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HomeMy WebLinkAbout22957-zFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-23854 Date SEPTEMBER 7, 1995 THIS CERTIFIES that the building ADDITION 135 WOOD LANE & Location of Property. 5355 INDIAN NECK LANE PECONIC NY House NO. Street Hamlet County Tax Map No. 1000 Section 86 Block 6 Lot Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 4, 1995 pursuant to which Building Permit No. 22957-Z dated AUGUST 22, 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 A DECK ADDITION TO A ONE FAMILY DWELLING "AS BUILT" AS AS APPLIED FOR. The certificate is issued to of the aforesaid building. DAVID CI(~{ANOWICZ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A FORM NO.$ TOWN OF SOb*THOU) BUILDING DEPARTMENT SOUTHOLD, N.Y. N~ BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] 2~ST.Z ~o,e ......... ~/..~ ..................... ~ CounlyTaxMapNo 1000 Sec,ion,,~;~,, ._.:... ~_~..~..,,,, Block ~. .... LotNo ~ ....... pursuant to appllca'tlon dated ........... Building Inspector, ~ee~......7.:....~.. Rev, 6/,30/80 Form No. 6 TOWN OF SOUTUOLD BUILDING DEPARTMENT TOWN ~IALL 765-t802 APPLICATION FOIl CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new buildiog 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate.of Code Compliance from arohitect or engineer. responsible for the building. .~ 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, i957) non-conforming uses, or buildings and "pre-existing" land uses: i. Accurate survey of property showing all property lines, streets, building and uuusual natural or topographic features. 2. A properly completed application and a consent to iespect signed by the applicant. If a Certificate of Occupancy is denied, the Buildi,g 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-existinM Buildin~ - $[00.00 3, Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Cergificate of Occupancy - Residential $15.00., Commercial $I5.00 Dote. .................... New Construction ........... Old Or Pre-existing Building...~. ........... Location of Property...~.G~% ........ ~.~.~ .................... ~(~(.I .......... House No .... ~ ~Street ~ Hamlet Onwer or O~ners o~ Property ......... I.¢...~t~)~p.~{G.~ ................................ Subdivision ............... . .................... Filed Mnp ............ Lot ...................... ?e mZ No., :. ..Date ermit .............. ..... Health Dept. Approval .......................... Underwriters Approval ......................... 'lancing Board Approval ........................ ~equest for: Temporary Certificate ........... Fi~al Certicate 7ee Submitted'. $ .... ,.. ~.,o.~o. ................. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] INS~TION [/_.~NAL [ ] FIREPLACE & CHIMNEY REMARKS: ~~ '-'- INSPECT~~ 765-180Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG, [ ] FOUNDATION 2ND [ ] INSU.~'I/ON [ ] FRAMING [ ~ll~C [ ] FIREPL/~&CHIMNEY FIELD INSPECTION REPORT DATE COlqHEflTS FOUNDAT ION ( IS'F) FOU~)ATION (2ND) ROUGll FRAHE & PLUHBING Il INSULATION PER N. Y. ......... -II STATE ENERGY CODE .... ~___,,~~',, ~__~_ ., ¢_~~  ===ADDITIONAI. C~RTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Disa ~proved a/c ....................... ~ - · · J .... . AP.~I~ICATION FOR BUILDING'PERMIT BOARD OF }IEAL~ll · ·., ...... SETS OF PLAk. tS .......... flECK .......... SEPIIC FORH .............. CALL ..... HAlL TO: ,,, ', 1995 Date ................... 19... INSTRUCTIONS a.' Tlds application must be completely filled in by typewriter or itt 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 locatiou of lot and of buildings on premises, relationship to adjoining preznises or public s6-eets or areas, aud 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 tllrougbout 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 ItEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soutbold, Suffolk County, New York, m~d other applicable Laws, Ordinauces 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 Oil in building for necessary. · .~fi~..' 