HomeMy WebLinkAbout22972-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
$outhold, N.Y.
CERTIFICATE OF OC~uwANCY
No Z-24577 Date August 16~ 1996
THIS CERTIFIES that the building addition
Location of Property 3650 Eugene's Road, Cutcho~ue
House No. Street Hamlet
County Tax Map No. 1000 Section 97 Block 8 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated August 14~ 1995 pursuant to which
Building Permit No. 22972-Z dated August 28r 1995
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is a one stor~ addition to an existin~ one family dwelling as
applied for.
The certificate is issued to
Mar~Elizabeth Gilbert
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N 379906 dated
PLUMBERS CERTIFICATION DATED
N/A
March 11, 1996
Z~/A
Rev. 1/81
Inspector
FORM NO.$
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y.
N?
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
............... ..........................
22972 Z
Oo,n~,ToxMo,~r,,o. 1000 Seo,on.....~2 ............ B,o¢,~.....,~.... ............ Lo,,,,o ..... ~ ...............
~.rsuon, to opp,cot,on doted ...... ~.-..-....x'..~.~ ............. 1~....2~ o.d o~prov~ b~e
Building Inspector.
Fee $....Z~...~.~... ....
Rev, 6130/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN I~LL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Thls 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 frum plumber certifying that tile 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 Compl. iance 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 nses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing alJ property lines, streets, building and
unusnai natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy ia den~ed, the Building Inspector shall state the
reasons therefor in writing to the app]icant.
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming poo] $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 Certificatn of Occupancy - . .25¢
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Resideutia] $15.00, Commercial $15.00
Ne%q Construct~o~Y./~.~.'~.~.~..?.~.._~.'~. Old Or Pre-e~sting Buildil~./ ........... .~... ~
Location of Property...~. ~..~..~ ........ ~¥.~..~t?~.~.~2' .~d~ .......... d~-~..~../~.?~.~..~. .........
House No. Street ItamIe t
Onwer or Owners of Property ............................................................. , .....
County 'Fax Map No 1000,
Subdivision..~.~7.. ............................ Filed Map ............ Lot
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept. Approval ........................... Underwriters Approval .........................
PJanni~lg Board Approval .........................
Request for: Temporary Certificate ........... Final Certicste ...........
ROIJGI! FRAME
INSULATION PRE N. Y. {{
STATEENERGY jj
THE NE V YORK BOARD OF FIRE UNDERWRITERS
I '[?R~99 BUREAU OF ELECTRICITY
--- 85 JOHN BTREET, NEW YORK, NEW YORK 10038
Dat~ !~?*~ 1-! ~ ~9~6 Application No. on,lie ~'[~/~ ~ ?~9'~6
THIS CE~IFIES THAT
o~y the d~tdcal ~uipment ~ ~db~ be~w and int~uc~ by t~ option t ~m~ on t~ ~e appllcati~ ~u m~r in the prem~es ~
H~RY E. KENNEDY, 365~ EUGE~S RC,~ C~H~, N~Y.
in the following l,,~ation; ~ n~se~,ent ~ Ist FL ~ 2nd ~. .~ctlo, Bl~k Lot
~sexamlnedon ~! }~Y O2 ~ i~96 and found to be in compliance with the N~onal Elect~c~ Code.
DRYERS
DISH WASHERS EXHAUST FANS
DIMMERS
SYSTEMS
NO, OF FEET
OTHER APPARATUS:
HOT "RS:2~F H.P.
S E R V I C E
SAGE ELEC, INC.
MARINE PLACE
GREENPORT, NY, 11944
GGqERAL MANAGER
Per . .
This certificate must not be altered in any manner; return to the office of the Board if incorrect, Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE AILTERED,
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
Daniel J. Dunne
2175 Pine Neck Road
$outhold, WI 11971
To Whom This May Concern:
We are unable to complete your Certificate
because of the following reasons:
of Occupancy
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is (~m~=[a~ae~/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT % 22972-Z
Please contact our office
cooperation.
on this matter. Thank you for
$OUTHOLD TOWN BUILDING DEPT.
765-J.80Z
BUILDING DEPT.
INSPECTION
[ ] FOUND~TIONIST [ ] ROUGH PLBG.
i ~)ORA~ION 2ND i ]] IF~AU~ATION
[ ] FIREPLACE & CHIMNEY
DATE
76S-1802
~~/NSPECTION
[ ] FRAMIIqG [ ] FINAL
[]FIREPLACE&CHIMNEY
R EMA~KS:~~
BUILDING DEPT.
765-1802
BUILDING DEPT.
IINSPECTION
£ ] FRAMinG [ ] FINAL
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
] FOUNr)ATION 2ND
[ ] FRAMING
ROUGH PLBG.
,~iSULATION
FINAL
[ ] FIREPLACE & CHIMNEY
.,..,..,~s~ /~ ,~~-.~
DATE
IINSPECT~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS:
[ ] ROUGH PLBG.
[j,/]~INAL
DATE
INSPECTOR
]:ORM NO. 1
TOWN OF SOUTttOLD
BUILDING DEPARTMENT,.
TOWN HALL
SOUTllOLD, N.Y. 11971
TEL.: 765-1802
CALL ............
HAlL TO:
Inspector)
APPLICATION FOR BUILDING PEFIMIT
INSTRUCTIONS
Date
:(0 ......... :957
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 buildh~gs on prenilses, relationship to adjoining premises or public slicers
or areas, and givis~g a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by tiffs application may not be commenced before issuance of Building Permit.
