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HomeMy WebLinkAbout22872-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-23766 Date JULY 13, 1995 THIS CERTIFIES that the building. ADDITION Location of Property 240 BAY ROAD GREENPORT, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 43 Block 5 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 19, 1995 ~ursuant to which Building Permit No. 22872-Z dated JULY 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 DECK ADDITION "AS BUILT" TO EXISTING SEASONAL DWELLING AS APPLIED FOR. The certificate is issued to GEORGIA AIAMSTRONG & STEPHEN WITENKO (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ,.i ........ ~.,.,Z ..................... 19.E..~.,~ 22872 Z Permission is hereby granted/C: ~// ~ .,. ~' _ .......... .............................................................................. CountyTaxMapNo. 1000 Section.....~..~.../X ........ Block....~ ............~,,~o. ,.~.,: ....................... pursuant to application dated ................. ~..Z~...~.. ............ 19....~....J.. ....... and approved bvthe Building Inspec~ Fee $..../'~....~.........'~.. ..... Rev. 6/30/80 Building Inspector ,' jUi l I 9 t995 Form No. 6 TOWN OF SOUTHOLD 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 unusual natural or topographic features. 2. Finai 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 1% 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 i. 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 Buildinz - $100.00 3.Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residentia~ $15.~0, .Commercial $15.00 Da te ........ ?1.?. (?.~. ....................... New Construction ........... Old Or Pre-existing Building ................. Location of Property . ~T~ ['~,_'~. '(~..~J~ ~.VJ~.~.~..~... ~.~ ~.~.~. ~..~.~. House No. Street Hamlet Onwer or Owners of Property....~..~..~.1.~.. ~f~.~.~.~-.~..~.~..~...~7~. 1~....~..~..~ o't3,o .g.., p County Tax Map No 1000, Section .......... Q...Block....O. .O.~ ..... Lot .... .~... Subdivision ................................. Filed Map ............ Lot .................... Permit No ............... Date Of Permit ................ Applicant ........................... Health Dept. Approval ......................... Underwriters Approval ........................ Planning Board Approval .................... lequest for: Temporary Certificate ........... Final Certicate..f ........ ?ee Submitted: $ ..... ~.~ ..................... tR 7 ....... FIE~D I~;PECTION REPORT DATE . COMMENTS FOUNDATION (IST) FOUNDATION (2ND) ROUGR FRAME & ...... -_-]. PLUMBING [NSULATION PER N. ¥. STATE ENERGY CODE FINAL ,j OCT £ BLDG. DEPZ TOWN OF SOUTHO! P,~iCE J, _ , <, . ? 765-1802 BUILDING DEPT. INSPECTION FOU.DATIO. ,ST [1.0UG..'BG. FOUNDATION 2ND [ ]/INS~T'O" FRAMING [ g~I=INAL FIREPLA~ CHIMNEY DATE JUb, l g 1995' Examined ,~.~ .Z. Approved..',Z...~. ~... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 ., 19~... Pe....it No .......... BbARD OF HEALTH 3 S'ETS OF PLANS SURVEY .................. CHECK . ::::::::::::::::::::::::: HAIL Disapproved a/c ................................ '..:. i ...... . ............... ~/'/h (Bu_il_di~g Inspector~ ~,~'~' Date ................... 7.9... 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 st?eels 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 i~sued 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, pr'¥or 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 inspect6rs on premises and in building for ne~e.~s~ry i~asp'e~ctio~s .... --' ' ~ '~Sig~na,[u. re of' applicant, or~n~a ~m% if a corlSoration) · .7..0..e:~..,7.9.o¢. ~....u..r%...~...¢. .... t .o.&~6T....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... p. w. ~..c~ .~. .... (~ ~.~..) Name of owner o? premises . .~. :~...O./~. ~ (~..../~.-.~..pt.~...D..~.)....~...T~..~...~.H...~.. '...~.?..F.~T~' .~..~..~. (as on the tax roll or latest deed) 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 .................................................. ...... .~'ff.~ ............ ~ A .7... tT~/~..., i...' ...... ?. (~. ~.4-. ~ ~.. ?. ~.., .'.¢..~.~. ~o..~.. House Number Street Hamlet Conhty Tax Map No. 1000 Section ... :~...~..~.,...0.~.. Block ...Q..~.: ..O.Q.. i... Lot..0..0...~.~..Q..~. ..... Subdivision ...... .~.. ................... ' ......... '. Filed Map No .... ,~ ......... Lot . . ~..: ........ (Name) . 2: Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....O..t~..~. .... ~.../~..( .~.? .... .B.bQ.~...~.~. ).~..4 ........................... .. b. Intended use and occupancy ...b~j~.~ J.~. ........ ' ........................ : ....................... .3. Nature of work (check which applicable): New Building .......... Additiofi .......... Alteration .... ; .... Repair .............. Removal .............. Demolition .... : ·. · i ...... Other Work .............. Cost.~../~ ~ ! (Description) 4. Estimated '" ' ...................... Fee ................................... (toI be paid on filing this application) 5 If dwelling number of dwelling units Number of dwelling t~nits on each floor If garage, number of cars ................. 6 ' If business .......................................... ' .................. commercial or mixed occupancy, specify nature and extent of eachi type of use ........ ' .... 7' Dimension[ of existing struct'ures ' ' .................... if any: Front Rear Height Numl~er of Stories ........ ' ........... : ..... Depth Dimensions of shine structure with alteration~ or additions: Front ; Rear ........ Depth ~ Height '. ................................. ................................ ' ........ Numbe~ of Stories ' 8 Dimensions of entire new construction Front ' "' ' ' .................... Height Number of'Stories .............. : Rear ..... ; ......... Depth ...... 9 Size ofl0t: Front Rear 10' Date of Purchase ......... ' ................................. Depth ..................... ~, . . · '. .................. ' ......... Name of Former Owner ..... hp ] ....................... 11. Lone or use d~stnct tn whic remises are situated ............ . . 12 Do dc 1 ingl din ' ' ......... ' ....................... ' .... . . es propose onstruction rio ate any zon aw, or ance or regulation: . .i. · · .................. 13. Will 10t be regraded ....... .. .............. Will excess fill b ' d fr i .... 14 N fO fp i ...... 1 eremqve omprem scs: Yes No . ameo wnero rem scs ........... , ........ Address ............ : . Phone No ............ ;... Nam~ of Architect ........... ' Add ' ' N fC ................ ress .......... I Phone No ......... : .... amc o ontractor .......................... Address .......... .I Phone No ............... 15. I~ thio proper within 300 feet of a tidal wetland? *Yes...i .... No ......... ld · If yes, Southo Town Trustees Permit may be required. PLOT DIAGRAM interior or corner lot. ~ . .. STATE OF NEW. YORK, e c cou r /?F (N~me of individual signing cef'fitract above named. OR USE. IS UN[gWFUL W ,Tt OUT ,CE !tFIC ....... being duly sworn,._a~oses any says marine is me app~ OCCUPANC 'He is the '-- (Contractor, agent, co~porate officer, etc.!) ........................... of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to make and file this application; that all statements contained in this'application are {rue tO the best ofh!s 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 .......... :....~..'.:.day?f...~....'. 19~./ No'tary Public, .~/~4~...~.~.,('.~.'.~ i.. County ~/,~t~ . .. . .. ,,t, . z . , . , . . .