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HomeMy WebLinkAbout22604-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~RTIFICATE OF OCCUPANCY No Z-23682 Date JUNE 5, 1995 THIS CERTIFIES that the buildin~ Location of Property 555 WEST ROAD House No. County Tax Map No. 1000 Section 110 Subdivision ACCESSORY Street Block 7 Lot 7 Filed Map No. Lot No. N.Y. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 3, 1995 pursuant to which Building Permit No. 22604-Z dated FEBRUARY 28, 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 ACCESSORY DECK "AS BUILT" IN RMARyARD AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE HO. PLUMBERS CERTIFICATION DATED GUSTAVE C. BICKERT & WF. N/A ~]A Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N_o 22604 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted ~/~ , ....... ~....~.. ~....,~-~:~ .................................... .... .~..~-~.....~....,~,~ ~..:2-.. .... ,,~...,,~ .......... ~ ....... ..~ ......... ~ ....... ..~.~.~.~..~......~?.:......~.~..~..~ ....... ~..-. .............. .'........ ........................................... ..................................................... ~,.'~:~......:...,...~-.-..~,:: ...................................... at premises located at........~....0~...~..'~.. ....... ~...~...,~.....~.~..... ................................................................ ................................................... ~,z,,.'~, ~..6~,',.~..~ ....................................................................... Counly Tax Map No. 1000 Seotlon....,~,/.,.~.,, .......... Block ...... .,.~,..7. .......... LotNo ...... ..~...'.~.. .............. pursuant to applleation dated ............ .~../~.. .............................. 19......~....~,..~.., and approved bythe Building Inspector, ~ee ~,./..~.,~. /~' Building Inspector Rev, 6/30/80 ~ TO~srN OF SOUTtlOLD i' .'T---/BLDG. DEPT.. _ LO ] BUILDING DEPARTMENT ~ ~JUN -~ ~ ,~ ji~,iJi 765-1802 ~ ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This ~pplication must be filled ia by typewriter O~ ink and submitted to the building inspector ~i~h the following: for new building or ne~ u~e: 1. Final survey of property with accurate location of all buildings, property lines, s~re~, and unusual n~tu~l or ~opo~F~ph[2 [~Eures. 2. Final Approval ~rom Ne~lth ~ept. of ~ster supply ond se~e~age-disposal(S-~ form). 3. Approval of electrical installation from Board of Fi~e Underwriters. ~. S~orn statement from plumbe~ ~e~tifyiug tha~ the solder used in system contains less than 2/10 of ~ lesd. 5. Co~er~ial buildin~, industrial building, multiple ~esidences and simila~ buildings and installations, a ~e~tificate of Code Compliance [rom a~chiteet or e~gineer responsible fo~ the building. 6.Submit Planning Board Approval of ~ompleted si~e plan requirements. B'.. Fo~ existing buildings (prior to April 9, 1957) non-~onforming 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, Swiping pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. Certificate of Occupancy on Pre-existing Buildinm - $100.00 3.Copy of Certificate of Occupancy - $20.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.90, Con~ercial $15.00 Date ...... .; ................... New Construction ........... Old Or Pre-existing Building ....... ~.. Location of Fro-ertl,. ~J~ ~/~-~ ~ ~ ..... -_ ~.~ ~ ~ ~ ......................... ~-~'~.~.. ~a ~ ~ ........ CM~... ~.... House No, Street Ha~et o~ or 0~,~ o~ ~o~rt~ ....... , .... ' .~C,f<~ .......................... Cou~ ,~x ,~ ~o ,000, Se~t,o~.../Z.~ ..... ~o~ .... ~ .......... ~o~ .... ~ ............... Subdivision ............................... Filed Map ............ Lot ................ Permit No.~.O.~. .... Date Of Pemit...~/~/~ Applicant ...... Health Dept Approval ' Underwriters Approval Planning Board Approval .................... Request for: Fee Submitted: Temporary Certificate ........... Final Certicate, . . ~,.,~~.., .,. ........ ....... .... '"~ '' 'rf FFB I 0 1995 BLDG. DEp~ [~OLD 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 February 2, 1995 Ms. Helen L. Bickert 223 Diane Place Paramus, NJ 07652 Dear Ms. Bickert: We received you Building Permit application today re- garding the existing deck on your property. In order to process your application, we need for you to have it signed and stamped by a Notary Public. Enclosed is all the paperwork you sent to us for you to complete. Thank you. SOUTHOLD TOWN BLDG DEPT. I I VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (5t6) 765-1802 FAX (516) 765-1823 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD February 2, 1995 Ms. Helen L. Bickert 223 Diane Place Paramus, NJ 07652 Dear Ms. Bickert: BLDG. DEP'r. ~.,J_T _O_~W~ ,.