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Home My WebLink About25337-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27422 Date: 11/22/00 THIS CERTIFIES that the building ADDITION Location of Property: 505 PARK WAY SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 11 Lot 15 su~dlvision Filed Map No. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 28, 1998 pursuant to which Building Permit No. 25337-Z dated NOVEMBER 18, 1998 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 NEW ENTRY/UTILITY ROOM ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · ~ne certificate is issued to RUTH BORST of the aforesaid building. (OWNER) SIYFFOLK CO%/~I~I DEPART~T OF ~ALTH ~_PPROV~J~ ELECTRICAL CERTIFICATE pLUMBERS CERTIFICATION DATED N/A N-483336 Rev. 1/81 03/22/99 03/08/99 KING PLUMBING /-~u~horlzed 'S~gnatu~ 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. 25337 Z Date NOVEMBER 18, 1998 Permission is hereby granted to: RUTH BORST & ANO. 505 PARK WAY SOUTHOLD~NY 11971 for : CONSTRUCTION OF A NEW ENTRY/UTILITY ROOM ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 505 PARK WAY SOUTHOLD County Tax Map No. 473889 Section 070 Block 0011 Lot No. 015 pursuant to application dated SEPTEMBER 28 1998 and approved by the Building Inspector. Fee $ 75.00 ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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 o~ 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 resi~~Tsi~&&ar ~u~l~ and installations, a certificate of Code Compliance fr~~ ~r ~n~n~~° responsible for the building, h~il 6. Submit Planning Board Approval of completed site plan ~direment~s~ I B. For existing buildings (prior to April 9, 1957) non-confCrmibg uses, or build~n~ and Upre-existing" land uses: ~ 1. Accurate survey of property showmng all property lines, streets, buil~ipg an¢ 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 - -..25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..!./....~........~/~(/(~ ....................... New ........... or re-ex t g Location of Property...~¢.C P*~ .g .......... y ¢. ........... ........ ~' ........ e.~.TRe ~.~ ......... House No. Street Ha~et o~w~= o= ow,~=~ o~ ~op~r~y..8.~.T.~ .... .6. e. Bi % ...................... , ................ County za ~ap No tO00, Sectfon..¢.~R ~ioct 11 ..... ~ot. ~ Subdivision ............................ F~ked Ha ......... Lo~ .................... Permit ~o.2 ~2~.~.. ~..DaCe 0f Pe=~ ~. ~ ~.. ~ ~.App~can~ .l~.l.~.. ~. ~e.~ 9~.~ ~ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~. ...... Fee Submitted: FIELD INSPECTION REPORT DA~E . . , ......-----~. ./- COI~MENTS .~,~ ~_; ~ II II / ~ ~ (~~ ~o~T~o~ (~) ' ~ :- II ~P~ & " II PLUMBING ~ II INSUI~TION I~R N. ¥. STATE ENERGY CODE FINAL ADDITIONAL COI~IENTS: Town Hall, 53095 Main Road P. O. Box 1179 SouthoEI, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Pe~it Mo. Z~--~ 7 ? ~ Owner: ~7~ |~0[~ P lumber: (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Sign~ture ) Sworn to before me t~hi~ ~ day of ~f~ , 19~9 ~ ) ' /~ ounty Npt~ry~ubllc, ~~ ' )40,0 ~Z 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/ ] I/,,NSULATION/ [ ] FRAMING iv ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING I/~FINAL [ ] FIREPLACE & CHIMNEY 76S-1802 BUILDING DEPT. INSPECTi/ON [ ] FOUNDATION 1ST [//] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS,/~~/~g'~-~<~ D~I'E //~/~'~ INSPECTO~~/~ 765-1802 ~,~ BUILDING DEPT. NSPECTION i//~DD~::: :S~ ii~::uGLHAT:LoB:' [ ] FRAMING [ ] FINAL [ ] FIREPL~~/f~_N,-~/.'