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HomeMy WebLinkAbout14215-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20258 Date OCTOBER 3, 1991 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property 950 SOUTH HARBOR ROAD SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 75 Block 3 Lot 13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 5~ 1985 pursuant to which Building Permit No. 14215-Z dated AUGUST 22~ 1985 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 GARAGE ADDITION & ALTERATION TO EXISTING GARAGE TO LMNG AREA OF EXISTING ONE FAMILY DW~.TW.ING. The certificate is issued to JEANBTTK H. GOLDEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING PLUMBERS CERTIFICATION DATED SEPT. 26~ 1991 - RALPH GOLDEN 'Building Inspector Rev. 1/81 FOB,11d[ NO. lB TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ('I'HIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO Permission is hereby gronted to: ...... ..~.~.~.~..~....~.~ .......... .... ~.~.~.~./.. ~../.~.....~.~......~ ............. .... ~.~ ~.--~......~ .~.. '/..: ...................... ,o ...~.~....~..~ ....... ~.~ ..... ~~....~_._~ ~._.~./~.~.:...~... ~.~.~..~..~. ......... ~ ........ ~JJi~...~/~.-~. ............................. o, pre~,~,,L~,~ ~, ....... ~:.0.. ........ ~..~./....~/..~....~..~.~.,.~.:~ .................... .......................................................................................................... ,:~.~.o....~....'/., County Tox Map No. 1000 Section ....~...Z.~...-~.. .... Block .. ... .~. .. .. ~.~.. ....... Lot No.....(~..../....~.. .......... the Building Inspector. Rev. 6/30/80 BLOG, DEPF. ]-OWN OF ~/)UT~O O APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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. Bl 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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 i Date ....... ~.~P~ ...... ,. ~ .......... Ne~ Construction ........... Old Or Pre-existing Building ...... g .......... Lo~ation of Property.. ~Q. ~P.~. ~.~X~ .~.~..~PB~q~.~..~. %q~...%~7~ ............. House No. Street Hamlet On,er or Owners of Property ...... ~.~.~ .~,. ~Q~ ...................................... CoUnty Tax Map No 1000, Section .... .~.--. .... Block ....... ~. ...... Lot .... /.~. ............. Subdivision .................................. .. Filed Map ............ Lot .................. .... Permit No .... 1~ ..... Date Of Permit .... ~f~ .... Applicant.. ~D~. ~....~0%~ ..... Health Dept. Appro .... Underwr Approv ................ val ...................... iters al ~0/~ Planning Board Approval ........................ ReTuest for: Temporary Certificate. .. Final Certicate... ~ ...... ......... TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit Owner ~c ~ O~r~ (please print) '(fflease ~rlnt) I certify that the solder used in contains less than 2/10 of 1% lead. the water supply system Sworn to before me this 19_q NOtary Public, ROBERT L SCOTT, IR. NOTARY PUBLIC, State of N.~ N~. 4725089, Suffolk Tefra Expires May 31,49 (plumber's signature County Al iClo~v or Formerl~l . . ', APP?~O¥~D AS NOTED ~ NOT!~ ~UILD]NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE ~ ~ m~v'~ ~ INSPECTIONS: . ].. FOUNTAIn,ON.. - TWO R~QUIRED_ FOR . . ~.~ D CONCRETE 2. R~.~ F~MING & PLUMBING 3. [NSU~Z'~ON 4. F~N>L C~ cz~ ~¢m~mkl MUST BE ~¢'~4~ z== FOR C. O. ALL CO~, h.~ .~N SHALL ~E~' :THE REQU{REMENTS OF THE N.Y.' ~ATE' CONSTRUCTION & ENERGY CODES. NOT .RESPO~S!B~. FOR .D~IGN OR CON~RU~ION ~ 99 35 ~0 W ¢?.0 ,, , . , FIELD ~INSP~CTION COMMENTS FOUNDATION (~st) FO~UNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N, STATE ENERGY QpDE FINAL ADDITIONAL COMMEN,TS 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 7654802 Received.~/~-.. .... ,19 .~ff. APPLICATION FOR BUILDING PERMIT Date...~. ............... 19 fl. INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 · gr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- · 4ation' ~ ! 