~,0 F SOUTHOLD .,, We received you Building Permit application today re- garding the existing deck on your property. In order to process your application, we need for you to have it signed and stamped by a Notary Public. Enclosed is all the paperwork you sent to us for you to complete. $OUTHOLD TOWN BLDG DEPT. ~ ~ KNO~ ALL MEN by these p~esents, that [,~. constitute, and appoint my daughter, DORIS RO, BINSON residing at 223 D~ane Place, Paramus, New 3e~sey my t~ue and lawful attorney in fact for me in my name, place and stead, and t~or"my u'se and benefit: To exercise, do or perform any act, right, power, duty, or obligation Whatsoever that I now have or may acquire the legal right, power, or capacity to exercise, do, or perform in connection with, arlsin~out of, or relating to any person, item, thing, transaction, business property, real or personal, tangible or intangible., or matter ~hatsoever~ To ask, demand, sue for, recover, collect, receive, and hold and possess ali such sums of money, debts, dues, bonds, notes, checks, drafts, accounts, deposits, legacies, bequests, devises, interests, dividends, stock certificates, certificates of deposit, annuities, pension and retirement benefits, insurance benefits and proceeds, documents of title, choses in action, personal and real property, intangible and tangible property and property rights and demands whatsoever, as are now, or shall hereafter liquidated or unliquidated, become owned by, or due, owing payable, or belonging to me or-in which ! have or may acquire an interest, and to have, use, and take at1 lawfu: ways and means and legal and equitable remedies, procedures, and writs in my name for the collection and recovery thereof, and to compromise, settle, and agree the. same, and to make, execute, and deliver for me and in my name att indorsements, acquittances, releases, receipts, or other sufficient discharges for the same;~ To lease, purchase, exchange.'and acquire, to bargain, contract, and agree for the lease, purchase, exchange,and acqutsttion of; and to take, receive,and possess any real or personal property whatsoever, tangible or intangible, or interest therein, on such terms and conditions, and under such covenants, as said attorney tn fact shall deem proper; To improve, repalr, maintain, manage, insure, rent, lease, bargain, sell, release, convey, subject to liens, mortgage, and hypothecate, and tn apy way or manner deal with all or any part of any real or personal property whatsoever, tangible or intangible, or any interest therein, which ! now own or may hereafter acquire, for me and In my name, and under such terms and conditions, and under such covenants as said attorney in fact shall deem' To engage tn and transact any and all lawful business of whatever nature or,.kind for me and tn my name, which powers shall continue even if ! shall become disabled; -2- l125PG13q To sign, indorse, execute, acknowledge, deliver, receive, and possess such applications, contracts, agreements, options, covenants, deeds, conveyances, trus deeds, security agreements, bills of sale, leases, mortgages, assignments, insurance policies, bills of lading, warehouse receipts, documents of title, bills, bonds, debentures, checks, drafts, bills of exchange, '" notes, stock certificates, proxies, warrants, commercial paper, receiptS, withdrawal receipts and deposit instruments relating to accounts or deposits in, or certificates of deposit of, banks, savings and loan or other institutions or associations, proofs of loss, evidence of debts, releases, and satisfaction of mortgage, judgments, liens, security agreements, and other debts and obligations, and such other instruments in writing of whatever kind and nature as may be necessary or proper in the exercise of the rights and powers herein granted. I grant to my said attorneys in fact full power and authority to do and perform all and every act and thing whatsoever requisite, necessary, and proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as I might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that my said attorney in fact, or his substitute of -3- 1125P61 0 substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and I herein granted. This Power of Attorney shall not be affected by the disability of the principal and shall remain in full forc~ and effect, and my attorney in fact, DORIS ROBINSON, shall retain all powers set forth herein even, and'especially,~if I shall become disabled, whether mentally and/or physically. I have been advised that this Power of Attorney may be construed as "durable*' in the light of the above languageand pursuant to N.J.S.A. 46:2B-8 and it is my express intention that it be construed as a "durable Power of Attorney". THIS POWER OF ATTORNEY SHALL BECOME EFFECTIVE UPON MY DISABILITY. This instrument is to be constrhed and interpreted as a general power of attorney. The enumeration of specific items, acts, rights, or powers herein does not limit or restrict~ and is not to be construed or interpreted as limiting or restricting the general powers herein granted to said attorney in fact. The rights, powers, and authority Qf said attorney in fact to exercise any and all of the rights and powers herein granted shall commence to be in full force and effect upon the signing hereof, and such rights, powers and -4- 1 1t251 1 I authority shall remain in full force and effect hereafter,d>, co until such time as I shall revoke the same by notice, in -'~',-,I c~ P'! r~t~ng. ~ ~ IN WITNESS WHEREOF, I have hereunto set my hand and  H~LE~ L. BICKERT ' ' ' '.