number or description according to deed, and show street names and red,cate wheth. interior or corner lot. ,7 STATE OF NEW YORK, S S COUNTY et (Name of md~vidual signing contract) above named ·.. being duly sworn, deposes and says that he is the apphcan He is the ................... (Contractor, agent, 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 tki. apphcation, that all statements contained m this apphcafion are true to the best of his knowledge and behef, and that th{ work wall be performed in the manner set forth m the apphcation filed therewith Sworn to before me this ......... ( ..... day of .... ~i ...... ~7. ~ N0[AI~.I,UmlC, s~ ~ li~ ~ (S~gnature of apphcan t VILLAGE OF GREENPORT s. 3. 39' 30" E. LA.