'ans. ~~~'~"'~' ,, t~ ' admit authorizeS inspectors premises ailS ~ons.g~.(,,-~ (Signature of applicant, or oam~,, i¢ a-~orporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N ,ne of o ner of ! .&.. .............................. (as oil tile tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nanle and title of corporate officer) Builder's License No .......................... Plumber's License No ..... ' .................... -- tl Elect c nsLcenseNo ....................... Other T adc s L cense No. Locatiou of land oil which proposed work will be done ................................. ; ................ llouse Nunlber Street }-lander County Tax Map No. 1000Sectiou ... :..~..~:? ........ Block ....... ~.. ' Lot...'~. .......... Subdivision ............... ~Z-7. ................... Filed Map No ......... .~. .... Lot ............... (Na~ne) State exJsling use ariS occup,ancy of premises and intended use and occupancy of proposed constructiou: a. Existing use and occupaocy ........ .~: (5.~..;E'2.~..~. O..~.: ..... .3. 10. 11. 12. 13. 14. 15. property lines. Give street and block interior or corner lot. Nature of work (check which 4pplicable): New Buildin'g ......... ; Addition . .' ........ Alteratio .... ;. Repair ............ .. Removal ....... De nolition Other Work. o.~..~ Estimated Cost ... ... cr o ~ (to be paid on filing this application) If dwelling, number of dwellin4 units .............. . Number of dwelling units on each floor · If garage, number of cars .... I. ................ If business eom~nercial or mixed ............................... ' ...................... .... , . occupancy, specify nature anti extent of each type of use Dimensions of existing stmcturles if auy: Front Rear ' lleight Ntnpt~er of Stories ............................. Depth ..... Dimensions of shine structure with alterations ........................................................ Depth ' ' Height or ad~litions: Front ................. Rear ' Numbel of Stories ' Dimensions of entire new construction: Front ...... l ~'.."~. · .: Rear .... .[ [~. ~ ..... De . .[,~.~' Heig it . . .--.-.-.-.-.-.-.-.w~..- . Number of Stories . pth .......... Si fl [ .... ' ........ ~ ............................... ze o ot: Front ......... ,.. ............ Rear ...................... Depth ...................... Date of Pnrchase ' Name of Former Owner ........................ Zone or use d strict In which pr trlises are situated ................................. '. d I i lin ti I .................. Does propose construction rio, ate any zon ng law, or~ a ce or regu etlon: .... Will 6t be re faded . ' ~ . . N ~ ~ g ' '" ' ' '~t't)4' .... ' ............. Will er~,cess fill be_removed from premises: Yes ~__~__o~ rune o~ Owner of prermses .I,gP~t4~D. (,-4.c,q.q~O~/~Adclressr~/.6~p... l'~e.,~,4'~i.c.~.t,r/~ Phone No..7,~.g.-r 2~Zf'~ ....' Na f A I itc me o rcl ct ......... i ' Address ............. Phone No ...... Na fC ~t tor .......... ' ......... ~ne o o~ fac ........ ~ ...... Add '" ........... ress ................... Phone No ................ I.s this property within ~00 feet of a tidal ~wetland? *Yes ...... · If yes, Southold ~.own Trustees Permit may be require~. ' ....... " PLOT DIAGRAM Locate clearly and distinctly all!ibuildings, whether existing or proposed, and. indicate all set-back dimensions from aumber or description according to deed, and show street names and indicate whether STATE OF NEW YI~RK~ / /'~ ! S COU.UT¥ OF (Name of individual signifig contract) above named. being duly sworn, deposes mid says that he is the applicant He s tie i (~(~ ~_~-- ' i (Contractor, agent, cor'porate officer etc.) ' . of sakl owner or. owners, and is dulYlauthorized to perform or have performed the said work and to'make and file this application; that all statements contained in this application are t'rue to the best of his knowledge and belief; and that thc work will be performed in the manner ~et forth in tile application filed therewith. ' Sworn to before me, ~tis : I ........... / ............ day, of ./4.. ~~., 19.~..~ : .... ·. · · .............