HomeMy WebLinkAbout23635-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No—Z-25063 Date JUNE 2, 1997
THIS CERTIFIES that the building ACCESSORY
Location of Property 1525 AQUAVIEW AVE. EAST MARION, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 22 Block 2 Lot 3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 2, 1996 pursuant to which
Building Permit No. 23635-Z dated AUGUST 16, 1996
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 TWO CAR GARAGE IN FRONT YARD AS APPLIED FOR.
The certificate is issued to STEPHEN MOECK
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
B ' lding Inspector
Rev. 1/81
"UK NO. f
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)
N° 23635 Z Date ......... ......... ...l.3�................... 191:f�
Permission is hereby granted to
. .../?� .e . ............... ..
............ s .. �� ' Q. .,
� 39. . ....�..�. r
. .. . . 1.. .,(.rArc.. ...
Qc- (cp. .. . . . ...... ...Qr.4... ...' . ................................................
atpremises located at ...... .... ..... ................. ....................................
..........................................................45............ .....................................................
County Tax•Map No...1000 Section .. � .... Block .......�.......... .•....•.'..••..••
.7'.� Lot No. :� .. ...........
pursuant to application dated .................... ... ,�r ............, 19.&P, and approved by the
Building Inspector.
Fee $...I.•�..?
...
. ........................ .. ......... ..........................
Building I or
Rev. 6/30/80
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 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 $25.00,5:� 'cessory 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 - .25¢.
4. Updated Certificate of Occupancy — $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . ... . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . .
Location of Property. ... . .A ou 4.✓/E� . . .�VE... . . . .. .ITAST. JIM e2V. . .. . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property..STg/°/{-CN . . . . . d E . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .
County Tax Map No 1000, Section. .. . . .. . . . .Block. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . .
Subdivision. . . . . . . . . .. . . .. . . . .. . . . . . . . . . . . . . .. .Filed Map.. . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . 3�3, ?: Cr
.Date Of Permit. A . /6, . ./�6. ,Applicant.ST p . . . � .jr. . . .
Health Dept. Approval. . . . . . . .. . . . . . . . . . . . . . . . . :Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . .. . . . . .. . . . . . . .. . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. .�5. °�. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . .. . . . . . . . . . . . . . . . . .
APPLICANT
C 0 5a�
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU N
[ ] FRAMING [ FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
DATE 7INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE IMNEY
REMARKS:
l
DATE � INSPECTO
I'1 Iii.0• [N:{n-,t;'1'I on It I.POlur DA'1'li (:OMMI:N'1'S
11
1-'OIINI)A'I'I ON /
FOUNDATION OND) II
II
ii
KOIIGII FRAME A 1 II o
PI.UMR 1 NG II
----
_ . _
1 NSl)LA'CI ON E'1;R N. Y.
S'I'A'1'g 1?NIiRGY
CODE. I \
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I II
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FI NAT. I
1AADD 1_'1'1 ONA1. COMMEN-I'S-
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r
llua — Q .1..1111 . . . . . . . . . . . . . . .
r.m,.M � FORM NO. 1 3 SETS OF PLANS . .. . . . . . . . t . . . .
TOWN OF SOUTHOLD SURVEY . . . : s : . . .. : . .. . . . . . . . . . .
BUILDING DEPARTMENT CHECK . : + . .. : . : . . . . .. ... . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY:
BLDG.DEPT. CALL
TOWN O UTHOL@ QQ '
19./. MAIL TO: . . . . : . . . . . . . . . . . . . . .
Approved13',!�� . Permit No. ............ ................:...................
.... .. ,�..
Disapproved a/c ....:.............................. ....................................
......
1 p U - •. (1)uilding.Inspector). .
APPLICATION FOR BUILDING PERMIT «
AUG 2 �.
. .
...Date. . . , 19. .
E�DG. DEPT. INSTRUCTIONS
a. 'Ibis application mast 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 mast be drawn on the diagram which is part of
1 this application.
c. The work cowered by this application afty not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Sada
. 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.
APPLICATICK IS HEFM MAZE 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-mr
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, ordinanc , building code, housing code, and
regulations, and to admit authorized inspectors on premises and in buildi or aces inspections.