~'-- ' ~TRAINA' STATE OF NEW JERSEY, COUNTY Of BERGEN, SS.: of Wood-ridge, New Jersey personally came before me and acknowledged under oath, to my satisfaction, that she a) is named in and personally signed this document; and b) signed, sealed and delivered this document as her act and deed ey at L f N. J = -S- 8Kl125 1 2 FORM NO. 1 I TOWN OF SOUTHOLD ~ -' 3~j R, Il,, DING DEPARTMENT TEL.: 7G5-1802 Examined .., 19 Disapproved a/c ............................. ' BOARD OF tIEALTH ~ ........ 3 SETS OF PLANs .... % .... SURVEY .................. C,l C .............. SEPTIC NOT i FY ~ CALL NA I L .................. TO: _ ding Inspector) ' APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS ~ a. This apl~lication 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 sfi'eets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ¢. ' 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 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 necessar~ inspecA4~ns. / (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State wl~ether applicant is owner, lessee, agent, architect, e~gineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. · ' ' (Name'and title of corporate officer) er's Li N .-ff~ .Z/~.. ' Build cense o ......................... Plumber's License No... ' Electrician's License No Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................. ... ltouse Nuniber ~, ~ .~ Street i " ' ! 2 2'. Cou ty Ta× ap No 000 Section · - :. Block ..... ' · ', , ' ....... . ...... : Lot Subdivision · ·,.; .................................. '. Filed Map No ......... Lot ....... (Name) .............. tare ex~stmg u~,.-, aad occupancy of premises and intended use and occupancy of proposed construction: . ~ Ex~shng Use and occupancy ~ rY~q~ ,Oo..~./-- P-~' ~'/'-d~ - I~ntenaed usc and occupancy ......... f ' ' ,'" ....... ';:"'"'-"'"'"'"¢'J bl ) N ildi ' ,3. Samreo wot cec w c a ca e · ewBu ng .......... . eration ........ R pal R in I Alt · e r .............. e ova .............. Demolition ............... O~[~er, W-o ' ~ Estimated r,,. ~ ~;O~.~ , (Description) ' i (to be paid on filing this application) If dwelling, number of dwellin'g units ...... /. ·.. Number cf dweliing units on each floor ........... · If garage, number of cars ~ .... ' If business, commercial or mixed OCCUnnn ....... ' ......................... , ........ . ~ ,.__,.y, apecny nature aha extent of each type of use ........... if ...... Dimensions &existing structu es, if any: Front ight ~ ............ pth i ·: . Rear De He ............... u,mber of Stories ..................... ' ............................ Dimensions of shine structur,, with alterations or additions: Front .......................... ' ......... Depth . ~ " ~ ' . ' t ........ '"' ' ........... i'" nmght ...... . ............... Rear ........ ' . ............ i{.. Number of Stones ........... i .i.. 8. u~mensions of entire new construction: Front... · ..... Height ...... . Nui .... . ......... ; ear ............... Depth ...... '~. ' · ........ rover or ~tories ....... 9. Size of lot Front' ~--J.~/ · 'i ...... '3543;) ............... ' . .......... ,~ ........... ~tear.../..%'r. )' ' : .' ..... 10. Date of Purchase .. , · .............. Depth . ~'~../.~' ..... '- ..... ' ' 'I .......... ' ......... marne of Former Owner . ~9~..'//~..~/,- - 11. z. one or use uismct in which nremises are situated re.r,' r-/,o~ ~_. ,.. / ................... 1 ....... 12. Does proposed construction violate any zoning law ordinance 13. Willlot be regraded . · , .... or regulation: ....................... ' . 14. Name of Owner of premises ~e/.~.'.o / Te,~ x,-~j..'_L'...wftu excess fill be removed from premises: Yes ,. . ~ ..,...,. o... ~.,.q-,.-~-../. Address ............... Phone No . . l~ame of Architect ...... .~.e./~. ............ . ....Address ................... Phone No .......... ' Name of Contractor . X'~ ./.~. .... -,. . " ~ ............. aeuress ........... . ..... Phone No... 15.' Ip this property within l~0'0 feet of a tidal wetland? *vo~ ~ ''' 'e. · . o..... *If yes, Southold iTown Trustees Permit may be req~g~[]>~' ..... PLOT DIAG RA/Vl Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back &mansions from property lines. Give street and b ockinumber or description according to deed, and show street names and indica{e wheth&t~ TATE OF NEW YORK, OCNTy . s. (Name of individual signir rove named· ~'~. r.. ~ng duly sworn, deposes and says that he is the applicant' contract) . · the ! (Contractor agent cori~orate officer ) ............ ' ........... etc ' ' ' p~.aid..ow.ne..r or owners, and fs duly iuthorized to perform or have performed the said work and to'mai() and file this lcauon, mat ali statements coma ned in this application are true to the best of his knowledge and belief; a~id that the )rk Will be performed in the manner s& forth in the application flied therewith. ,om to before me this ............... day of. .. 19.. .tary Public, '- . ! · · · ..: :.'