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HomeMy WebLinkAbout15099-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19007 Date MAY 1, 1990 THIS CERTIFIES that the building Location of Property 795 MONSELL ~ House No. County Tax Map No. 1000 Section 138 Subdivision ADDITION AND ALTERATION CUTCHOGUE~ N.Y. Street Hamlet Block 01 Lot 05 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 12, 1986 pursuant to which Building Permit No. 15099Z dated JULY 18~ 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 ADD A DECK & REBUILD FRONT PORCH AND ALTERATION WORK ON KITCHEN, BATH & BEDROOM AS APPLIED FOR. The certificate is issued to GERALD S. WELLS & WIFE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HFJkLTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PElbk~lT ('THIS PEP>AlT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15099 Z Permission is hereby granted .~.~:..~.~...> ~,~' · ..~...,~,~..>,.~,~ ..:~..>..... at prem,ses 'o~ated at .......~....~.~ ....... ./~..~...~...~ ................ ...................................... ............................ Coun~ Tax Map No. ,000 Sect,on ..1~.. ....... B,~k ....(. ................ Lot No....~..~ ...... pursuant to appJication dated~.....Z~ ................. , lC).~..~and approved by the Bu~l,ng Inspector. Fe, ~..(./..,.~...~. Rev. 6130/80 FOUNDATION FOUNDATION (1st) (2nd) ROUGH FRAME & ?LUMBING INSULATION FERN. STATE ENERGY CODE FINAL 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined Disapproved a/~¢- ..................................... Received ........... ,19... (Building inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 ali 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) ~:" (Mailing address of applic'ant) State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~. ~ ~. · .~...~ .x.~. - · ~ .......................... tas t era roil or lat~rt deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · Builder's License No...,/'~ · .' Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done} ............. ~. ................................ ........ ............ .............. County Tax Map No. 1000 Section . .~..~.~. .......... Block ...... / ........... Lot...~...'~'. ............. Subdivision .... ~~ ............... Filed Map No. .1,~ .~.~'... Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~...~ ............ ~.~,~ .a.~ ~,~ .... ; ............. b. Intended use and occupancy .~.~.~--~. ~ ~;'~ .... 3. Nathre of work (check which a~plicable): New Building .... ' .. Addition .... Alteration . Repair ......... ~,~.. Removal .............. Demolition .............. Other Work ............... I ............... Fee ~.~.~Y'..~.~..~.Z--" , ~ (Description) 4. ~snmated Cost ..... ~''/:, '~ '~'to be paid' ......................... on filing' this' application) 5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................ If garage, number of cars .... ] .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extant of each type of use 7, Dimensions of existing structurps, if any: Front .... ; .'.. ~ ....... Rear ............... Depth ............... Height ............... Number of Stories ....... ., ................................................. Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ,' Height Number of Stories Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9 Size of lot: Frd[nt ' Rear ............ ' ................................. Depth ...................... 10 13 ' . ate of Purchase ......... , Name of Former Owner ..................... 1 1. Z~one or use district' ' in which prbmises are situated ......................... 12. Does proposed construction vio~late any zoning law, ordinance or regulation: ......................; ......... 13. Will lot be regraded ........ ! ........... ,. ....... Will excess fill be remglved~from premises: Yes No 14. Name of Owner of premises ~. ~',./,~d/.,d~ ..... Address'~7~./.-~. ~.. Phone No. ~.,~ ~,. ,~ .~',,~?.' Name of Architect ......... ' ................ Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address .... : ............. .,P~hone No ................ 15. Is this property located iwithin 300 feet of a tidal wetland? eyes .~.. No ..... *If ye.s, Southold Town Trustees Permit maybe 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 blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S cout, rrY OF ................. ............................. ~ .................... being duly sworn, deposes and says that he is the applicant :(Name of individual signi,ng contract) above named. He is the ...................... i .................................................................. i (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 manne~ set forth in the application filed therewith. Sworn to before me this Notary Public ............. i .... County ' (Signature of applicant) ~LDG. DEPT. TOWN OF SouTHOLD Form No. 6 TO'tN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ?PLICATION 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. 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 $1f. 00, Commercial $15.00 ........... New Construction...~,. .... Old Or Pre-existin ..... Location of Property ..... 2f.~. ...... .~.... House No. Street Hamlet Onwer or Owners of Property .............. ' County Tax Map No 1000, Section.~.~.~ ....... Block ..... ~ .......... Lot...~., ............... Subdivision .................................... Filed Map ............ Lot ...................... Permit No. ~ .~.~ ~...~..Date Of Permit...~.*~..~.~ ...... Applicant ............................. Health Dept. Approval ........................ .. Underwriters Approval ...................... .. . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~. ..... '~ee Submitted:~,~O ' $' '~' '~'~.....~. , ! y.~,~.../.O.F. ,,~.... ~ ,~.~, ~ ,. ................