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HomeMy WebLinkAbout23038-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N_o 23O38 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE~ION OF THE WORK AUTHORIZED) Permission Is hereby grant~ to: ....... ~~.~ ........ ~..%..,......./: ./..~z/.. ....... . t o....~. ~.~ ...... . ..~...~ ........ ~......~..../._?..~.......~...... ~,,2~..,.'~,...: .~........~...... ~.... ~~ ..... ~. ~ ...... ~::'..×~,==.....'.~....~.,(../..,. ..~..~ ........ ~.,r.~:~..-~ ...... ~..:..~/...L.~.'.~.~. ......... ~.~.~...:~. ....... ~... a,~m,ses,o¢ot~l......./..~..?..O.. ........... ~ ....... ~.'~ ....... ~.~ ........................... OountyTaxMapNo, 1000 Sectlon.,....~..?.. ............. Block ....... ...~.,,./.. .......... LotNo ........~...Z .............. pursuant to application dated .......... ~..~ ......... ,/,,~ .......... 19...?..~., and approved by the Building Inspector'. Fee $...~..~] ................. Rev, 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23948 Date OCTOBER 12r 1995 THIS CERTIFIES that the buildin~ i%DDITION Location of Propert~ 1280 NORTH PARISH DRIVE BOu'£~OLD NY House NO. Street Hamlet County Tax Map No. 1000 Section 71 Elock I Lot 27 Subdivision Filed Hap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SKPTEMBE~ 15~ 1995 pursuant to which Building Permit No. 23038-E dated OCTOBER 3~ 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 TWO SETS OF STAIRS OFF EXIBTING DECKS OF AN EXIBTIN~ ONE ONE FAMILY DW~.?.ING "AS BUILT" AS APPLIED FOR. The certificate is issued to DONALD & ROBIN BROWN (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 IOWN OF SOUTilOLD BUILDING DEP ART~ENT TOWN HALL 765-!802 ,, :' - 4 19CJ5 .:, BLDG. DEPT· TOWN OF $~UTHOI.D APPLICATION FOR CERTITICAT~ 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: l. Final surYey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic ~eatures. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-? form). 3. Approval of electrical installation from Board of Fire Underwriters. &. Sworn statement from plumber cersifying 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 ~opographic features. 2. A properly completed application and s consent to inspect signed by the applicant. If s Certificate of Occupa~cy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling S25.00, Alterations ~o 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~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $i5.00., Commercial $I5.00 New ~onstruction ........... Old Or Pre-existing Building ................. ~ouse No. Street Hamlet Subdivision .................................... F'i lcd Hnp ............ Lot ...................... ?er,,it Of ~" He~lLh Dept. Approval .......................... Umietwriters Approv01 ......................... 'isnning Board Approv:li ........................ :~.equcst for: ~empor,qcy Certificate ........... Fin;~i Ccrtica~e ........... Tee Submitted: ;(1111,11)^'1' I Ofl (IST) "r3U tt[)^'l.' I ON (2tt[)) PI,UMI~ I N(~ FInAl, ADI)[TtONAI, COHMENI$: 3q ©,~_, ;Fo ,© k TOWN OF SOUTHOLD BUILDING DEPARTMENT, ~-, /~ ~ ~:~ ~ TOWN HALL ' L~ ~ ~CSOUTHOL~,N.Y. 11~7] ~ ~ ~ ' ~ , ~TEL.: 765-180~ Disapproved a/c ' BOARD OF HEALTII ..... 3 SETS OF PLANS SURVEY CHECK ................ SEPTIC FORt[ CALL ........... MAIL TO: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tlds apPlication must be completely filled in by typewriter or in ink and submitted to the Building Inspector,, sets of plans, accurate plot plan to scale. Fee acco[ding to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public: or areal, and giving a detailed description of Iayout of property must be drawn on the diagram which is part of this ca~ion. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such ! shall be kept on the premises available for inspection tt~roughout the work. e. No building shall be occupied or used itl whole or in part for any purpose whatever until a Certificate of Occu shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant Building Zone Ordinance of the Town of South01d, Suffolk County, New York, and other applicable Laws. Ordina~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein des~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ~ admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporatiop .~.~. ~.~..~..,.CPa. c.~.~¢.. ~.,.,. { ~ ~.T~ ~, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or bt .... 0..cu. o. e_.C? .................. ~ .................... ' .............. . ...................... Name of oxvner ofpremises .'~).C)f)I~L.k,,& .~..,.. ~'~.CI3 kJl&ch...~...'~CeVLITI...~..,..~:>.C13 .t-¢O1~3 .... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authoriied officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............................................. · .. ocx b c. ......... t& ...... llouse Number Street ttamlet Con'nty Tax Map No. 1000 Section ...~.~.[ ......... Block .... I. ' Lot...~77 ........ Subdivision Filed Map No. Lot (Name) , State existing use and occupancy of premises and iotended use and occupancy of proposed construction: a. isting ,,se a,,d occupa,,cy ¥..:-.c c,ccc ........... b. lntended use and occupancy .(~. ¢JJke.~D,e.C~.. ~ C x'kC'dX(~['C'7 .... Ce.'~'*'~ .e.RTC..~. ...... .3. Nature of work (check which applicable): New Building .......... fi, ddition .......... Alteration .... Repair .............. Removal .............. Demolition .... : ......... Other Work ............... .... (Description) . 4. Estimated Cost . N.I. 1~ .,. Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ · If garage, number of cars ........................................................................ 6. If business, commercial or mt.xed occupancy, specify nature and extent of each type of use ............... , ..... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... tteight ............... Number of Stories ........................................................ Dimensions of s~me structure with alterations or additions: Front ................. Rear .................. Depth ....................... tteight ......... ~ ............ Number of Stories ' 8. Dimensions of entire new cpnstruction: Front ............... Rear ............... Depth ............... Height ............. ;z Number of Stories ....................................................... 9. Size oflot: Front ..I.~.~.,., ......... ... Rear.../.%.c>,~.'7 ...... ~... Depth 10. Date of Purchase .[:~:~.>.o~.~.~X..."4-..~. ,~ .[, .q,.~..~ ..... Name of Former Owner ~ .~.c2:~.'4..~.c.?~. {'~"~L k..~ .'~ i 1. Zone or use district in which premises are situated ....... . .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: . ['~.~, ........................... 13. Will lbt be regraded . .'~.~.: .................... Will excess fill be removed fronL~remises: Yes No,~ 14. Name of Owner of pre,roses ~5,~. t.q-..~L-~ · .-~.CO ~.C'~ Address [.~'~ O. ~o..DO.C ~ .~,..c~'~on~C~qo."/(.a'~.. 1 .~'"/.S.... Name of Architect ........................... Address ................... Phone No ................ Nmne of Contractor .......................... Address ................... Pho.ne~o ................ 15. IS this property within 300 feet of a tidal 'wetland? *Yes ........ No...~ ...... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM · Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro'm property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. -. ' CTATE OF NEW YO~K, S.S :oum¥ or K. .... .............................. ':~ ........ ......... being duly sworn, depose~ and says that he is the applicant (Name of individual signing contract) bore named. ie is the ..... ...................................................................... '... ............ (Contractor, agent, cm:porate officer, etc.) f said owner or owners, and is duly authorized to perforn~ or have performed the said work and to make and file this pplication; that all statements contained ~n this application are true tO the best of his knowledge and belief; and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to before me this 19~..~.~ ,,~ c~mission ~p~r~~