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HomeMy WebLinkAbout26842-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27356 Date: 10/17/00 THIS CERTIFIES that the building HEATING SYSTEM Location of Property: 25330 MAIN RD ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 18 Block 6 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 11, 2000 pursuant to which Building Permit No. 26842-Z dated OCTOBER 17, 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 INSTALLATION OF NEW HEATING SYSTEM & HOT WATER HEATER AS APPLIED FOR "AS BUILT" The certificate is issued to CHARLES EMER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 10/10/00 PLUMBERS CERTIFICATION DATED 10/12/00 MARK BLOCK Auth ized Sign ture 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. 26842 Z Date OCTOBER 17, 2000 Permission is hereby granted to: CHARLES EMER 501 MEADOW OAKS COURT EL PASO,TX 77932 for INSTALLATION OF NEW HEATING SYSTEM & HOT WATER HEATER AS APPLIED FOR "AS BUILT" . at premises located at 25330 MAIN RD ORIENT County Tax Map No. 473889 Section 018 Block 0006 Lot No. 008 pursuant to application dated OCTOBER 11, 2000 and approved by the Building Inspector. Fee $ 75 . 00 AuthorizEff Signalrure ORIGINAL Rev. 2/19/98 Form No. 6 CONTACT: TOWN OF SOUTHOLD Bill Cooper 477-0551 BUILDING DEPARTMENT TOWN HALL Call Deborah Doty when 765-1802 pre-C/O is available 734-6648 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, 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. B. 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 $15.00, Commercial $15.00 Date : . 9/25/2000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. .yes. . . . . . . . Location of Property. . . . ?5330,Mai_n.Road4 .C►rient . . . . . . . . . . . . . . . . . . . . . House No. . • , . . . Street • • • • • .Hamlet. . . • • , . • . • • • . �er or Owners of Property. . . . . W. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .County Tax Map No 1000, Section. . . 1 . . . . . . . . . .Block. . .6 . . . . . . . . . . . .Lot 8 . . . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicare. . .Yes . . . . . Fee Submitted: $„100;00 . . . . . . . . . . . . . . . . �— B� d 9 357 Town Hall,53095 Main Road = Fax(516)765-1823 P.O.Box 1179 Telephone(516)765-1802 Southold,New York 11971 • OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: Building Permit No. Owner: /71f-X--�'-A X Y (please'print) Plumber: `y��c,� �L o c� (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this Carrie Anderson Notary Public,State of New York t 2 �� day of OC.-vobel- RsgWtratlon#01AN6033841 Q atrfied to Suffolk County Notary Public, SuS��\\{ County Nov. 29,2001 BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . _ . . . TOWN HALL SEPTIC FORK . . . . . . . . . . . ... . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NOT I FY Po� CALL . . . . . . . . . . . . . . . . . . . Examined . . . ., MAIL TO . . . . . . . . . . . . . . . . . . . . Approved . l/ . . . . Permit No.c�. ya-' . . . _ . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �, . . . (Building I Spector) APPLICATION FOR BUILDING PERMIT Date . . . '.1.0/1A/2000/2000 19 . . . 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 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for inspectio Signature of applicant, or name if a coro� c/o Doty, PO. Box. 1181,. Cutchue og ,,NY. , 11 935,., . . . . . . . . . . . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. attorney for owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . .Charles.> ne. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest 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. . . . . . ... . . . . . . . . . . . . . . .Burt's Reliable Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . I. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25330 Main Road, Orient, NY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... . . . . . . . . . . . .. House Number Street Hamlet County Tax Map No. 1000 Section . . . .18. . . . . . . . . . . . Block . . . . .6. . . . . . . . . : . . . Lot . . . B. . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . (Name) 2.. State existing use and occupancy of premises and intender; use and occupancy of proposed construction: a. Existing use and occupancy . . . :9ne-fqWi1y.residenee • • • . . . . . . . . . . . . . . . . . . one-family residence with new hot water heater b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -3. Nature of work (check which applicable): New Building . . . . . . . . . : Addition . . . . . . . . . . Alteration . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . Other Work sea below . . . . (Description) 4. Estimated Cost . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . : . . . . . . . . . . . .. Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of-each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . . .. . . . . . . . Rear . . . . . . . . . . . . Depth . . . . . . . . . . . . . ... Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . ... . . . . . . . . . . . Depth . . . . .. . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . .Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . .. . . . . ... . . ... . . Rear . . . . . . . . . . . . . ... . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . :. . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . • Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . Nameof Contractor . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . 15. Is this property within 300 feet of a tidal wetland? *Yes. . . . . No. . . . . . . . . *If yes, 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. Building Permit for an existing.new hot water heater that was installed in 1998+ STATE OF NEW YORK, S.S COUNTY OF . . . . .WMI TA . . . . . . . . . . . .t?MPU1 H J> m . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . being duly sworn, deposes and says tha ns the applicant (Name of individual signing contract) above named. Ua-� .She.is .the attorney. for•the•owner• :. . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 1jj&knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. iworn to before me this . . . . . . . . . . . . . . . . ... . .day of. . .OCtober . . . . . . . ..4#-2000 JUDY L OKEEFE Notary Public,State of Newyork CO u ,lotary Public, .NoL 30 4OW952 • • • • • • • • • • Qualified in Nassau County. \ Commission E*resJon t lY 13,1 �t . • • . (Signature of applicant)