HomeMy WebLinkAbout23456-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-25109
Date JULY 1, 1997
THIS CERTIFIES that the buildin~
Location of Propertz MONTAUK AVENUE
House No.
County Tax Map No. 1000 Section 10
Subdivision
ALTERATION & ADDITION
FISHERS ISLAND,
Street Hamlet
Block 7 Lot 24
Filed Map No. Lot NO.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 25, 1996 ~ursuant to which
Building Permit No. 23456-Z dated RAY 17, 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 ALTERATIONS & ADDITIONS TO EXISTING ONE F~/~ILY DWELLING AS
APPLIED FOR.
The certificate is issued to
of the aforesaid building.
MARY JEAN PEHLAM
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N/A
H-051994 -- SEPTEMBER 25, 1996
MAY 21, 1997-DAVID DOROSHEVICH
- //u/ng Inspector
FORM NO.3
TOWN OF $OUTHOLD
E.U~LO~NG DEPAR'~MENT
TOWN HALL
$OUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
23456 Z
CounlyTax Map No. 1000 Section ........ ,,/.1~, .......... Block ............ ~ ......... LotNo ...... ~ ..........
pursuant to application dated ,...~/--~ ................................ 19 .~..... ......
Building Inspector,
Fee $~..~./~,.
and opproved by the
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 uagural or topographic features.
2. Final Approval from Healch Dept. of water supply and sewerage-disposaI(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 c6mpleted site plan requirements.
For existing buildings. (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing aii property lines, streets, b~iidi~ 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-existin~ Buildin~ - $i00.00 ?
3. Copy of Certificate of Occupancy - ,
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Hesidentia~ $15.00, Commercial $15.00
House No, Street
Onwer or Owners of Property ................................
Con=y T= 000, Section...CO..L ..... Bloc ...... q. ........ .... ..............
Subdivision .................................... Filed Map ............ Lot ............ 7] ........
Health Dept. Approval.. ........................ U~derwriters Approval.~.~..~.~:.~.-~./-f~,~.~
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate..~. ........
....................
Town Hall, 53095 Main Road
P,O. Box1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
CERTIFICATION
Building Permit NO.
(please print)
(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
EILEEN a. WALL
NOTARY PUBLIC, NEW YORK STATE
/ -NO, 01WA9509185
QUALIFIED IN SUFFOLK COUNTY~,~
TERM EXPIRES OC;TO:':~, q'~ 19~
County
UNDERWRITERS CERTIFICATE
RE.qULREO
FOLLOW~NG INSPECTIONS:
'~, FOUNDATION '~VO
FOl~ POU~ED CONCRETE
~. tNSULA1'IO~3
4, FINAL, CONSTRUCTION MUST
~E COMPLETE FOR
PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
REQUIRED BY PART. 714 OF
N.Y. STATE BUILDING CODE.
---- k)
,, I_1
Ii ~1 -
PROVIDE OPENINGs FOR
EMERGENCy ESCAPE AS
RE(~UIRED BY PARt 714 OF
N.Y. STATE DUILDING CODE.
DATE COMi~:NTS
~0~ATION (
20~ATt 0N (2~)
NS~TION PER N. Y
ADDITIONAL COMMENTS:
HEDGE _STREET_
N 1736.25
16§1.23,
IRON
PIPE
N 1834,81 /~
W 567.83 JOHN R.
N 17~6.85
524.45
GUARANTEED TO:
MARY JEAN PELHAM ~ L~ND TITLE iNSURANCE
IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SUR-
VEYS OF THE NEW YORK STATE LAND TITLE ASSOCIATION.
TITLE NO. RH9411~3
.~' ,.~. ~ n ~ R {'"'~' ' '. . BOA'RD OF HEALTH .........
I~"~ ' ~ ~ ~ ~ FO
~J~ {~ ', ' ~OWNO~SOU~,O~D ~u~v~ ............ ~ .....
"~l~ ~PR tg~ ~t"-~ .BUILDING DEPARTMENT CH~CK ~.f~,~ ...........
, ~ ,.- ~ , I TOWN HALL SEPTZC FORH ..............
~ '~ SOUTHOLD, N Y 11971 , '
....... · ,. ~A ~
_I , ~ ~. /~, ~ .. , n . .~.~ ........
............. ......... ......
APPLICATION FOR BUILDING PERMIT
Date . .~.~ .., 19
INSTRUCTIONS
~ a. Tiffs application must be corn ?letely filled in by Wpew~ter or in ink and submitted to the Bulldog Inspector, with 3
~;ets of plans, accurate plot plan to sca~e. Fee according to schedule.
b. Plot pl~ show~g location o~ lot and of build~gs on premises, relationship to adjoining premises or pubic streets
or areas, and giv~g a det~led description of layout of'property must be drawn on the diagram ~hich is pa~ of this app,-
cation.
