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Home My WebLink About24004-zFOP~ NO. 4 TOWN OF 8OUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25355 Date: 11/12/97 THIS CERTIFIES that the building ALTERATION Location of Property: ROW OFF PENINSULA RD FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 10 Block 3 Lot 10 Subdivision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 14, 1997 pursuant to which Building Permit No. 24004-Z dated M3~RCH 20, 1997 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 ALTERATION & INSTALL A WINDOW IN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ISIS A BARTELS of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS OERTIFICATION DATED N/A N/A N/A ~~~nspect or Rev. 1/81 lrO~l~ NO. · 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) NY 24004 Z Permission is hereby granted to: ~.~...../.~:...~..,.~.~..~.....~/.~.:...~.~:~ ~.~:..~....Zy...,..~....~..~...~..~_ ..~..:~........~...:..~..~...~:..:..-...e..~..~..~-~ ,o.~:~ ......... ~: ......... ::.~......~.....~:~.....:~..., ....... ..~...~:~ ........ ~::~..~. ........ ~:_:~ ........ ~~:~ ..... .~: ...... ~:~:_.:z..:... ................................... .:... ....................... ~ ...... County Tox Map No. 1000 Section ....~..~.. ............. Block ...... . .~....~.. ....... Lot No ...... .~..~. ............ pursuant to opplicotion doted ................ .~././~'..'.~...'i ....................... , 19..~.~ and opproved by the Building Inspector. Rev. 6~30~80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE 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 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. Bo For existing buildings (prior to April 9, 1957) ~on-conforming uses, or buildings and t'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 hy the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees i. 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 - $20.00 4. Updated Certificate of Oacupancy - $50.00 5. Temporary ~ertificate of Occupancy - Residential $15.00, Commercial $15.00 Date ......... IO ~ .~.~.~.~..~. .................... New Construction ........... 01d Or Pre-existing Building .... ~ ......... Location of Property ' House No. Street Hamlet Onwer or Owners of Property..~?....~.i.~....~...f-...~.. ............................ . County Tax Map No i000, Sestion.~(~ ....... Block...~ ........... Lot..l.~. ................ Subdivision ............................... Filed Map ............ Lot .............. Permit No. ~.~..~...~ ....... Date Of Permit.~.~- ·~. .... Applicant.%~.~ .~..~q~.C.~,~.~.~-~='. .... Health Dept. Approval ................. .. ... .. .. Underwriters Approval .................. ... . . .. Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate..~ ..... Fee Submitted: $..~:.~.~ ................... , ,nO 3.%_S' .... ....... " ?OZ~I ~I"IVDS ~oOOi ~ .zoIM MAR ,i BLDG. DEPT. - z : Examined ....... '~: ~/ .... Approved ........ ~./~.., 19 ~ge,'mit No. FORM NO. 1 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1802 Disapproved n/c ..................................... · 3 SETSOF PLA~S ~:SURVEY ~. ~ ...... ~,.,.,.. ' CilECK SEPTIC FOlttl IIOTIP¥| H^IL TO: '' APPLIOATION FOR BUILDING PERMIT INSTRUCt'leNS a. This application must be completely filled tu by typewriter or iu ink aud submitted to the Building Inspector, wit sets of plans, accurate plot plan to scale. Fee.aceordiug to schedule. b. Plot plan showing location of lot and of buildings on premises, relatiouship to adjoining premises or public sire or areas, and glvh~g a detailed description of layout of property must be drawn on the diagram which Is part of ibis all catiort. c. The work covered by thl{~ application may not be commenced before issuance of ,Buildlug Permit. d. Upon approval of this application, the Buildlug luspector will Issued a Bulldtng Permit to the applicant. Such per shall bo kept on tire premises available for inspection throt, ghout the wot'k, e. No bulldlug khall be occupied or used tn whole or in part for any purpose whatever until a Cefltflcate of Occupa~ shall have been grauted by the Building luspeetor. APPLICATION iS IIEREBY MADE to the Buildh~g Department for file issuance of a Building Pertnit pursuant to Buildiug Zone Ordluance of the Town of Southold, Suffolk County, New York, m~d other applicable Laws, Ordinance~ Regulatious, for the construclion of buildings, additious or alterations, or for removal or demolltlo,h as herein descri~ The applicant agrees to comply wlth all applicable laws, ordluances, building code, housing code, aud regulatlous, anti admit atttltorfzed lnst)ectors on p~emlses and tn buildlug for necessary inspections. .... ............. - ' f, gigmi).ure of applicm)t, or name, if a corporation) _(Mai[lng address of applicant) State whether applifaut is owner, lessee, agent, architect, eugineer, general contractor, electrician, plmnber or buil~ Nameofownerofpremises .."'