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Home My WebLink About22493-zFORM NO. 4 TOWN OF souTHoLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Bouthold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23377 Date NOVEMBER 30, 1994 THIS CERTIFIES that the buildin~ REPAIR Location of Property 3820 SOux~ HARBOR ROAD House No. Street County Tax Map No. 1000 Section 86 Block 3 Subdivision Filed Map No. SOUTHOLD, N. ¥. Hamlet Lot 1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 28, 1994 pursuant to which Building Permit No. 22493-Z dated NOVEMBER 29, 1994 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 REPAIR EXISTING ACCESSORY BUILDING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building.' SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MICHAEL WORTIS & ORS. N/A N/A N/A / ~uildi~g Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. Ne 22493 Z BUiLDiNG PERMIT {THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE'QON OF THE WORK AUTHORIZED) Permission is hereby granted to: ~:~:.../.......~>..¢..~., ...... ~/,~,,,.b/:.~. bJ0~> /~.....¢.~.. ......... ~ ...................... : ........ ,..&.L,.~...~.../.,...~....../..L.~.~ /.. ................... ,o . . . .~. . : ~ .......... ~ ....... :~.,. . '.,. ~ ......... ~ : ~ ....... . .:. . . . ./. .~ . . , ........................ ................................................. ~~J.. ................................................................. CountyTax Map No. 1000 Section...~ ............. BIock....O~. ............. Lot No ..... ~./.,. .............. Building Inspector. Fee $ .......... ~,¢~r,.- ..... and approved by the Rev, 6/30/80 me Be TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 This application must be filled in by typewriter OR ink and submitted t~"the building inspector with the following: for new building or new use: I. Final survey of property with accurate location of all buildings, property ~ines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 fo~m). Approval of electrical installation from Board of Fire Underwriters. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. Comercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or ~ngineer 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 all property lines, streets, building and unusual natural or topographic features. ,~. 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.O0 0ctober ~y 1994 Date ................................... .... . New Construction ........... Old Or Pre-existing Building.~ ............... Location of Property .... 3820 South Harbor Road ~9g~qld House No. Street Hamlet ~ Michael Wortis, Ruth Emerson Wortis, Nicholas Pott Onwer or Owners of rroperty .................................................................. County Tax Map No 1000, Section 086.00 n~u 03.00 ...... Lo~.. Q.I...QOO. , Subdivision ' .................................... Filed Map ............ Lot ..................... . Permit No.. 22493-Z 11/29/94 . , ~ Charles R Cuddy .............. Date Of Permit .......... app±icant ........ ' Health Dept. Approval .................. ........ Underwriters Approval ........................ . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate..f ........ Fee Submitted: $ 25.00 . .......... / BLDG. DEPT. TOWN OF SOUTHOLO .,, FORM NO. 1 /' *',' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... ((/.~.~...'.., 19F.~. Approved ....f.//~.q .... ,19?.~ermlt No..~..°~..~.~..~.~. · Disapprove~l a/c ..................................... (Bu)rdi~(~ Inspector) APPLICATION FOR BUILDING PERMIT Received. .... Date '.N.q V .e.m.b.e..r INSTRUCTIONS .......... ,19... 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 scal~. 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 layout of property must be drawn on the diagram which is part of this appli- ~ C. rThe work covered by this apphcatlon may not be commenced before issuance of Building Permit.. ..... .~-. , . d. Upon approval of tiffs 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 Departme~nt for the issuance of a Building Permit pursuant to the Btr~!ding Zone ,Qr~inance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances'or Regulations ~f6~e construction of buildings additions or alterations, or for removal or demolition, as herein described The applican~t:.