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Home My WebLink About22807-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23691 Date JUNE 9, 1995 THIS CERTIFIES that the building Location of Property 51680 MAIN ROAD House NO. County Tax Map NO. 1000 Section 63 Subdivision REPAIR SOUTHOLD NY Street Hamlet Block 6 Lot 3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 23, 1995 ~ursuant to which Building Permit No. 22807-Z' dated JUNE 7, 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 PORCH REPAIR TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WILLIAM F. QUIRK JR. & JOHN C~.ARTOSIESKI of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 (owner's) N/A N/A N/A Building Inspector~ FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUIHOLD, N.Y. BUILDING PERMIT NO_ (THIS PERMIT MUST BE KEPT ON THE PREMISES,,,~ UNTIL FULL COMPLETION OF THE WORK A~THO~IZED) ~07 z ~o,~ ...... ~.~~.~ ............ ~ ............ CounlyTaxMapNo. 1000 Section ........ ~ .......... Block .................... I~otNo. pursuant ,o application dated .................. ~~....~..~.. ...... 19....~:~......, ...,~,., and approved bylhe Building Inspector. Rev. 6/30/80 Building Inspeo~r Form TOWN OF SOUTIIOLD 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 unnsnal oatural or topographic features. 2. Final Approval from Uchlth Dept. of water supply and sewerage-disposal(S-9 form)· 3. Approval of electricml installation from Board of Fire Underwriters. 4. Sworn statement fromfplumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residence~ an ' ' · · and installations,~a certificate of Code Com~lia=~= ~ .... d smm~lar.buzldmngs spons~ble 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 Occupang-v--- N~w~dwelling $25.00, Additions to dwelling $25.00, Alterations to dwell~$25.00,~wimming pool $25.00, Accessory building $25.00, Additions to accessor~~$25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing ~uildine - $i00.00 3. Copy of Certificate of Occupancy - $20.00 " 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.00' New Construction Old O Pre llouse No. Street Hamlet C°unty Tax Map No 1000, Section....~.,.~ ..... Bluck ...... ~ ........ Lot ..... ~ ..... Subdivision .................................... Filed Map ......... Lot ........ · · ..... Underwriters Approval.,. -.. . Planning Board Approval .... ~//~.. ............ i~equest for: Temporary Certificate ........... Final Certicate ........... ee Subml~ ted: $.. FIELD INSPECTION REPORT DATE COI~tENTS FOU~TION~ (~sT) Il " ROUGH FRAME & PLUMBING 1T Ii " STAT~ EN~R~ jj FINAL ' HAY 2 3,1995 Examined,~ Approve~.. Disapprove~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180'a ::,:...::::. SEPTIC ...... CALL t . . · I~IAIL TO: , ' APP~7~CATION FOR BUILDING PERMIT Da,e .... INSTRUCTIONS a. Tlds 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 19cation of lot and of lmildings on premises, relationship to adjoining premises or public sti'eets or areas, and giving 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 this 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 permit shall be kept on the premises available for inspection throughout the work. e. No huilding shall be occupied or nsed in whole or iu part for any purpose whatever until a Certificate of Occupancy shall have been granted I?y the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for tlie issuance of a Building Permit pursuant to the Building Zone Ordinance of tlie Town of Southbld, Suffolk County, New York, and otl~er applicable Laws, Ordinances or Regulations, for tlie construction of buildings, additions or alterations or for removal qr demolition, as herein described The appl cant agrees to comply with all applicable laws, ordinances, building code, housiug code, and regulations, and to admit authorized inspectors on premises and in building for necessar~c~fions. ~~a -- (Signatum of corporation) (mailing address of applicant) State wlietlier applicant is owner, lessee, agent, architect, engtneer, generai contractor, electrician, plumber or builder. 6 ld ' , (as on tim tax roll or latest deed~l~.~O~ED AS NOTED If applicant isa corporation, signatnre, of duly authorized officer. FE~~,_'~~'' (Name aJld title of Corporate officer) 785~802 9 AM ~ 4 Builder's License No.../.~. ~.~ .~ ....... FOLLoWiNG 1. ~OUNDA'riO~ .. ~O FO~ POURED CONcreTE Plumber's License No ......................... 2. ~OOGN . FRAMING & PLUMBING 3, INSU~TION Electrician's License No ....................... 4. FINAL CONSTRUctIoN MUST ~E COMPL~E FO~ C.O. OflmrTrade's License No, ' ALL CONSTRUcTIoN SHALL ..................... THE REQUIREME~S OF ~E N.~ ' ~TAT~_ CONsTRu~ION &. ENERG~ .... ]. Location of land on which proposed work will be ~o~e ............ O~S.' 'R~' '~IBLE FOR ~ / / I DESIGN OR CONSTRu~ION .. Itouse Number Street Hamlet ........ ........ :... ..... ........... Subdivislon..: ..... . ............................. '. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and oc'~upancy of proposed construction: a. Existing use and occupancy ... ~ ~' ... .~t ................................ .. b. lutended use and occupancy ..................... . ...... : ......................................... '3. 5. If dwelling, number of dwelling ~nits ...... If garage number of cars 6. If business, commercial or mixed occt~pancy, specify nature and extent of.each type of use ...... 7. Dimensions of existing structure',if any: Front ........... · · .. Rear ............... Depth Height Numlber of Stories Dimensions of shine structur, e with alterations or additious: Frout Rear Depth ' i Height ' ; Number of Stories · D~mensions of entire new construction: Front .............. Rear ............... Depth Height ' Number of Stories 9 Size ofl0t: Front · ' ' Rear Depth 10 DateofPurchase ~' ' ' Name of Former Owner 11 Z or use di trict in wli I pre[hi situ ted · one s ~ c ~ scs are a ................................ !2 Do s pr posed constrt etlon violate any zm lng law rdmanc' egulat' ' ' ' .... . , e o I ~ , o e or r ion: . . . , . . . , ........ 13 Will lot be regraded ...... '. ~ Will exc fill b Oved fr m premises: · · .................... ess e rem 0 14 Name of Owner of premises i Address , Phone No [5,' Natme of w eck which applicable): New Building . ~ ....... ; Addition .......... Alteration .... ;.. i Repair ... ~'. ......... RemOval ............ Demolition ........ Other Work .......... ..... (Description) Estimated Cost ~.~.~.~, (7/J...'.. Fee '-~' i (to be paid on filing this application) ...... . Number 6f dwelling units on each floor .............. Yes ' No Name of Architect I .......... : · ' ' i Address Phone No . Nmne of Contractor ......... i ............... Address ................... Phone No ................ Ip this property within 3',00 fee~ of a tidal 'wetland? *Yes ........ No ......... · If yes, Southold Tiown Trustees Permit may ~e required. PLOT DIAGRAM Locat.e. clearly and distinctly all ~bmldmgs, whet!aer existing or proposed, and. indicate all set*back dimensions from property hnes. Give street and block nmnber or description according to deed, and show street names and indicate Whether interior or corner lot. ~ ' ' STATE OF NEW YORK, COUNTY OF ................. SiS ................................................ being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) above named. He is the (Contractor, ageut, corporate officer, etc.) of said owner or' owners, and is duly iautlmrized to perform or bare performed the said work and to make and file this application; th,it hll statements contal~led h~ this'application are true tO the best 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 ~ne this ........ =7%z4.'.~.. :....'. '.da{ of. I[ : .... ' ..... , 19/.9 Uta, Pub,e,. County Notary Pub,ic, St ,to of Now York (~[ apPlicant) No, .¢952246, Term Expires J