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, .