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HomeMy WebLinkAbout22844-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-2390B Date SEPTEMBER 25, 1995 THIS CERTIFIES that the building ADDITION Location of Property 670 PRI~rATE ROAD ~12 ORIE~Vf, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 15 Block 8 Lot 27 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 9, 1995 ~ursuant to which Building Permit No. 22844-Z dated JUNE 20, 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 OWE FAMILY DWELLING AS APPLIED FOR The certificate is issued to JANICE ROBINSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 W/A N/A FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ....................................................... N9 22844 Z Permission Is hereby granted to: .......... /.~... .................................................... ............ .......... .......... ....... ............... Counh/TaxMapNo. 1000 Section..../~ ....... Block ......... ~ ........ LotNo....~...~.., ........... pumuant ,o application dated ................. ...~...~t..~....~.. ...... 19.......~..~d approved by the Building Inspector, Fee .................... Rev, 6/30/80 Porto No. 6 BUILDING DEPARTMENT ~ APPLICATION FOR CERTI¥I¢ATE OF OCCUPANCa~__.~'"~L-OG':~2~!~' / 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. Rinal survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from tiealth Dept. of water supply and sewerage-disposal(S-9 form). 3. App{oval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/IO of 1% lead. 5. Commercial building, industrial building, maltiple residences and similar buildings and installations, a certificate of Code Comp%iance from a~ohitect or eng£neer 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: 1. 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 O~cupancy - 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-existinz Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $]5.0P,, Commercial $15.00 [ ...~.~, Date .... .~....~' . k .~.J. ' .................... Location of Property ....~.,~..~...~.,B~ .................. ~..~.~ .......... House No. , Street · Hamlet Onwer or Owners of Property......--~..~..~..[.~.~...,....~[~30~............... ............. ' ........ coun,y .,,a~ ~sp ,o 1ooo, ~ectiou ..... /.5--.. .... '~'nc,~ ....... %. ...... ~ot .... ..~..--2 ............ Subdivision .................................... P'iled Map ............ Lot ...................... Permit 'o..~...~_[~....~a~e Of Permit. ,lealth Dept. Approval...~. ............... Underwr, ters Approval ....... ~.14 ............ Planning Board Approw~l ..... ~ ............ Request for: Temporary Certificate ........... Final Certicate ........... ~s0~tt ............ Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 i, 0~ TOWN OF SOUTHOLD ~,~. · August 23, R & R Home Improvement & Bldg., Inc. P.O. Box 676 Greenport, NY 11944 Fax (516) 765-1823 Telephone (516) 765-1802 1995 Re: Janice Robinson Prem: 670 Private Road %12, Orient NY To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 22844-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD August 23, 1995 R & R Home Improvement & Bldg., P.O. Box 676 Greenport, NY 11944 Inc. Re: Janice Robinson Prem: 670 Private Road #12, Orient NY To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 22844-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. F1.ELD ~NSPECTION REPORT DATE COI"R'tEI~S vOU~TtO~ ( I SX) II ~ II' II ROUOH Fm~ s ~ II FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ · ~I~ULATION [t~] FINAL 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ I FOUNDATION 2ND [ ] I~LATION [ ] FRAMING [/~] FINAL [ ] FIREPLACE & CHIMNEY INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS/ULATION [ ] FRAMING [ C*~FINAL [ ] FIREPLACE & CHIMNEY ~REIVI~ARKS'., ~ A,/,/0°/6 /97.5'0 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... i~ Inspe~ BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ CALL .... ; ...... MAIL TO: 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 l&yout 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for ~'emoval 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. · (Sigqature of applicant, or name, if a corporar'~on) - · (Mailing, address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... '7aU (*e~..~..qlo.l~.,.o.~.." .......... (as on the tax roll or latest deed) If applican~ corpor~.~duly authorized officer. ....... (Nam/,~nd title of corporate officer) Plumber's License No ......................... Electrician's License No ....................... JUN - 9 1995 Other Trade's License No ...................... ~ 1. Location ofland on which proposed work will be done. ~1'~-~ ~)o~-~ ~)~[ House Number Street Hamlet County Tax Map No. 1000 Section ....... ~.~.. ........ Block ....... ~. .......... Lot .... .27..~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) 2: State existing use and occupancy of premises and intended use and occupancy of proposed co~nstruction: a. Existing use and occupancy .................. ~,.~.,1~O~1 ................... b. Intended use and occupancy ~ ~ /.~[ ,~.#~~1~1~8 .................. ................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .~..~.-'.QI~.. Alteration .......... Repair .............. Rem( val .............. Demolition .............. Other Work ............... ; (Description) ~.~ .6*~. ,n, Fee 4 Estimate'd Cost ~'~ [ (to be paid on filing this application) 5. If dwelhng, number of dwellin~g 9nits ............... Number of dwelling units on each floor ............. If garage, number of cars ....~7': .................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structure!, if any: Front ............... Rear .............. Depth .............. H;ight ............... Numlber of Stories ............................ ~. ................ ~ ......... Di nensions of same structure wilh alterations or additions' Front /' i Hight .~...~. r ............... ~_~ ............. Depth ....... 3.2. ......... ;. e .................. Number of Stories .................. · 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ........ Num~_.er.o f Stories .................. ) ........ 9. Size of lot: Front .... ]ff.'.~.,,. 5! ......... Rear 10. Date of Purchase ..... ~/'.g.t~/~/.. '. ' ....... l.q.7..,.~- ....... Depth .. ].~..O. ............. ............ h[amo qf Fo~-mer Owner .~ .'~r ............ i... ' 1 1. Zone or use district in which pre~uises__ are situated...~?.~'.5.t ~.~..~.'3)~3. 12. Does proposed construction vi~te any zoning law, ordinance or regulation: ...&).6. .......................... 13. Will lot be regraded .... ~...~.~97 ............ , ...... Will excessffill he xemoved from premises: . Yes No 14. Name of Owner of premises .40~[q~ ~o. lat.~?tk... Address ~['~.t~ ~.. ~..r~.~. Phone No .. Name of Architect .......... i .................. Address ............ ,... Phone No ................ Name of Contractor . .~'~g.~.. ~.q[[~ .'f~5 .......... Address ¢.0.,i .~ .6.7.gO.~.~.:.. Phone No. q 7.7.-: ./~5.-~.,,~, .. 15.Is this property loeaged within 300 feet of a tidal wetland.* *YES .... N0..~..; *If yes, Southold TownI Trustees Permit may be required. . PLOT DIAGRAM Locate clearly and distinctly ail ibuildings, 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 comer lot. STATE OF NEW YOI?eK,,~, ~ ~' S COUNT',' OF ......... (_~f.,~../4J.~.. ~¢.~..'~(,, ................. being duly sworn, deposes and says that he is the applicant · (Name ~ffindividual signing contra'ct) above named. He is the ..................... , .....C~.~ ................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dub authorized to perform or have performed the said work and to make and file this application; that all statements conta ned in 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 me this ............ ..... ......... .... .... ..... ~ 4'/~$05~ ~ ~I~,, ~f (Signatufi~5'f applicant ) .................................................... .~ ~....~ _~, ~...~ " r ~ ~ ?. 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