Loading...
HomeMy WebLinkAbout23176-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24079 Date DECEMBER 13, 1995 THIS CERTIFIES that the building ADDITION Location of Property 2005 NEW SUFFOLK AVE.& 735 REEVE AVE. MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 114 Block 9 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 11, 1995 pursuant to which Building Permit No. 23176-Z dated DECEMBER 12, 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 ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" AS APPLIED FOR. The certificate is issued to ELEANOR SALOMON, DECEASED (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A f/70u*'ldidg Inspector Rev. 1/81 FORM 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) q9 Date.............../?/ ........................., ...... N9 23176 Z ��} Permission Is hereby granted to: 7'�9 / �����4Si lggkPIl .L©. ..?..4..-�... .......... .... to..... .../.o ........ ..... 5. . :: t'r. .. .. .... /•�y�........,...... ... .................................................................................................................................................................. .................................................................................................................................................................. � ................................... at premises located at.......e?'� /'' r1...`JE( 1 `....4w............................................. ...................................................... � ................................... County Tax Map No. 1000 Section ........ ....... Block........©. ............ Lot No. ......&................ pursuant to application dated ................. 19...9.s ... and approved by the Building Inspector. o0 Fee $... .. -............. `.... .. .............................. uilding Inspector ..........4 Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1302 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 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 from plumber certifying that the solder used in system contains less than 2/10 of 17 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. t 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 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 Buildins - $100.00 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 Date . // <1-17. �� . /.Sr. . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . .cOld 0 Pre-exi ting Building. . . .,. Location of Property. . . 7* . . .i� House No. Street ` Haml, Onwer or Owners of Property/ - ' '�•� ' County Tax Kap No 1000, Section. . ./f.\� . . . . . .Block. . . . . . . . . . . . . .Lot. . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . ?_anning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . 3eauest for: O [[Temporarr�y Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . . Fee Submitted: $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ! . . '. . . . . . . . . C . C3.12 5056 APPLICANT o �aYo�q jI ') FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . TOWN OFSOUTHOLD !: SURVEY 4 . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . DSC I 11995 TOWN HALL SEPTIC Font) . . . . . . . . . . . . .a SOUTHOLD, N.Y. 11971 TEL.: 765.1802 NOTi Y ; ALL • . . . . . . . . . . . . . . Examined . . . . . .//oL 19 /5 HAIL To Approved /�. . . . . ., 19 Permit No. 0'W7 Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( it g h .pector) APPLICATION FOR BUILDING PERMIT Date , .4 , a.'i. . . . . . . ., 19 !K 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. 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 sltall be kept on tine premises available for inspection throughout tine work. e. No building §hall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sltall 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 fire 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 Inspectti�oJ§.� d' (Signature pit t nan , if a corporation). . . . (Mailing address of pplicant) State whether applicant is owner, lessee, ager , architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises (as on the tax roll o atest do) 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. 7 � . . . . . , . . . . . . . . /moo- /i -.i�. . . . . . . . . . . . . . . . . Clouse Number LStreet 11 at County Tax Map No. 1000 Section . . . ./ / ( • . . . . . • . • • Block . . . . . Lot : (� . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Ma No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . . P (Name) 2. State existing use and occupancy of premises a1 d intended use prid occupancy of proposed construction: .(r . . . . . . . . a. Existing use and occupancy , . . . . . . . . . q Szt;:.�•.3ea. . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . C V4 tee ' ` L,.s'^5`j .. �•}{a Lni.$lei,rai.rr. .f'a= : N t ,f a; VON"e> Q1,r rn�zs 3. Nature of w rk (check which applica a New Building . . . . . . . . . , Addition . . • . . . Alteration . . . . . . . . . . a Repair . . . . . . . . . . . . . . Removal . . . . . .. . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . - (Deess cription) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee c� . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . 6. if business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . , . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . • . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . • . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . , Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . _ . . . . . . . . . Name of Contractor . . . . . Address . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . 5. 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED_AS NOTED DATE: /a%��%yL. B.P.# - FEE: �>°% BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION • TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.U. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF NEW YI�IC �<� S.S OUNT OfZ . . . .. . . being duly sworn, deposes and says that lie is the applicant (Name of in( ividiyl signing contract) Bove named. leis (lie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �.1 (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ork will be performed in the m�7set forth in the application filed therewith. worn to before me this > > • / :dayce��ef 19�t ;v . , otary Public, . . . .FIOBERT,1:S •TT,•.1 County NOTARY PUBLIC.S bf N.Y. `" No.4725089;Su Ik Co u ' Term Expires ay 31, 1W (Signature of applicant)