~p~.qes to comply w~th all applicable laws, ordinances, buildmg code, housmg code, and regulahons, and to admit authd~3dtnspectors on premises and in building for necessary insp~ti0ns. (Signature of applicant, o~'~Ame, if a corporation) Charles R. Cuddy, 'Arty for Applicang · - ~O0 · 0.1~: .¢6u.r~r~..~oad.,..~0. Bo.x. · ~ §4.3 .... (Mailing a~ldress of applicant) Riverhe~d, NY 11901 · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumb6r or builder. Name of owner ofpremises ~i. chael. ~ortis .............. _:~.,:~,.~.<.~..:,~..~.,~. on the tax roll or latest (as ~ DEPARTI~ENT .~t If applicant jsa corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: .............................................. 1, FOUNDATION - TWO REQUIRED (Name and title of corporate officer) FOR POURED CONCRETE 2. ROUGH-- FRAMING & PLUMBING Builder's License No. ......................... $. INSULATION 4. FINAL - CONSTRUCTION MUST Plumber's License No ......................... BE COMPLETE F~R'C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. Electrician's License No ....................... STATE CONSTRUCTION & ENERGY CODES. NOT' RESPONSlB~.E FOR Other Trade's License No ...................... DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done .................................................. South Harbor Road Southold House Number Street Hamlet County Tax Map No. 1000Section ..... .8.6...0.0. .......Block 03..00 . Lot. 0l .000... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: occupancy ........ ~.~..C.c.¢.5~..i .¥~... .............. .:. ,.' .... ................ a. Existing use and b. Intended use and occupancy ....................... ' 3. Nature of work (check which applicable): New Building ;,.~¥,;~; ..... Addition .......... Al~e.rll~ion x Repair Demolition Other Wdrk ~.~ ..... ........ aemovai ........ ..... .............. ....... ...... '-~ ..... " (Description) 4 Estimated Cost .' ...... ! ~" :~ ?"'~' "Fee i '" ~' : "'~ ~ ~' '~' (to be paid on filing this application) 5 If dwelling, number of dwelli,g units ~ Number of dwelling units on each floor If garage, number of cars ~ 6. If business, commercial or mi ~ed occupancy, spec~y nature and extent of each type of uso ~ . 7 Dimensions of existing st~ct if any' Front Rear ' Depth * · lr~ .... ~. ' ............................ Height ............... N ~mber of Stories ............................................ D~ensions of sam~ stmctur with alterations or additions: Front ................. Rear ...... Depth ..................... HeiSt ...................... Number of Stories .......... 8. D~ensions of entire new co~ stmction: Front ~ R~ar ..... , D~pth Height ............... N amber of Sto~os ............................................ ,9. Size of lot: Front ..................... Rear ...................... De~th .......... 10. Date of Purchase ....... [ ~'. .............. -- Name of Fo~er Owner .. ~P~ ...... 11 Zone or use district in which ~remises are situated 12. Does proposod construction ~ iolate any zoning law, ordinance or regulation~O ............................. ' Yes 13. Wffi lot be regraded .... ~.~ ..................... Will excess fill be removed from premises: 14 Name of Owner of p emises Address Phone No ' N~e of Architect ~ ' ' Address " ' Phone No ,, Nme of Contractor ...... 2 .................. Address ................... Phone No ................ ~ ' ' ~ ~ ' P~T DIAG~ Locate clo~l~ ~d distinctly ifil imfld~gs, whether existing or proposed, ~d. indicate ri set-back d~ensions from prope~ Hnos. Give street and bloCk number or description accord~g to deed, ~d show street nmos and indicate whoth~? STATE OF NEW YO'RK~ S.S ..... ~..~.. .... ~ ................ bein u sworn, deposes and says that he is the, a cant '-:~ ~, ~,*,,~,(Name ofindl~idual s gning contract) above named. Heis the .0~.g. qr~Y..~gF..~. 9~O~F. ............................................................. . (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is [uly autho~zed to perfom or have perfo~ed the said work and to m~e and file this application; that ail statements e; stained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ ncr set forth in the application filed therewith. Sworn to before me t~A~ ...... ......... Nota~ Public~~ ¢~_~. ~.. County PublIo, State of N~ ~w York No. 487950~ i ~ ~ ......................... , OuaflfledlnOuff~ke0u~ ~. Charles R. Cuddy ~ (Signatumofappllcant)