~..C,. .... .~,'D.~ A....~,~.~'L,\.~. ....................................... . . (as or, tile tax roll or latest deed) If applicaut is a corporation, signature of duly authmized officer. (Name aud title of corporate officer) Builder's Liceuse No... C~.r./~ .'~.~ .-../~..Z .......... Plumber's License No ......................... Electriciau's License No ....................... Other Trade's License No ...................... 1. Location of land on wadch proposed work will be do,,e...~L~¢/O .... ~d.r~a~r¢. ~hnd...~ ¢ .... IIouse Number Street Hamlet ¢ ' ' .'.l.O Couuty Tax Map No. 10008ection . ~ ............ Block ............. ,.. Lot:. .. Subdivisiou Filed Map No Lot (Name) 2. State existing use and occupancy of premises and intended use aud occopancy of proposed constructtou: ' ~. Ex~stmg use ~ud occupancy ........... ~¢ ........................... b. [uteuded Use and occupancy .............................. 3. Natnra of work (check which applicable): NeW Building .......... Addition .......... Alteration . .k'/~....../ .'. Repair Removal Demolition Other Work ' 4 Eslimated Cost .................... Fee ................. (to be paid on filing ti,is application) 5. If dweUing, number of dwelling units ....... /. ...... Number of dwelling nnits on each floor ................ · lfgarage, number of cars ,, ................................. , ..................... , .............. 6. If business, commercial or mixed occupancy, specify natm'e and extent of each type of uso ..................... 7. Dimensions of existing stmotures, lfany: Front ............... Rear .............. Depth ............... tleigbt ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ,.. lleigbt ...................... Nnmber of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... lleigbt ............... Number of Stories ... ~ .................................................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Dale of Purehaso .................... . ......... Name of Former Owner ............................. 1 I. Zone or uso 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 I,I. Name of Owner of premises .... ; ............... Address ................... Phone No ............. Name of Arehiteet ,.,, ....................... Address~_ ~ ................. ~_ _.,. .,Phone No ................ Name of Contractor .... ~ad~ ~'.~/, i5. I~ thiB property within 300 feet of a tidal wetland~ *Ye~ ..... ~.. No..,..,... *If yes, Southold Town Trustees Permit may ba required. PLOT DIAGRA~ Locut~ c}uady and distincily ~1~ buildings, wbult%~r existing o~ proposed, and, indical~ al} set-back d}munsions from property lines. Giv~ sireei ~nd b~ook numbe~ o~ d~scripi{on ~ocording lo d~d, ~nd show slreei names and indioate inl~dor o~ oom~e~ OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY . ,' Rrc.qUlRED 765-1R02 9 ASzt TO 4 PM FOR THE FOLLOWLS;G , ,',;j'~Ct ,'-.' ~: 1, FOUNDATION - 'J'. ' ~FOLJlR~D FOR POUF~D C~;;C~'~ E 2. ROUGH - ~R,~[~iNG & pLtlrt~NO 3. {NSU~TION 4. FINAL - CONSTRUCTION MUST BE CO;~L~VE FOB C.C,. ALL CONS]T. UCTIOt~ SHALL MEET THE REQUirEMENTS OF THE N.Y. STAVE CO~STRt!CT:ON f EHE~GY CODES. HOT RESPONSIBLE :" :.R DESIGN OR CONSTRUCTION Ei<F;ORS ~FA3EOF~E " ~SS :ouNT,,woi ' ,/ ...... .~...0..~..~ .... H.":....~.q ~.~ .......... being duly sworn, deposes and says that tie is tb~ applic,nt (Name urinal signinB contracO hove named. is Ilm ......................................................................................... (Contraolor, agent, ~orporato said owner or owners, and ts duly alHbor{z~d to perform or h~w pedormed Ibe said work and io make ~nd fi{e Ibis pl~{i~ul{on; i{mi MI statements contMned in this ~ppli0~tion um irtm to ibc b~st of his knowl~dg~ ~nd be}iuf; und that the york will be p~rformed }n il{o mannur set forth in ihu ~ppl}uai}on ~tud lhu~uwith. ;worn to bef~ ~otary P .............. ~ ........... x .... Ou~l{fl~a tn Suffolk C~Y