HomeMy WebLinkAbout22643-zFORM NO. 4
TOWN OF SOUTEOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATEOF OCCUPANCY
No Z-23567 Date MARCH 28, 1995
THIS CERTIFIES that the buildin~ ADDITIONS
Location of Propert~ 810 ISLAND VIEW LANE
House No. Street
County Tax Map No. 1000 Section 57 Block 2
Subdivision Filed Map No.
GREENPORT, N.Y.
Hamlet
Lot 8
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 6, 1995 pursuant to which
Building Permit No. 22643-Z dated MARCH 27, 1995
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 DECK & oPEN PORCH ADDITIONS, ALTERATIONS TO CLOSE IN SCREEN
PORCH TO EXISTING ONE FAMILY DWELLING "AS BUILT" & AS APPLIED FOR.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
ROSALIA E. GIOIA
N/A
N--302488 -- JANUARY 14, 1994
N/A
Rev. 1/81
FORM NO.$
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOW~ HALl.
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 22643 Z
Date ~larch 27, 19.?.,5. ......
Permission Is hereby granted to:
Rosalla E. Gioia
840 Island View Lane
Greenport, N.Y. 11944
to CONST.R,.U, CT DECKS & OPEN PORCH ADDITIONS~ CLOSE IN SCREENED PO.R,,g,[t.
(ALTERATIONS) TO EXISTING Ol~E FAI~ILY DNELLING "AS BUILT" /LND APPLIED
FOR.
Counly Tax Map No. 1000 Section ....... .5...7 .............. Block ....... .2. ................. LotNo ..... .8. .....................
pursuant to application dated ........I~GI~...~ .................................. 19...~ ......... and approved bythe
Building Inspector.
Fee $.,../.,~./. .............
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN ~LALL
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 top6graphic 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 i% 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.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'.'pre-existing" land uses:
i. 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 Cernificate 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Oc.cupancy - Residential $15.00, Commercial $15.00
Da et ................... '~ [..~.~.~ .............. ~
New Construction ....... Old Or Pre-existing Buildin .........
Location of Property? ~q~ ~--~C~O ~l~t~P ~,fO~. ~Jo.p.~..~.. ~]
House No. Street Hamlet
Onwer or Owners of Property ...........................................
County Tax Map No i000, Section .... ~.]~ ..... Block..~. ...... Lot..~ ........
Subdivision ~ Filed Map Lot
Permit No ................ Date Of Permit ............... . Applicant .............................
Health Dept. Approval .......................... Underwriters Approval ........................ .
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ..... ~
Fee Submitted:~, £[~$ .... ~ ~ ................... ~.~,~ .~..~
~" ....... NEW YORK ~I~A~ OF EIRE UNDERWRITERS ~ i
~ THE ~:~ ~,
1000121 BUREAU OF ELECTRIC~Y ' .......
~ 85 JOHN STREET. NEW YORK, NEW YORK 10038
N ~2488
o~y t~ e~tr~ ~u~men/~ ~ be~w a~ int~u~ by t~ ep~.ant ~ On <t~ a~. ap~t~ numar ,n t~ prem~s of
ROSALIA GIO A, 84~ ISLANDVIEW LANE, GREENPORT, N.?.
in ~he~allowin~ loe~tion; [] B~en~nt [] I~t ~l.
we~examinedon JANUARY 14 , 199¢
[] 2nd il. OUT Section Block
and found to be in compliance with the National Electrical Code.
RANGES
;PECIAL AEC'PT
E R
V I C E
SERVIC~ DISCONNECT
1 100 CB
)THER APPARATUS:
L.t 6
EXHAUST FANS
AMT, H, P
DIMMERS
OF CC. COND
OF NEUTRAL
PAUL R. BURNS
275 TOWN HARBOR LANE
$OUTHOLD, NY, 11971
LIC.~282
GENERAt MANAGER
This certificate must not be oltered in ~ny monner; return to the oHice of the ~ord i} incorrect. Inspedors mey be identified by their credentials,
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ............... ~..';'¢'~ , 19 .~.%~
Disapproved a/c .....................................