--'---"' -" /~ ~ NSP~ 765-1802 BUILDING DEPT. /Q ~/~ [ ] 'OUNDATIONIST [~UGH;~B;. [ ~NDATION2ND [ ]INSULATION [~ F~MING [ ] FINAL [ ] FIREPLACE & CHIMNEY ~4o,c Disapproved a/c ............................ .. . ... BOARD OF HEALTH ............... 3 SETS OF PLANS ......... ' ...... SURVEY , . CUECK ......................... SEPTIC FORH ................... [~)~_{ ~: ~. OEPI. .~. [ INSTRUCTIONS 3 ~ts of pl~, ~a~e ploC pl~ to ~ale. F~ ~i~ to ~le. b. PloC pla ~ 'l~i~ of lot ~ of ~ildi~s ~ pr~s, relatio~ip m ~joini~ pr~s or ~lic str~s or are~, ~ givi~ a ~ail~ ~ari~ci~ of layer of pm~ ~t ~ ~ ~ ~e di~ ~i~ is ~r~ of ~is a~li~i~. ~: 'fl~ ~ ~ by ais a~li~ci~ ~y ~c ~ ~ ~fore'is~e of ~ildi~ Pe~t. . U~ ~al of ~is a~li~ti~, ~ hildi~ I~ctor {~11 is~ a ~ilding Pe~t to the ~pli~t. ~mit ~11 ~pt ~ ~ ~s avail~le ~r i~ti~ a~t ~ ~rk. ~. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le or in ~rt for ~ ~ ~at~r ~cil a ~rtificate of ~m~ ~all ~e ~n ~C~ by ~ hildi~ I~tor. ~I~I~ IH ~ ~ to t~ hildi~ ~mnt for ~ ism of a ~ildi~ Pe~t ~t to the ~ildi~ ~ ~i~ of ~ ~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~er a~li~le ~s, ~i~es'or ~lati~, for t~ at~ti~ of hildi~, ~iti~ or alterati~, or for ~al or ~lltia, a ~rein ~ri~. ~ a~li~t ~s to ~ly ~ all a~li~le l~s, o~i~s, ~ildi~ c~, ~i~ ~lati~, ~ m ~it ~ri~ i~tors ~ ~s ~ in ~ild!~ for ~s~ i~ti~. (Si~e of a~h~t, ~ ~, if a ~ratian) ~ili~ ~ress of ~lic~O State ~hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmber or builder ...... C~..~..T.~ ~ ~.a.a.. ......................................... R u'Cl~ ~o~ S ~ N~ of ~r of premiss ........................................... (an m ~ ta roll or latest ~) If aM)licmt is a c~orporatine, sipae of aly mtI~ri'z~t officer. (Nam and title of corporate officer) iI rs Plumbers License No...]..0..~.~g...~... R ....... Electricians License hb ...................... Or_her Traders License No ........ Location of land o~ uhich proposed ~ork ~ill be done .............................................................. 6'"'-'o.~ p~rqj4 A-~ .,¢.R<.:/:?/'~qcL,.?. ........... LRZ/...;/.x ...... (...q.7..}.~ .... ~ Nmber Street _I~1 et ~i~isi~ ...a.o.¢~..~..~..~?. ~. .............. ~iled ~p ~...z..I. 9. ~ ...... ~t .... ..~..~. ..... S~ate existing use aad ocaupanay of premises and intel~l~l use a~d occt~nc~ of propo~d co~stl~ction: a. ~sti~ ~ ~ ~ ........... ~. ......... P.. .... t...T. ..... a .................................. b. I~tanded use and occupancy ............... .~ ........................................................... 3. ~atn~e o[ ~ n~ a l~ble ~ ......... ~ ........ Altern on ..... ~ir ~1 . ~ ...... l~liti~ Other ~ 4. Esti~t~ ~s .. .).~. .~ ......... f~ .............................................. If ~rage, ~r of ~rs I I~cate clearly ~ distinctly Prom proper~y lines. Gxve street a~ ~hether interior or corner lot. PLOT DIAORAH 11 buildings, whether existing or proposed, and indicate all set-back dimensions blnck nmber or deseriptlon according to deed, a~d show street names ar~! indicate · ~r^'lE OF ~i~ YO~, ...... ..... ............................... ~ ..... ................ ~ng om.y ~m, de~s ~1 ~ys U~a~ he ~s ~ a~li~n~ }M is the ........................... [ ........................................................................ (~rse~or, s~nt, ~or~rate officer, of ~id ~r or ~rs, a~ is ~lly ~tlmrlt~ to ~rfom or h~ l~rfo~ tl~ mid ~ m~l to ~ke a~ file this a~llcati~l; that all stat~nts c~t~iM in this n~l icati~ are tn~ to the ~at of his k~l~ Lhat the ~rk will ~ ~rfo~ in tl~ ~mmr ~e Eorth in ~a a~licati~ fi1~ t~th. ,9~m to before me this (SiSoamre nf Appl. ie~dt) (2} ,I