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Home My WebLink About26809-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27372 Date: 10/24/00 THIS CERTIFIES that the building ADDITION Location of Property: 5270 MAIN BAYVIEW RD (HOUSE NO.) County Tax Map No. 473889 Section 78 Subdivision Filed Map No. SOUTHOLD (STREET) (HAMLET) Block 4 Lot 33 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 27, 2000 pursuant to which Building Permit No. 26809-Z dated SEPTEMBER 29, 2000 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 CONVERSION OF HEATING SYSTEM "AS BUILT" AS APPLIED FOR. · ~ne certificate is issued to BARBkRA NORKELUN & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPAR~qT OF }IED~LTHAPPROVA3~ ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATW~3 Rev. 1/81 N/A PENDING 10/12/00 N/A ~ut~ature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUIT.DING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26809 Z Date SEPTEMBER 29, 2000 Permission is hereby granted to: BARBARA & ORS NORKELUN PO BOX 815 SOUTHOLD~NY 11971 for : CONVERSION OF HEATING SYSTEM~ "AS BUILT" AS APPLIED FOR. at premises located at 5270 MAIN BAYVIEW RD County Tax Map No. 473889 Section 078 Block 0004 pursuant to application dated SEPTEMBER 27~ Building Inspector. Fee $ 75.00 SOUTHOLD Lot No. 033 2000 and approved by the Rev. 2/19/98 ORIGINAL Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FORCERTIFICATE 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 o2 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - ~ .25N~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building ................. Location of Property.~.-~.~Q. ~ % ? .~......~...~.~. House No. Street Hamlet Onwer or Owners of Property.~...~.~. 60~J-~ ~~ O~,., ~z~ ~ ~ .............. - ................... ......... County Tax Map No 1000, Section .... l.~. ....... Bi~ck ...... .~. ........ Lot...~ ................ Subdivision .................................... Filed Map ............ Lot ...................... Permit No.~.~.~P.~.~.....Date Of Permit ................ Applicant.~. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $..~..~.:.0..0. .................. ''A FLIC T ................. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ _ ] FINAL [ ] FIREPLACE & CHIMNEY DATE INSPECT FORHN0. I TOWN OF SOUTHOLD BUILDING DEPARTHENT TOhqqHALL SOUTHOLD, N.Y. 11971 TEL: 765-1802 Disapproved a/c .................................. Inspecto /pLICATION FOR BUILDING PERMIT INSTRUCTIONS ~UARD Of HhALI~ ............... 3 SETS OF PLANS ......... ' ...... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... DEC ........................... TRUSTEES ...................... NOTIFY: CALL ... MAIL TO: .................... a. 'Ibis application u~st be c~npletely filled in by typewriter or in ink and anhmitted to the l~ilding Inspector ~ 3 sets of plarm, accurate plot plan to scale. Fee according to schedule. b. Plot plan shcr~ring location of lot ard of Buildings on pronisos, relationship to adjoining promises or public streets or areas, and giving a detailed description of layout of property mast be dram on the diagran which is port of this application. c. 'lhe work covered by this application may not be com~nced before issuance of Building Pemit. d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pemit shall be tmpt on the premises available for inspection throughout the x~rk. e. No Building shall be occupied or used in whole or in port for any IXWpese whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY bla/lg to the Building Department for the issuance of a Building Pennit pursuant to the Building Zone Ordinance of the To~n of Suuthold, Suffolk County, New York, ~and other applicable Laws, Ordinances or l~latiorm, for tim cotmtruction of buildings, additions or alterations, or for r~oval or ~molition, as herein described. The applicant agrees to o,,,.,ly with all applicable laws, ordinances, Building cc~le, housing code, and regulat~.ons, ~u~l to admit authorized inspectors on premises and in building for necessary inspections. ........ (Signature of applicant, or nam, if a corporation) (Mailing addr/ess of applicant) State wtmther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Builde Nane of ~ner of prem, ses '~"(as on the tax roll or latest deed) ''~'''~~'')''~' ~~'"~"~' .... ~ ..................... If applicant is a corporation, signature of duly authorized officer. (Nam 'and title of corporate officer) Builders License No .......................... Ph~ubers Licerme No .......................... Electricians License No ...................... Other Trade's License No ..................... llo~se Nmber Street I~,.1 et Cctmty Tax Map No. 1000 Section ................ Block ................ [ot ................ Subdivision ...................................... Filed Map No ................ l~t ............... (~) 2. State existing use and occupancy of premises and intended tme and occupancy of proposed construction: a. Ymisting use and occupancy ..................................................... : ....................... b. Intended 3. P;-~ture of ~ork (ct,~c_k ~hich applicable): I~ l~filding .......... ~iti~ .......... Alteration .......... [~ir ............ ~i~al ............. l~liti~ ............ Oflmr I~ .~..~~ ......... (~pti~ ~. Esti~mt~ ~st ............... f~ .............................................. (to ~ ~id ~ filing fids a~licati~) 5. If &rolling. ~mr of ~lli~ units ............ [~r of &~lling tmlts ~ ead~ fl~r ................ If garage. ~r of cars ...................................... fi. If ~si~ss, ~rcial or mi~ ~, ~ci~ ~ture ~ ~tent of ead~ ~ of u~ ...................... 7. Di~nsi~s of ~isting st~res, if a~: ~t ................ ~ar ............... ~pth ................. t~iO~t ......................... ~r of Stories ...................... Di~nsi~ of ~ st~re with alterati~s or ~itlons: ~ont ............... ~ar ............... ~pth .................... ~i~t .................... ~mimr of Stories ............... '~ 8. Di~mnsi~ of entire ~ ~st~ti~: ~t ................ ~ar ............... ~pU~ .............. l~i~t ......................... ~r of Stories ..................... 9. Si~ of lot: ~t .................... ~ar .................... ~pth .................... lO. ~te of ~rd~a~ ..................... ~ of Four ~r ........................................ I I. ~ or u~ district in ~id~ prmi~s a~ si~t~ .............................................................. 12. ~s ~o~ ~t~ti~ violate a~ ~ing 1~, o~i~e or re,latin: ........................ 13. Will lot ~ ~ .................... Will ~ess fill ~ r~ ~m ~i~s: ~ ~ ll~. ~s of ~r of ~s ........................... ~ress .............................. M~ ~ .............. ~ of ArdHt~t .................................... ~ress .............................. M~ ~ .............. ~ of C~tr~tor ................................... ~ress ............................... M~ ~ .............. 15. Is this p~rty ~fl~in ~ f~t of a till ~tl~? * ~ .......... ~ ...~. PLOT DIAGRAM l~ate clearly ~ disti~tly all ~ildi~s, ~m~mr ~isti~ or pro~, a~ i~icate all ~t-~ di~,nsions ~ pro~r~ li~s. Gi~ st~t ~ bl~ ~mr or ~scrlpti~ acco~ing to ~, a~ ~ strut ms and ~icate ~8mtlmr interior or co~r lot. .......................................................... being duly s~on,, deposes and nays that he is tlm applicant (t~re of i,xlividual signing contract) above mqmed, lle is the ................................................................................................... (C<~:tractor, agent, corporate officer, etc.) of .~aid miner or o~mers, and is &fly authorized to ~[[o~ or h~ l~rfo~ the ~ifl ~A a.l to rake a~ Pile this a~lllCation; that all state.ars c~tai~ in this a~l. icati~ are tn~ to die tmnt of his k~l~ and lml. le[~ al.l that the ~rk ~ill 1~ ~rfo~l in the ~r ~t forth in .................. ........ , ~ELI~B~ A 8TATHIS NOTARY PUBLIC, (SJ~l.ure of A~lJc~t) N0. Te~ Ex