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HomeMy WebLinkAbout27513-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27861 Date: 08/09/01 THIS CERTIFIES that the building ADDITION Location of Property: 505 RUCH LA GREENPORT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 52 Block 3 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 24, 2001 pursuant to which Building Permit No. 27513-Z dated JULY 31, 2001 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 INSTALLATION OF NEW HEATING SYSTEN IN EXISTING SINGLE FAMILY DWELLING AS BUILT "AS APPLIED FOR" . The certificate is issued to EVERTON M. HOLDER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 08/02/01 PLUMBERS CERTIFICATION DATED N/A Authorize Si ature Rev. 1/81 FORM NO. 3 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) PERMIT NO. 27513 Z Date JULY 31, 2001 Permission is hereby granted to: EVERTON M. HOLDER 505 RUCH LA SOUTHOLD,NY 11971 for INSTALLATION OF NEW HEATING SYSTEM IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS BUILT" at premises located at 505 RUCH LA GREENPORT County Tax Map No. 473889 Section 052 Block 0003 Lot No. 004 pursuant to application dated JULY 24 , 2001 and approved by the Building Inspector. Fee $ 150 . 00 Autho d Vignature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOU'THOLD BUILDING DEPAR'TMEN'T TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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, industr.iat 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. B. For existing, buildings (prior Lo 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - .25C 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .August, 3,,, 2001. . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . 327 . . . . . . . . Ruch Lane Southold House No. Street Hamlet Everton A. Holder Onwer or Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . County 'Tax Map No 1000, Section. . 52... . . . . . . . .Block. . . . . .3 . . . . . . .Lot. . . 4 . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . 27513 Burt' s Reliable . . . . . . . . . . Permit No. . . . . . . . . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . Applicant . . . . . . . . . . . . . . . . . . llenl.tli Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: 'Temporary Certificate. . . . . . . . . . . Fill _ erticate. . . . . . . . . . . 00 Fee Submitted: $. . 25. . . . . . . . . . . . . . . . . . . . . . . . Q s f94 . . . . . . . . . . . . . APPLICANT Co Z-a-?g6t TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Budding Plans TEL: 765-1802 survey PERMIT NO..d $ ! Check . Septic Foim N.Y.SD.E.C. Trustees Examined ,20 Contact. Approved ,20 Mad to: Disapproved a/c Phone: Build Inspector APPLICATION FOR BUMDING PERMIT. Date, , 20 _ 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 waterways. 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 issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupancy is issued 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 cr. ed.The applicant agrees to comply with all applicable laws,ordinances,building code,houa and regale ' ,and to admit authorized inspectors-on premises and in building for necessary inspections. r . (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor,electrician,plumber or builder Name of owner of premises_ J'/�', Z V e rl,0lJ /7d/ler (as on the tax roll or latest deed) If applicant is a co ration, signature of duly authorized officer T0/5,k/ ©rte, 0--ZZ Z- U, (Name and title of corporate officer) Builders License No. Plumbers License No. c23 7�� Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will bene Asch 1-4x- o House Number Street Hamlet County Tax Map No. 1000 Section Block 3 Lot Subdivision Filed Map No. Lot (Name) ;. Mate existing use and occupancy of premis an intended use and occupancy of proposed conshucdon: a. Existing use and occupancy �.5,,W,<� g b. Intended use and occupancy Nature of work(check which applicable):New Building_.Addition - � o D, Repair Removal _ Demolition Other r� e ` t icrtion) k Estimated Cost Fee (to be paid on filing this appli(iaiion) >. If dwelling,number of dwelling units l Number of dwelling units on each floor If garage, number of cars r mixed occupancy, specifynature and extent of each type of use. i. If business, commercial.o cup cY� j�z7. Dimensions of existing structures,if any: Fro Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Al Rear Depth Height Number of Stories. S. Dimensions ofen ew ction: Front Reaz Dept Height Number of Stories D. Size of lot:Front RearDepth 10.Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated sed constriction=tmngaw, ordinance or regulation:12. Does propo13. Will lot be re-graded Will excess fill be removed from premises: YE 14.Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15. Is this-property within 100 feet of a tidal wetland? *YES • IF YES, SOUTHOLD TOWN TRUSTEES PE S E REQUIRED 16. Provide survey,to scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS. COUNTY O being duly sworn;deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (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. Sw rn tq,before me this r 4` day of JQQ 20 Q k_ 0' Notary Public tignature of Applicant LYNDA M. BOHN NOTARY PUB011B06020932 of New York oualified in Suffolk County Term Expires March 8,20�L The New York Board of Fire Underwriters Bureau of Electricity is in the process of issuing a certificate of compliance for the electrical installation as provided for in the application for inspectioW�� ``W 32-7 Ou&4 e►. New York Board of Fire Underwriters Bureau of Electricity Inspection activity pursuant to Application # OIL has been completed and a certificate of compliance setting forth the detail of the ea Y: s eing prepared Inspector D to Form 00(Rev.06/00)