HomeMy WebLinkAbout15041-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTME~qT
office of the Building Inspector
Town Hail
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19838
Date APRIL 5~ 1991
THIS CERTIFIES that the buildin~
Location of Property 1395 NAUGLE8 ~RIVE
House No.
County Tax Map No. 1000 Section 99
Subdivision
ADDITION
~TTITUCK,
Street Hamlet
Block 4 Lot 16
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 19, 1986 pursuant to which
Building Permit No. 15041-Z dated JUNE 27z 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
AL ~ND MARGARET LANE
Rev. 1/81
I~O~B~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDilNG PERA~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 15041
Z
Permission is hereby grant~[?~: ~. . ., ~
............
..............
at premises I~ated at ./..~.~.~.~~.....~.~ ...............
County Tax Map No. 1000 Section ...... ~m~ · ~ ...... "'[k ..... gl ~ ........ Lot NO' '''!''~'' ..............
pursuant to application doted ....... ~....!....~. .................. , 19.~...~., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 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.
]. 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 - $i00.00
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 Construction...~ ...... Old Or Pre-existing Building .................
,ocation of Property~ ..... !~}! .~P.~. P~% ......... ~.~P~ ............................
House No. Street Hamlet
}nwer or Owners of Property Ag ~ ~AR~N~
ty 099
]oun Tax Map No 1000, Section .............. Block ............... Lot ....................
:~bdivision ................................... · Filed Map ............ Lot ......................
'ermit No ................ Date Of Permit ......... cant .............................
ealth Dept. Approval .......................... Underwriters Approval .........................
lanning Board Approval ............. ~ ...........
equest for: Temporary Certificate ........... Final Certicate ...........
ee Submitted: $ .............................
TOWN OF SOUTIIOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTIIOLD, N.Y. 11971
TEL. 765~I 802
To Whom This May Concern,
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
/5/ No Underwriters Certificate on file.
?he check is(oU~not on file.) $25.00
/5/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Dui]ding Permit t~ I 5 0 4 I Z
Building Dept.
***/5/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728'4
TOWN HALL
SOUTItOLD, N.Y. 11971
TEL, 765-1802
To Whom This May Concern,
We are unable to complete your Certificate of Occupancy because
of~follo~iag reasons.
)An appl~.cation for Certificate of Occupancy is not on file.
)No Underwriters Certificate on file.
w/~The check is (~/not on file.)
)No Health Department Approval on file.
)No final inspection has been made.
.Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # ].._~__0._ ~ . ] Z
)No Plumber Solder Certificate on file.
(all permits involving plumbing being isBued after
April 1, 1984)
FOUNDATION {1st)
COMMENTS
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING'
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
t
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
COUTHOLD, N.Y. 11971
TEL.: 765-1803
Approved 19 .~.~. Permit No. )..~.'~.
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. 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 prenfises 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 inspe~,~s./.¢45:~... ~"~..
(Signature of applicanfh-~fname, if a corporation)
.... ..... !3(... ..... : .... . .......
(mailing addresg of applzcant) .
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... ~..~.z~..~/? ..................................................................................
Name of owner of premises ..... ff...~.. · ~ .~.~- ~. .......................................................
(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 ..........................
Plumber's LicenseNo .........................
Electrician's License No .......................
Other Trade s License No ......................
1. Location of land on which proposed work will be done ..................................................
..... /3. ................ ............ ..........
House Number Street Hamlet
County Tax Map No. 1000 Section ...... ~..~. ........ Block ...... .~. .......... Lot.../~. ............
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 ...... ~.~.~(_,. ~.. .~./fl~/~../4 .~.. ~., ..¢5',~.~.~.~..~..~..~' ......................
b. Intended use and occupancy ....~../../~.~.~. .... .z~.~..~.~.,4..~.....~..~.' .~?.~..~.z.-:~..6..¢.-~ .....................
Ns,ute apphcable): New ,,u,ldmg .......... .*. dditio , teration.
ReI~air ........... ; ..j ~R~moval .............. Demolition ...... n. ..... Other Work ...............
ii1118 [ ~,!, ~ ~, (Description)
4. Estimated Cost . .~/~,~.¢g" ............... Fee ......................................
....: ; :... ', Z .&/4 .~:: , ........... (to be paid on filing this application)
5. If dwelli 'ng, nt~m~er ~ ~iweliing units .... /. .......... Number of dwelling units on each floor ................
If garage, number of cars .... i. · ./ .................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......... ,,~.~ .........
7. Dlmenstons ofextshng structures, tfany: Front...~. ~.' ........ Rear .. 0¢..~; ....... 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 cons/ruction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stohes . .
./, J7'.C9 -i R ' '
· Depth ,/4~.. d~.~....
9. Size of lot: Front ... ,,~.~ . .~ ............ ear .... ,/,~. ff. ............ ~ ....... ~ '
10. Date of Purchase .... ~:/.~.i :~.f~. ............. - Name of Former Owner .... ~ Z-. ~.4¢¢. ................
.... ' · . ............ ~¢...f/.,e.~cc...~.,~..z ...........................
11.Zone or use d~stmct m which ptemmes are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: ................................
Will lot be regraded ...,,dfC. ~i'. ...... ,~r ....
13 ......... Will excess fill be removed from premises: Yes No
14. Name of Owner of premises ,~. ,l, dl¢.~., ..... Address3]~.l% ,c,~,¢~ ,¢¢4~-,~ Phone No .~.~.'~ ' .~.,2...ff~.
...... --,, ' ;¢,/~, ~-,4,?,4t,;¢~ ....................
Nam~ of Architect ......... i .................. Aooress ................... Phone No ................
Name of Contractor ~.,¢¢~'¢...ff//?Rq?~. ,~./PX, .,¢.44.e..,. Address ~X'. ~.2..¢I¢, .~.¢..~dd(.i,~Phone No..'J'd.~. :?.,¢?~'....
15. Is this property located withinl.00 feet of a tidal wetland? * Yes ..... No ..~.,.
· If yes, Southold Town T~ustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street nanms and indicate whether
interior or comer lot.
STATE OF NEW YORK,
COUNTY OF ............ S.S
........... ~.~.....~.'~.."~..~'. ....................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ....... C~?.~...Y-'./4 .~..' '~' .'fi-:. · ...............................................................
(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 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
..... /. ?..~.~.~ .......... ,~ay 'of..."~?.' .df?~...: ......... 19.~.
Notary Public ......... .~ ......! ................. County
Notary Public, Sta~ of N~w York ........................
I~o. ~sa~ ((.~nature of applicant)
Qualified in Suffolk County
Commission Expireal M/u, eh 30, 19~7'