HomeMy WebLinkAbout26660-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27206 Date: 07/25/00
THIS CERTIFIES that the building ACCESSORY
Location of Property: 375 AKA 706 BROWN ST. GREENPORT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 48 Block 3 Lot 22
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 10, 2000 pursuant to which
Building Permit No. 26660-Z dated JULY 21, 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 ACCESSORY GARAGE IN REAR YARD AS APPLIED FOR "AS BUILT"
The certificate is issued to OLLIE M. BOYD
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
A h rized Signature
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. 26660 Z Date JULY 21, 2000
Permission is hereby granted to:
MELISSA CLARK
103 STERLING AVE.
GREENPORT„NY 11944
for
CONSTRUCT ACCESSORY GARAGE IN REAR YARD AS APPLIED FOR
"AS BUILT"
at premises located at 375 aka 706 BROWN ST GREENPORT
County Tax Map No. 473889 Section 048 Block 0003 Lot No. 022
pursuant to application dated JULY 10, 2000 and approved by the
Building Inspector.
Fee $ 35 . 00
Author z d Signature
ORIGINAL
Rev. 2/19/98
TOWN OF SOUTHOLD
r� pry BUILDING DEPARTMENT
TOWN HALL
765-1802
LJ ti ; i �► � '
APPLICATION FOR CERTIFICATE OF OCCUPANCY
T :,,, s. "A,appl' ation must be filled in by typewriter OR ink and submitted to the buildir
with the following: for new building or new use:
1. Final survey of .property with accurate location of all buildings, property linen
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 buildi
- 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.
4y
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings a
I-spre-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 applican
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 - .25e,.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $1`55.00, Commercial $15.00
Date
New Construction. .. . . . . .. Old Or Pre-existin Build g.. . . .!. . . . . . . • . • . . • • • .
Location of Property. . . ! . ...�ron. . . . .... e�' . . . . . . . . .. . . . . . . . . . . . .
House No. Stree P Hamlet
Me(I"Ssa—Onwer or Owners of Property.. . ,�jl .�;, ,. , ,, , , , , ,
County Tax Map No 1000, Section. .o . . . . . ..Block. . . 0. . . . . . . . . .Lot.. . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . .
oo r `�S�-�th.r .1 fes
Permit No. . . . . . . . .Date Of Permit. ��I �.j Applicant.IM � a . . . .
Health Dept. Approval. . . . -.. .. . . . . . . . . . .. . .Underwriters Approval. . Pj. . . . . . . . . . . . . . .
Planning Board Approval. .. .�)A... . . . .. .. . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . .
5_ . 00
Fee Submitted: $. . . . . . . . . .. . . . . .. . . . . . A
. . . . . . . . . . . . . . . . . . . . .uak.t . . . . . . . . . .
(5)"ZC, APPLICANT
C 0a�� d
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
i
DATE � � � INSPECTOR ��
If
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it
FOUNDATION ( 1ST)
u II
II II
II II
--------------------------
FOUNDATION----(2ND)______ ________ _______________________________________________________�
----------------- p ------- II
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ROUGH FRAME & --u
PLUMBING ii u IfD
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_______________________ —_--------__
INSULATION PER N. Y. II N H
STATE ENERGY
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FINAL JI(I e
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ADDITIONAL COMMENTS:
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p1d
BOARD OF HEALTH . . . . . .
3 SETS OF PLANS • - • - • • -
FORM NO. 1 SURVEY . . . . . . . . . .
TOWN OFSOUTHOLD CHECK • • • • • • - • - -
BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . .
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL
- • • • - - • -
TEL.: 765-1802 MAIL TO :
Examined . . � �G. . . . . . . .,
Approved . . .� I �. . . . . . . < Permit Noa.4&h0_F.-_-
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Buildin In pector)
APPLICATION FOR BUILDING PERMIT' O0
Date . . . . . . . �. . . . . , . ., . . .
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 necessary inspectWs. r ,
. . . . M.e1].5�.�.C.�o,r K. . . . . . . . . . . . . . .
(Signature of applicant, or name, i corporation)
_70� 'RI-cn 0 'S� UT eR Q�__(�,
. . . . . . . . . . . . . . . . . . . . . . . . . . .] . . . . . . . . . . . .J. . .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Q w:nom-. . . . . . . . . . . . . . . . . . . . +. . . . .
Name of owner of premises . . 1`�!� 1• S Som. G l a,�'< . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a . . . . .corporation, signature of duly authorized officer.
. . . . . . . . . . . . . � .. . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
ALL CONTRACTOR' S MUSTB UFFOLK COUNTY LICENSED
Builder's License No. . . . . . . rylA. . . . . . . . . . . . .
Plumber's License No. . . . . . .�J.� . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . .
.
Other Trade's License No. . . . . 01A. . . . . . . . . . .
1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7) to '� ro w n S�--,. . . . . . . . . . . . .G� ?. �'. . . . . . . . . . . . ..
House Number Street Hamlet
County Tax Map No. 1000 Section . . . .4 a . . . . . . • • • . Block . . . .0.3 . . . . . . . . . . Lot . .��. . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy
p of proposed construction:
k . . . . . . . . . . .
a. Existing use and occupancy . . . . . . • • •" ' : ' ! • "�S� ". . .. . . • • •-. R
„ s,•E
b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nature of work check which applicable): New Building . .`r. . . . . . . Addition �. . . . . . . Alteration . . . . . . . . . .
3 ( g
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . .
(Descripxion)
4. Estimated Cost . . . .� 0. . . . . . . . . . . . . . . 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 . . . V_ S.PCT.'I �N . . . . . . . . . . . .
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 ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . .
Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . .
S. Dimensions of entire new construction: Front . . . . . . . . . ... . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Denth . . . . . . . . . .
JjW'lQ.- 20 O CO
10. Date of Purchase Name o Formez Ovyner .( t�, . o . . . . . . . . . .
11. Zone or use district in which premises are situated . . _!` ��VT��1 p��. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Does proposed constructio v'olate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regraded . .N.1. . . , . . . . . . . . . . . . Will excess fill be removed from premises: Yes No
14. Name of Owner of premises (Y1�.!SSa- C�o.�-�� Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . .
Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . .
Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . .. . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . .
15. Is this property located within 300 feet of a tidal
�� wetland? *Yes . . . . . No . . . . .
*If yes, Southold Town Trustees Permit may be requMed.
PLOGRA
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.
S�E A-TrAcHeb Flt-,ANS J U ev is y
STATE OF NEW YORK, S.S
COUNTY ? .C. . . . . . . . . .
ei~1.,S<5 fir. . K . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Heis 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 se orth in the application filed therewith.
S to before Ime this,
. . . . . . .` . . . . .day of. . . . . . . . ., € �
Nota
Pu
. . . . . . . . . . . . County
IYV�IDACbAL
M.JOHN S�/ _
NOTARY PUBLIC,State of New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No.01 B06020932 (Signature of applicant)
Oualified in Suffolk County
Term Exires March 8, 204
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JOB Mf1.�s G Mle QRuwN gT� �'
R & R HOME IMPROVEMENT C�R�+sNPo L N,
<................
& BUILDING INC. SHEET NO. OF
P.O. Box 676 CALCULATED BY DATE
_..........<._............................. GREENPORT, NEW YORK 11944
(516) 477-1255 CHECKED BY DATE 7-2
SCALE
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