· ~uil~ Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
CALL '
HAIL TO:
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.
cd The work covered by this application may not be cbmmenced 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 'rem0val or demolition, as herein described.
The applicant agrees to comply with all applicabi~ laws, Ordinances, building code, housing code, and regulations, and to
~admit authorized inspectors on premises and in building for necessary ins tions .
.... ...................
-- ( ignat e of applicant, or name, if a corporation)
......
(Mailing address of applicant)
State whether applicant ~, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~ O(~. ~,/.~.
(as on the t~wA roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ...... ................
1. Location of land on which proposed work will be done ......................................... ' .........
House Number Street Hamlet
County Tax Map No. 1000 Section c.~'~ · B'i~ck '~ Lot t5~
Subdivision ..................................... Eiled Map No ............... Lot ...............
(Name) '
2. State existing use and occupancy of premises and intended us~aOd 9ccupancy of proposed construction:
a. Existing use and occupancy.. ~....~...,.~.~..~..~..~...~..~ ....... ' ........................................
b. Intended use and occupancy....~....~...~../..~.~...C~...C, k5..~['..":' .~.~. '.~. ~~~~~¢.
3. Nature of work (check which applicable): New Building .......... Addition.....~'~..... Alteration .~ ....
,Repair .............. Removall .... ~ ri,. ~r /Dem°litign_ ~ ........... ~e'O, rj?,_~e~G ?',///9M//'4/ /'(~ Other W°rk ~ [/) IM~"i -/--- "' ........ (Description)
4. Estimated Cost ,~.'q~.~ ~ ~ ~ ·
........ ~ ......................... Fee ......................................
(to be paid on filing this application)
$. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................
· If garage, number of cars ..... ; ..................................................................
6. If business, commercial or mixed[ occupancy, specify~ n,~ature and extent of each type of use .....................
7. Dimension.sofexistingstmctures if any: Front ~,g}ff'-. R~o~ ,,,5(:2- no,,,h ,~ 9.
Height' ..... /li~.' 7. t~/.Number' of Stories 'i ............................ ~' .................
Dimensions of same structure w,~h alterations or additions~-]~. ~.c~:~.' ........... Rear ..................
Depth .................... J. Height ............ ,,.<'. :.v. :..'. 7Number of Stories ......................
8. Dimensions of entire new constr~ction: Front .... "~' ',/~;t'/~,": Rear ............... Depth ...............
Height ............... Ngmber of Stories ,,<"./.L,'. :'. ~ .
· ": ............ 't ................... uepm . 4? 7.
11. Zone or use district in which pre~hises are situated .......................................
12. Does proposed construction vi.o, la~e any zoning law ordinance or regulation ~'120.. . ' .... i .....
13. Will lot be regraded ~ .0. I . · .........................
. ~ ^ ' .... ~' ';.4;.'~' ~ ........... Will excess fill be removed from premises: Yes _
Narne of Architect ~ _~ r~F~,~ /~ t~t~f.., nonecqo. "7 ......... ~...
.......... i ............. ,~uuress ................... Phone No ........... ~ ....
· 15. Is chis propert:y w±t:hin 300 feet of a tidal wee3_and? *Yes ........ No....~-~. ....
· If yes, Soul:hold T~wn Trustees Perm±t: may be required.
· .. PLOT DIAGRAM
Locate clearly and distinctly all ~uildings, whether existing or proposed, and, indicate all set-back dimensions from
street names and indicate whether
interior or coruer lot.
STATE OF NEW YORK,
COUNTY OF ....
......... C>~. I~Lt'A.. ~./~ ................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing ,contract).
above named.
He is the .- ..................
i (Contractor, agent, corporate officer, etc.)
~f said owner or owners, and is duly aCthorized to perform or have performed the said work and to m~e ~d file this
application; that all statements containe¢c~ this application are true to the best of his knowledge hnd belief; and that the
work will be perfomed in the m~ner se~ ~in the application filed therewith.
~wom~ before me this ,
.... ~ ....... .~... day of.
~[ ~o~' ~X:~i~X52g"~Y~g~,/~¢9~ (S,gnaturo of apphcant)'