.. ...... ...... .............................;....
(Signature of applicant, or name, if a corporation)
Jacul leu/.14ve,..4.%4 ln/ .
G•
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.....opAce.........................................................................................4.................
Name of owner of premises ..�5'�`e �e h....lf0 e.4 ...............................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.........................................................
(Name and title of corporate officer)
Builders License No. .........................
Plumbers License No. .........................
Electricians License No. .....................
Other Trade's License No. ....................
1. Location of land on which proposed work will be done...........................................................
.........�sa .... � .......................................rgVIe.we-, az /l'/av'iori ..!�:Y..../939........ ..........................
.
House Number Street hamlet
County Tax Map No. 1000 Section ...°z `......... Block ... ........... Lot .:3.............
Subdivision ...................................... Filed Map No. ............... Lot .....:.......
..
(Name)
2. State existing use and occupancy of premises and intended use am] occupancy of proposed construction:
a. Fasting use and occupancy ...:5.�'1��. ..; :ar-�ecl
P ..................................b. Intended use and occupancy .... wo .. N..... . . . �)...`:Q 4 ...............................
3. Nature of work (check which applicable); New Building ..V...... Addition .......... Alteration
Repair ............ Removal .............. Demolition ............ Other Work
(Description) .............
(Description)
4. Estimated Cosh .OD................. fee •........................................(to be paid on filing this application) ....
.
5. If dwelling, number of dwelling units ../�/}...... 1"ber of dwelling units on each floor .... .......
Ifgarage, nuaber of cars ....a�................................
b. If business, commercial or mixed occupancy. specify nature and extent of each type of use... ! ,
7. Dimensions of existing structures, if any; Front....-3.4........ Rear .31-4. Depth �.�P.
Ileight ....../y./............. UW)er of Stories .......It.............. .. ...........
Dimensions of same structure with alterations or additions; Pront ............... Rear .......
Depth .................... height ................,... Nni►er of Stories I........
8. LL
Dimensions of entire new construction: Front .Off,..... Rear �{'�. Depth
height ......' N.......... Umber of Stories .....!............... ... ...
9. Size of lot: Front ..1 ./.,•._ Rear ........ ........... Depth ....a 75" ......
10. Dale of Purchase .,,.19J ..... Name of Former Owner ...7'q Ylo !: ..... ....
It. Zone or use district in whidt premises are situated h., y�..................... ...............................
12. Does proposed construction violate any zoning lacy, ordinance or regulation: ,..lV�...............
13. Will lot be regraded ........... Will excess fill be removed from premises; YES
14. Names of Owner of premises ., 4G��1eh... Q��:k. Address .15-2� voxems. �;... Phone No, y�7.gam��.
Name of Architect ., . .93
Architect .......... . Address ........ ....... . Phone No, .............
Nameof Contractor ................................... Address .......... . ... .... ....Phone No. ..............
15. ,Is this property within 300 feet of a tidal wetland? * YES .......... ND ..... �s j r �vo>++ L I Sodnd AV
*TF YI?S, SE1(Il1nl1) 71Q,t1 TRIISR+J?S PLrI�lIT MAY BE RF[gIRLq).
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 nnber or description according to deed, and show street names and indicate
%++weber interior or corner lot,
S'L'ATE OF NEW YORK, SS
COUN'T'Y OFT . . . . . . . ). . .. . . .
• - 1. H:!•.... ./000. Cr�... tieing duly sworn, deposes and says that 1►e is the applicant
(Nome of individual aipning cwrroct)
above named,
Ile is the ..p V R�-•A.......... . ' •
................. .. ........................................... ........
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly'aut►orized to perform or have performed the said work and to make amd file this
application; that all statements contained in this application are true to the beat of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this nn
.................., . . .,..,,r;r.•+ day of .......... �
Notary Public, . ,. . County ®®®
Ltr,'5A.1. COOPER
�/jccEu N,� Ito Public .. .......
wo.
4822563,
of New Y ;• ;... .... ...,.
Term Expires Suffolk County
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