Loading...
HomeMy WebLinkAbout23185-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24088 Date DECEMBER 19, 1995 THIS CERTIFIES that the building ACCESSORY Location of Property 375 OLD WOODS PATH SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 1 Lot 3.3 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. 23185-Z dated DECEMBER 15, 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 AN EXISTING "AS BUILT" ACCESSORY SHED AS APPLIED FOR. The certificate is issued to KEVIN M. BOERGESSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A building 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) 9 N2 23185 Z Date........A/k/ ................................ 19../.. Permission Is hereby granted to: Q.,& .o ..rix....... s "........................................ . ......t�q:r.......119..7.1..................... ,td...... �......... �. ......... .....s �..........Vi s.... . s..... ; ......... ........................................................................... ...........................................................................................................................................I...................... ................................................................................................................................... ................................................. /s� ........... .................................. at premises located at...........dZ.5� & G��,SS ............. .....................................�74..................................... ...................................................................... ....................................J.................... County Tax Map No. 1000 Section ....�/............... Block.....©1............®. Lot No. ..S; ..3............... pursuant to application dated ............... ����............................ 19...../.�and approved by the Building Inspector. Fee S. ........ . . . . . . ...................... /ul�J4ing Inspector 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, l 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. 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, j Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - 5100.00 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 . . .Ia.a �J. . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . .;..�..,7 Old Or1'{��Pre-existing �Building._.f. . . . . . . . . . . . . . . Location of Property. . . . / li� . .R 3!. . . IQ. . . S��.� 1�C7 �17 /V I. . . . . . . . . . . . . . . . . . . . . . . . . . House No. Street �� V Hamlet Onwer or Owners of Property. . . :Q. ss v1 {V.-".::'r— !.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . . . . . . . . . . .Bllock. . . . . . . . . . . . . . . .Lot. .34 . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . .. . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant.'�'PV161. .^AStI1�����.Qv. - Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . .. . . . . . . . . . . . . Panning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . \ ,, Bequest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . M . . . . . . Fee Submitted: $. . . . . .. .. . . . . . . . . . . . . . . . . . \ paces Sc�S`1� t'PtLV7 ­Nd APPLIC T M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ✓rFINAL [ ] FIREPLACE & CHIMNEY REMARKS: 67 DATE ( _INSPECTOR 1 INAUTH RIZED ALTERATION OR ADDITION rO THS SURVEY IS A v1OLAMN Of SECTION 7:C9 OF TnI NEW YORK STATE EDUCATION LAW. COPIES OF MIS SURVEY NAP NOT EEARING ` THE L D SU:VZYi",Cc p':;D SEAL OR t ' E - - FMLOSSEO SEA!L9ALL,RCT S5 CONSIDERED , TO"W A VALID T.f!;CITY" �^'^p�^�/ GUARANTEES IMI..A ,#SAAU RUN 5 T E ONLY TO A) i v +R Tw SC3VfT 15 PWA_EC,A C >6 ALS TO IHE , EEELE ComaAxf' Gv p e A A.uKCY va i EENDENe 'EO THE Am ..F ru Lv�i1Y Ra5T4 iilitON.UL`Aui::_S a::hCr TZANA TO ADDIFE tBTULT!Oi6 OL SLM"*W Ov"BS..., A LL wVT , �.� r' ��. � _� rte" � ��b�� � t ✓i.'..d' fes` : � �� I (p'fip! tiG ro -.� Ti 1c Gjrn tvrrrz�r c r rv�r. .;ik `_c,?4x Map L .,i -N ?^s c; 5ui r FOFRMNO. '1 �3 SETS OF PLANS . . . . . . . . . . TOWN OF SOUTHOLD URVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT ��CIIECK . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 N UT I FY CALL . . . . . . . . . . . . . . . . Examined . . . . . . 19 MAIL TO : Q� . . . . . . . . . . . . . . . . . . .. O . • Approved . . . . .�, ./S� . ., 19/`)• Permit No. A . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i./Ins APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . .1/l. . . ., 19 9 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 sliall 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of builduigs, 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 insp(,eectiops. . . . . . .t`x%I. . ..�. .!�°`�.4�-,.�. . . . . . . . . . . . . . . . . . (Signature of applicalft, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. i . . . .Q .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .APPROVED AS•NOTED. . . . . . . . . . Name of owner of premises . . . . . . . . . . . . . . . . . . DATA: B:P.# t as on the tax roll or lam deed)) 3J� w BY: NOTIFY BUILDING OE"PAR MENT AT If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . 1. FOUNDATION - TWO REQUIRED (Name and title of corporate officer) FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . 3. INSULATION 4. FINAL - CONSTRUCTION MUST Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET Electrician's License No.. . . . . . . . . . . . . . . . . . . . . . . THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY Other Trade's License No. " " " " • . ' . ' . ' . " ' . . CODES. NOT RESPONSIBLE FOR DESIGN O N ? ION ERRORS 1. Location of land on which proposed work will be done. e�l..c. .I► I. .�:� .. . . . . . . . . . . . . . . . . . . . • • •1•1q1 House Number Street Hamlet Q County Tax Map No. 1000 Section . . u.7. . . . . . . . . . . . . Block . . . . . . . . . . . . . . . . . Lot .43 . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . riled Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . 4. Estimated Cost . . . . . . . '/00,0_0 (Description) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 mixed occupancy, specify npture and extent of each type of use 7. Dimensions of existing structures,if any: Front . ).a 1 i. * ' ' ' ' ' . ' ' Height . . . . . . . . . . . . Number of Stories . . �. . . . . . . . . Rear �.a . . . . . . . . . . Depth . . K . Dimensions of same structure with alterations or additions: Front Rear Depth . . . . . . . . . . . . . . . . . . . . . . Height Number of Stories 8. Dimensions of entire new construction: Frontr . . . . . ' ' ' ' Rear ta. Depth �. Height �]' . . . . . . . . . Number of Stories . . . . . /. . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear Depth . . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase .1170 :n. Name of Former Owner " '�' ' ' ' ' ' ' ' ' ' ' 1 1. Zone or use district in which premises are situated . IQ 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded a. . Wille ess fill be removed from premises: Yes No 14. Name of Owner of premises . . . Name of Architect Address tom ` ) . Phone No. .� T 5.7,5 L . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. Name of Contractor . Address . Phone No. 15. Is this property within 300 feet of a tidal wetland? *Ye " " " " " " " ' . " 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. Q� suJ I�N9 I'vV J Pao t f CLD 49aoa PArtl TATE OF NEW ORK, S.S 'OUNT OF . rfb/_/ . . . . . /k���� . . . . . beim duly sworn,C Y 1 , deposes and says that he is the applicant (Name o ndividual•signing contract) above named. le is the . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 vork will be performed in the manner set forth in the application filed therewith. 'worn to before me this . . . . . . . . . . ��. . . d,y of./. ?- (n . . . . ., 19 �� dotary Publi . VER6NICA'F: 'CIDONE. ounty NOTARY PUBLIC, Stats of Ner York No. 52-4661406 Qualified in Suffolk Cawft Commission Expires Dec 31, 19 �� (Signature Of applicant)