~. The work oowred by t~s appUcation may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Bufld~g Pe~it to th~ app~cant. Such pe~it
sh~l be kept on the premises avaflable~ for ~spection throughout the work.
o. No building shall be ocoupiedl. . , or used in whole or in p~t for any purpose whatever until a CeRificate of Occup~cy
shall have been granted by the Bmldmg Inspector.
APPLICATION IS HEREBY MADE to the Build~g Dep~tment for the issuance of a B~lding Pe~it pursuant to the'
Building Zone Ordnance of the Tow~ of Southold, Suffolk County, New. York, ~d other appficable ~ws, Ord~ces or
Regulations, for the const~ction of bufldhgs, additions or alterations, or for removal or demolition, as here~ described.
The app~cant agrees to comply with[ a~ applicable laws, ordinances, bufld~g code, housing code, and regulations, and to
admi't authorized ~specto~ on premides and ~ bulldog for necess~i~speetion~ ~ 'it
, ,. ...........
-- (Sig~fapylicant, or name, if a corporation)
.' (Mailing address of applicant) '
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
owner .. ............................
(as on the tax roll or latest deed)
If applicant is a ~orporation, signaturel, of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ......... ~ ................
Plumber's License No ......... i ................
EIectri~ian's License No ....... ; ................
Other Trade's License No ...... : ................
1. Location of and on which proposed work will be'done
riouse rqunmer : Street Hhmlet / ' .............
County Tax Map No. IOOQ Sectio~ ................. Block ................ Lot..- .............
Subdivision .................. i ................... Filed Map No ............... Lot ... ~', .~,..' ......
(NOme)
2. State ex]sUng use and occupancy o? premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy... .
b. Intended use and occupancy .... >' .... r~ m% .-.: --~,-¢:w. ...........
3. Nature of work (check which applicable): New Building ........... Addition ....... ,~u~e~atle;n,~,.~,¢.4; ~ .....
Repair .............. Removal .............. Demolition .... ..' ......... Other Work ...... ....: .....
4. Estimated Cost
............. r ................... Fee .......................................
(to be paid on fi!lp~t,h]§~l~p, licatibn)
5. If dwelling, number o f dwelling units. &"~,~,/. NUmber of dwelling units on each floor 7..
If garage, number of cars ..... ~.-7.~ ................ i ..................................... .
6,~' If business, commercial or mixed occupancy, specify nfiture and extent of each type of use . .-; ~ ~ ' .... i ' '.
7. Dimensions of,existing structt~res if any Front ~ /~/ ,, _~,c, rz I~ _ '. .... '~u' ! ......
. ~, .- o s~o,,f/same struetur~ with alte. rations or add, ions: Front ..... ~..~{iiiii'l{;~r'ji i ~O./'~~ .......
· ~mensmns of~qntire new construction. Front ~0 . L/! . ~ _~cl fit/_ ~ ' 'Z ' ~ ' ' ' X~g; .........
11. Zoneorusedistrictinwhichpremisesaresituat~ Tw.n.
12. D°es pr°p°sed constrq~tjon violate any zoning law, ordinance or regulation.
13. Will lot be re raded ?..(d~:2.. . . "~ ...........................
Name o~' Conffactor .... 5~A<%-.~.; ............ Address '"' .... ' ' ' ,-~ -. ' ...........
15.' Ip this property within~00 feet of a tidal wetla~'d'?'
· *If yes, Southold Town Trustees Permit may be requirg~]''':' ~o .........
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all ~et-back dimensions from
property lines. Give street and b. lock number orfi~scriptjon
interior or corner lot F-.)¢I , ~.2~.~.~ accord/ng to deed, and show street names and indicate whether
~TATE OF NEW YO~K,
'OUNTY OF..~0.['~...
.......... ~' '~' · ;' ~~ .... being duly'sworn, deposes and says that~is the applicant
(Name ~ individual signin= contract)
:bove named. '~0~
leis the..;.
(Contractor, agent, corporate officer, etc.)
f said owner--or o~}~ers, ~d is duly authorized to perfom or have perfo~ed the said work and to m~e and file this
pplication; that all.~ta.t~ments contained ~ this appl cation are true to the best of his knowledge and belief; and that the
/ork will be pqrfon~ed.lh~.fhe manner set forth in the application filed therewith.
worn to bef~e mcthis
.........
....