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 flhall 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 aall 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 ;uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, bu/j]ding code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary~.e~t!ons. ,~ ~...._, .... 'd ;';;a'd,;d .... (Signature of applicant, or nOhe, if a o p ' ) ...... (Mailing address of applifcant) ~tate whether applicant is owner, lessee, agent, archite~t, engineer, general contractor, electrician, plumber or builder. game of owner of premises . ..~..t-..~.( .~. ~/Z$.. ~,~./~../.../~.-..G.O. ..r~. ........................... (as on the tax roll or latest deed If applicant is a corporation, signhture of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~./.~.5 .'~'. ............. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... !. Locationoflandonwhichproposedworkwillbedone...?~..~...~..°-.~..~.~-.&.t.~..°.~..-~.d ............... ltouse Number Street Hamlet County Tax Map No. 1000 Section ...~..?..~'7 ......... Block .... .~. ............ Lot...).~. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ~. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which ~pplicable): New Building './ ..... Repair .............. Removal .............. ' Demolition .. 4. Estimated Cos .t~.'. I ........... Ot er Work ............... ~..~.~. ~ (Description) (to bo paid on filing this application) 5. If dwplling, number of dwelling units .... ,/ .......... Number of dx ,elling units on each floor... / If garage, number of cars .... [,~ ............ . ..................................... ...: ............ 6. If business, commercial or mixed occupancy, specifv~nat}tre and extent)f eac_9.h t¢,pe of use ............. 7. Dnnensmns. pfe){~stingstructures,~fany: Front ........... Rea: . ~ ......... Ddpth .80. ...... Height ./..~. .......... Number of Stories . ................ ................... ........... Dimensions of same structure with alterations or additions: Front ~ ......... Rear .. ~ ............ Depth ............... !... Height . ./..~.... ~, ..... ! ...... llumber, of Storjes ..... l. ................ -' 8. Dimensions of entire new construction: Front . .~'. · .7~.... Rear . ~-,~.~'"*-' .7~. :...Depth .r.~O. .~ ......... Ho ¢,ht ! t,./ .Number rff gtori~ / 9. S~ze of lot: Front . J. OO.. 'i ............ Rear ,../. D..~ ............... Depth ~,O~.: ~ ........... 10. Date of Purchase .......... i ........ '-' .......... Name of Forme~ Owner ... ~ ........................ I 1. Zone or use district in which pNmises are situated...~..* ~.a/e.~ .~. t.o .................................. 12. Does proposed conStruction vi01ate any zoning law, ordinance or mgulal ion: ./~/.O ........................... 13. Will lot be regraded ./~/.O ............. ,,..,.~ ...... Will excessfllL ~e re~aoved,.fl~om premises: Yes 14. Name of Owner of premmes .~.,.~"~o ..... : ..... Address . ,~ o~ -~...t~.M Phone No../~.. ~.~.3-.~ .O.~... Name of Architect ....... .':-. .....,.- ........ Address ........ Phone No ................ Name of Contractor ~'~*~7": '~"/e.~.. ~ ..... Address ~.~.~! ~.~.~ i ' I~ ~1/.~2''' Phone No.~.~'..-.,5']~..2.. ~... [ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propos, ~d, and. indicate all set-back dimensions from property lines. Give street and block number or description according to dee{ and show street names and indicate whether interior or comer lot. lO O ), ,! .... , ] zoo-q° . ' Bo,o STATE O F NEW~r'O'JRK· ~' oe ) r.l, l ~,,, *o~l 4 ..... · .~. · · .~'~-~.' · f/~ *./..~"~ ................... being duly yom, deposes and says that he is the applicant (Name of individual sigging contract) above named. He is the ................ O~;~~ ................................................... (Contractor, agent, corporat~ o fleer, etc.) of said owner or owners, and ~s duly authorized to perform or have perfo: med the said work and to make and fli~'-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 man~er set forth in the application filed there~ Ath. Sworn to before me this ........ ...... day f ..... .... N ot . PubUc, ........ .... fl, .