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HomeMy WebLinkAbout22788-zFOP~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-23671 Date MAY 31, 1995 THIS CERTIFIES that the building REPAIR Location of Property 38675 MAIN ROAD House No. County Tax Map No. 1000 Section 15 Block 2 Subdivision Filed Map No. ORIENT, NEW yORK Street Hamlet Lot 17.4 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 24, 1995 .pursuant to which Building Permit No. 22788-E dated MAY 24, 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 P~PAIR EXISTIN~ ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to STEPHEN KELEMAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Rev. 1/81 FOItM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 22788 Z oou~,,x,oP~o. ,o00 s~o,,o~ ......... z.~. ~,oo~ .......... ~ ....... ~o,~o._ ../...z..Y ....... pursuant to application dated .......................... 1 9... nd approved by the Building Inspector. ~.~ ....... Rev. 6/30/80 ~ MAY 2 ~ 199~ Form No. 6 TOWN OF SOUTIIOLD BUII, DING DE?ARTi'IENT TOWN IIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled iu by typewriter OR ink and submitted tu the bnilding inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all bnildings, property lines, streets, and unesual natural or topographic features. 2. Final Approval from Hehitb Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement fromfpiumber certifying that tbe solder used in system contairs less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residence · · . · and installations,~a certificate of Cod~ Cn~ ~' ~ s.and s~mzlar bu~ldzngs · responsible for th~ building ....... p~ance from arcbmtect or engineer 6. Submit Planning Board Approval of completed site plan requirements. B. ~ F~r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and · pre-ex~stzng land uses: i. Accurate survey of property showing ali 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 Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to d{~eliing $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 Buildine - $100.00 3.Copy of Certificate of Occupancy - $2Of00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.00' New Construction ........... Old Or Pre-existing Buildieg ................. Location of Property [1~. ....... House No, Street Hamlet '' ' Onwer or Owners ,.,f P roperty...~.'~p..~...~..L~ ..................................... oanty Tax ,ap 000, Section .... · .... ...... Subdivision ..... ' ....................... Health Dept Approval · ' ......................... Uederwriters Approval ......................... ?lanning Board Approval ................... 'equest for: Tem.p.~_.~r~ficate ...... [.-[. Filial Certicate ........... ~ee Submi_t ted: $ .......................... ~,~, ¥~o 71 .......... ,~,,.'.~: :.'. --'--c~.~-~ 3 ~' ' .............................. 765-180Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ~.~/SUI.ATION [ ] FRAMING [ ~'/FINAL [ ] FIREPLACE & CHIMNEY FIELD INSPECTION REPORT DATE COI~4ENTS FOU~AT[ON (IST) ROUGH F~ PL~BING INSULATION PER N. Y. STATE ENERGY CODE mm ADDITIONAL COFR4ENTS: l ©/v',5' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 , ." ' ...' ' ' // , (Buildinglnspector) / HAY Z 4 1995 . ~., ICATION FOR BUILDING PERMIT ' · ' ' INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK ......... ~ ........... SEPTIC FOR}I .............. CALL . . . .......... MAIL TO: a. This apPlication must be completely filled in by Wpewriter 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 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 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 South01d, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, generaJ contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 7 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 .................. ... i..' ' House Number Street Hamlet County Ta;~ Map No. 1000 Section '.Z~'' Block .... ~ 'Lot Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: " a. Emstmg use and occupancy ........... . ............................ .. use 'an Y Ai30cfT[ b. Intended d occupanc ' . ................... ?r c ' h · .3. Nature ofw beck wh~c Ppheable): New Building . ~ ........ Addition .......... Alteration .... ;. ' Repair ... ~ ......... Removal .............. Demolition ..... Other Work ..... · ' ~ i '"" (D ipti C~'-O~D O~ ' · escr on) 4. Estimated Cost . · I ....... Fee ................ ~ (to be paid on filing this application) 5 If dwelling number of dwellin~ units Number of dwelling units on each ' If garage ................ floor ................ number of cars ' 6 If business commercial or mix{d occupancy specify nature and extent of 7' Dimension's of existing structhr ' ,each type of use .............. es if any Front ~.0 Rear Height /e~ Number of Stories .~. i i .......... ~Dunensions of shine structure with alterations or additions Front ,?:~4-r~¢- ......... ~.'iJ ............. uepth ! Height ' ' .................................. ' ......... ... Number of Stories ' ' 8 Dimensions of entire new construction: Front Rear ..................... Depth Height Number of Stories ............... ' .............................. Size on;i: ............. ' ....................... ' ................................ Front ......... , i ............ Rear ............... Depth Date of Purchase ......................... .......... , ......... ' ......... Name of Former Owner Zo i h p ~mi it d ........ ' ..................... ne or use distr ct in whicr scs are s uate ....... i gl ,i ' ' Does proposed construction vic ate any zonin aw, ordina ce or regulation' .~,O. ........ Will 16t be re raded '/~'- ' ' ............... g ........ , .....,. ·, ........ Wall excess fill be remov, ed from premises: Yes N fO fp -,~./~. ~..¢/..e~. Add /~.~, O..r2~t. amc o wner o remises ........ reds ' one Name of Architect .......... , ................ Address. i .~¢~.5! ' ~j~/~ ~ r> ...... Phone No ................ Name of Contractor.· j//..~.~./f'.q~c,¢.' ~ ...... Address ..... .?.c~. '.,~L/.. ~one No..7~Y~2 . 15.' I.s this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Town Trustees Permit may be required. .. I PLOT DIAGRAM Locate clearly and distinctly ail! buildings, Whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. ~ . 10. 11. 12. 13. ~NOdFY BUILDING DEP~ 785-1802 9 AM TO 4 PM FOR T~ 'FOLLOWING iNSPECTIONS: ' 1, FOUNDatION ~0 REQUIRED FOR POUBED CONCRETE ] ~g, ~IOUGH ,, FRAMING A PI..UMBI~G 3. INSULATION [ 4. FINAL CONSTRUCTION MIJ~T 8E (,OMPLE]E FOR C.O. i ALI., CONSTRUCTION SHALL MEET Tide REQUIREMENTS OF THE N.~ STATE CONSTRUCTION & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN O~ CON~IRUCTION ERRORS STATE OF NEW-YORK l ~ie of individual signin~g contract) above nan]ed. ~ being duly sworn, deposes and says that he is the applicant i 'Contractor,>gent, corporate officer, etc.) of s..a]d..ow.ne.,r or ,o, wners, and 2s duly ,auth,'oxj..'.X~. t t,,~--~n%rm or have performed the said work and to make and file this ~ppucauon, mat an statements contaised m this application .are true to the best of his knowledge and belief; and that the work will be performed in the manner slet forth in the appticatmn filed therewith. ' Sworn to before me this ........... a. ~\ .1 .~..'~-.. '...day of..: .... //~,~... ' .... '., 10 .~c~ qo'ta~_~Public ..... :~ ~ .... .~.,?~'~''.t',~ County .~)~.~ ~ ~ ///' / ,,, ' · ,-: q ,G,N~ NEViLL~ ' ' Si nature ' .-~ m fi)~P,'~s October 31, j19~ ', ' 75