Sd. Upon *pproval of this application, the Building htspector will igsned a Building Permit to the applicant. Such permit
shall be kept on tile premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in p,'u-t for any purpose whatever nntil a Certificate of Occupancy
shall bare been grauted by the Building Inspector.
.APPLICATION IS HEREBY MAI)E to the Building Department for the issuance of a Buildiug Permit pursuant to the
Building Zone Ordinance of tile Town of Southbld, Suffolk County, New York, m~d other applicable Laws, Ordinances or
Regulations, for the construction of buildb~gs, additions or alterations, or for removal or demolition, as herein described.
Ti.ir applicant agrees to comply with all applicable taws, ordinances, building code, housing code, and regulations, and to
admit authorlzed inspectors on premises and in building for
(Signatu~ffo f applicant, or name, if a corporation)
........ ' ....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnilder.
Na,neofownerofpremises .~e~:..~..
(as on the tax roil or latest deed)
If applicant is a corporation, signature of duly authori/ed officer.
(Name and title of corporate officer)
Btfilder's License No ..............
Plunlber's License No .........................
Elect licla 1 s License No .......................
Other Trade's License No ......................
I. Location of land on which proposed work will b.e doue ..................................................
iblo~e' N~l~r ........ .... L./t-: ?~. ?..~... ~r~ ..... ' .... ' ........... ~~ ~' ~.~....'. ~ .............
County Tax Map No. 1000 Section ~:7 ~ ........ Block .O .~.Q.O ......... Lot.O~q.&.%O.O .....
Subdivision ..... ~.... Filed Map No ............... Lot ...............
(Name) .
2: State existing use aud occupancy oF premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy..Sf ~.~.ff.. ~..~, ~~ ........ ' .......................
'3. Nature of wink (check whi,.h applicable): New Building .......... Adsbilion . ..~/.. ..... Alteration ....
Repair .............. Removal .............. Demolition ..[,'~. :.: ......... Other Work ...............
'1~,C ~q 'i .~.' .............. ~scr?tion)
4. Estimated Cost ,..4t..o'~. :--r...; ...... . Fee
(to be paid on filial plication)
!
5. if dwelling, nmnber of dwelling units ............... Number of dwelling units on each floor ................
· If garage, number o£cars ........................................................................
6. If business commercial or mixed occu )mmv, specify naJ. nre anti extra t of each ty~e of use ........ '. ..... , .
v. I:)m~ens~ons ot exJstmg structures, if any: Front ,"~i .~.. ........ Rear . .~...54...~.. Depth . .(.. ~.. ......
te g it . /. fl../~..W' .... Nu nber of Stories .... /. ................. ' .......... i ..................
D,mcns,ons 9~same structure with alterations or addmons: Front .~t~. ~. .......... Rear ./.~..~... ..........
Depth . ./.Z..~.~. .............. lleight . .~. 25~.,'.~.~-~. ....... ... Nt,nbeL,o,f Stories...2-~. ...... i..~.;~. .......
8, Dimensions ofentir; new construction: Front . [.~..~. :'. ...... ~ Rear ./.~. ~ ~.. ......... Depth ./..Z.',~. .........
Height r4~../'?:..Z.~ ...... Number of Stories . . .7-. ....................................................
· % , z/, .
9. S, e of o(:' ront ........... Rear. ................ .................
10. Date of Purchase .t~..t~.,../~'~.~. .......... , ......... Name of Former Owner .~'.~ff.~ .............. ~ .......
I 1. Zone or use district in which premises are situated ....... . .............. j~2,/_/. . ...........................
12. Does proposed construction violate any zoning law, ordinance or regulation: ~/~. ............................
13.
Will
lot
be
regraded ....... Z, ................... Will excess fill be removej1 from premises: _ Yes (-.No
14. Name of Owner of premises ./7../q4~.~..~goo¢~. .... Address gal. ~.c9.. ~r~. ~..4.~,/.(..~.. Phone No.7...L4.77/..~.5.' '---- ....
Name of Architect ........................... Address ................ _.a :,..,,, Phone No ................
Name of Contractor-j~,,~,,a.'~,-,qu.~ ............... Address Z. (7..,..55. f.' .vff..M?~..g. . ./~...._p._.b~ne No. ?'.g..~.--.q. ~.$. 6. ....
15. Is this property within 300 f~et of a tidal wetland? ayes ........
· *'If, ye% Southold Town trustees Permit may be required. ~ .......
PLOT DIAG IL~M
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from.
property lines. Give street aud block number or description according to deed, and show street names and indicate whether
interior ar comer lot.
';TATE OF NEW YORK, S.S
20t)I?Y 0!: ........ ~ .......
. . . .~.~.~.~e.../f. ~-.....~..L,:(.g,Z .~,~'. .........· ......... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bore named.
ire is the ..... .~.C ........... .
(Contractor, agent, cor'porate officer, etc.)
,f said owner or owners, and is duly atttbodzed to perform or have performed the said work anct to make and file this
pplication; that all statements contained fll this application are true to the best of his knowledge and belief; and that the
:ork will be perfonned in the manner set forth in tile application filed therewith.
,worn to before me this
~o, 49~1364
Qualified in Su~d!k CounW ~
Commission E~ires May ~, ~9 ~
Al6 I 6 1995
U NDERWRITBR$ CERTIRCATE
OCCUPANCY OR '
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
APPROVED AS NOTED
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROI.,~H * FRAMING & PLUMBING
S. INSULATION
,4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION ,SHALL MEET
THE REQUIREMENTS OF THE N,Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
d u'r-o,q o ~v ~
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~ L E V/!T 1 otq
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