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;
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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
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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
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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, '- . ! ·
· ·
..: :.'