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HomeMy WebLinkAbout14878-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19384 Date SEPT. 25t 1990 THIS CERTIFIES that the buildin~ ACCESSORY BUIIDING Location of Propert~ 390 WABASSO STREET SOUTHOI~ House No. Street Hamlet County Tax Map No. 1000 Section 078 Block 03 Lot 45 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 9, 1986 pursuant to which Building Permit No. Z14878 dated MAY 13~ 1986 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 BUILDING. The certificate is issued to GRACE M. WEST (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 I~'OEM NO. ~ 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.o 14878 Z Date Permission is hereb/gronted to: .... ~~...~.:....~.~ ...................... ....... u:......~.~.'.~.......~ ... ............. o, prem,ses,oca,e~ at .. ..3. ~..~ ........ ~.~......~....:. ....... ~.~ ............. County Tax Map No. 1000 Section ..... ...~...~..~. ...... Block ...... ~..~. ...... Lot No......~....~...'~,,. ........ pursuant ,o application dated ....... ~.~...C~ ........................ , 19..~...~, and approved by the Building Inspector. Fee $,, ~'.:.~ ..... Rev. 6/30/80 Form No. 6 TOWN OF SOUTBOLD BUILDING DEPARTME~ TOWN HALL 765-1802 i ' APPLICATION FOR CERTIFICATE OF · ~- 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. Z. 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 ) leas than 2/10 of lZ lead. 5. Commercial building, indus, trial building, multiple residences and similar bui/dings 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. B. For existing buildings (prior to April 9, 1957) non-conforming usefi, or buildings and pre-exzstxng" 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 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 ........... ,ew Constructi Old Or Pre-existing Building ............ Location of Property ............ ' .... Street .... ''° ....... ° ........... Onwer or Owners of Property... , / County Tax M~p No I000, Section ..... , ........ Block ................ Lot ...................... o. · ........ Date Of Permit ....... Appiicant..o ~.: ................ unaerwrfters ~pproval ......... Planning Board Approval ................. Request 'for: .Temporary Certificate ........... Final Certicate ........... HANDY~I HU'r® ... and your budget! TOWN, OF SOUTItOLI) OFFICE OF BUILDING IN~'PECTOR P.O. BOX 728 TOWN }[ALL SOUTItOL~). N.Y. 11971 August '9, 1990 TEL. 765-1802 Grace West 11 Whittier Street Lynbrook, N.Y. 11563 To Whom This.May Co~cern, We are unable to complete your Certificate of Occupancy because.of the following reasons. /--~/An_ application for Certificate of Occupancy is not on file. '(ENCLOSED) /~/ /No Underwriters Certificate on file. /_~/~ The check is(~g~not on file.) $25.00 /5/ No 1Iealth Dept. Approval on file. /~/ No final inspection has been made. Please contact our office on this Thank you for your cooperation'. Building Permit It I 4 8 7 8 Z Buildinq Dept. ***/]/ matter. No Plumber Solder Certificate on ( all permits involving plumbinq beinq l~oued after April 1,1984 ) file. FIELD INS. FECTION FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE COM!~ENTS g FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined....Nh 19 Approved ...~....~).~...., 19 .~.{q Permit Ncx].?.~. ?. ~ ."~ Disapproved a/c ..................................... ................................ ...... APPLICATION FOR BUILDING PERMIT - 91986 ii BLDG. DE~:~T ~ TOWN OF SOOT.~ ~, t~ il l~ece±ved ........... ,39... Date ,~.].~.~.../.q ......... 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 of applicant, or name, if a corporation) ......... ./'/...4/:,,f/..r2'. ~' ~:,.:'.e... F.U. ............ :' :..:: ~.¥~,e.~..,,.?. .... ~..v. ...... /./.r.L~. ....... . ' )'e.~;~"~%~,':~ /'}.~:l~'~tling address of applicant) State whether applicant is owner, lessee agent, architect, en~neer, gen~e!~al cprttragtor ,electrician, plumber or builder. ..................... O..~..~..?ze ......... .,.....: ... e: ?.~'.. ?. :; ...................................... Name of owner of premises .C./&/..£... ,r~,~.,: dg..~.W'i~ 'i.. ~.:.;... !. J .............................. ,'~, ~ :.(as qS:g~e..t~x roll or latest deed) If applicant is a corporation, signature of duly authorized ~fficer. i ' (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ...... ~..~. 0. . ./M. did. ~g'.._cp .... ~....7'~. ................ ~o~r-/~o~o M..e..././.fT.I. House Number Street Hamlet County Tax Map No. 1000 Section ..... 7.~. .......... Block .... ~ ............ Lot .....q..5. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ............. .-7.~..o.q ..~. .... 5'.A,'.W..~ ..................................... 3. Nature of work (check which applicable): New Building .......... Addition .. ~ ....... Alteration .......... Repair .............. Removal .............. Demolition ............ ;.. Other Work .dt¢¢r4z.~ .~ ..... .' (Description) 4. Estimated Cost .................................. Fee .......... ~ ........................... (to be ~aid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unfl 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 structures, if any: Front ............... Rear ............. Depth ............... Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ......... ~. ............ 8. Dimensions of entire new construction: Front ............... Rear ........ ! ...... Depth ............... Height Nmnber of Stories ~ 9. Size of lot: Front ...................... Rear ...................... pepth ..................... 10. Date of Purchase ............................. Name of Former Owner . ~ ........................... 1 1. 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 ............................ Will excess fill be removed from premises Yes No 14. Name of Owner of premises .................... Address ............... '.... Phone No ................ Name of Architect Address ' Phone No Name of Contractor .......................... Address ............. ... Phone No ...... 15. Is this property located withinl.00 feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may _be required. Locate clearly and distinctly all buildings, wh or s d. indicate all set-back dimensions from property nnes. Give street and block number or descl4~tl~a~di~41~llle~tll~l~,lhlSvi street names and indicate whether interior or corner lot. ~1~ I0 UI'~IL,P~VVI"J, JI,,, APPROVED AS NOi r .. BY, V- NOTIFY BUILDING DEPARTMENT A"~ 7B6-1802 9 AM TO 4, PM t=OR THE FOLLOWING tN~PF. CTIONS: 'i FOUNDA'rlcm.~ TWO r~QUIRED FOR POU~ltt~O CONCRE~rE 2 ROUGH ~-:~:~A~ttl~G & PLUM~IING 3. INf~ULA rIO~,l "Dq~ PI~QUtR[':.MENTS Of: THE N.Y :~TATE CONST~IJCTION & ENERGY CODES, ~OT RESPONSIBLE FOR ~"~,~StG~',~ OR CO~'~PFRUCT~ON ERRORS, STATE OF NEW YORK, S.S COUNTY OF ................. WITHOUT CERTIFICATE OF OCCUPANCY (Signature of applicant) ................................................. being duly sworn, depoies and says that he is the. applicant (Name of individual signing contract) : above nmned. He is the ............................................................. i ........................... (Contractor, agent, corporate officer, etc.)! of said owner or owners, and is duly authorized to perform or have performed the sfiid work and to make and file this application; that all statements contained in this application are true to the best of his e and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............. t~ ........ day of ..... . .~..~ ........... 19~..