HomeMy WebLinkAbout22504-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23583 Date N3%RCH 31, 1995
THIS CERTIFIES that the buildin~ ALTERATION
Location of Propert~ 2870 GREAT PECONIC BAY BOULEVARD LAUREL NY
House No. Street Hamlet
County Tax Map No. 1000 Section 128 Block 6 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NO%~EMBER 17, 1994 .pursuant to which
Building Permit No. 22504-Z dated DE~ER 1, 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 A WINDOW ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to
RENEE GATEHOUSE
of the aforesaid building.
SUFFOLK COUNTY' DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N344215
PLUMBERS CERTIFICATION DATED
(owner)
~C~ 2, 1995
N/A
Rev. 1/81
//Building inspector
FO~M NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OU1~OLO, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 22504 Z
Permission is hereby granted to:
~...~~.~.........~ ../.~....~~
........... ~.~~....,, ........ ~... ................ .
,o ........ ~ ~ ~ .~..... ~......~ ~ ~..... ~ Z~.. ~ ~ ......
........ ~ ...... :~,....:~:.:::.~:: ........ ~::.:~...:~.:~ .......
~~~, ~ ::~ ..... ~.~ .................
..............
Oo,~,,ToxMa~o. ,000 ~eo~,on ....... Z.~...a'...... ~,oo~ ......... ~. ............ Lo,~o..z../. ....................
pursuant ,o application dated ............... ZY{~...~'....~?. .............. 19 .~....~... and approved by the
Building Inspector.
Fee $....~..~.....~...
Rev. 6/30/80
Form No. 6
~ TOWN OF SOUTHOLD ~ , (i~ ~ ~1 ~ ~ ;,'
BUILDING DEPARTMENT . [5 t':~
TOWN HALL ~: ~ ·
765-1802 FEB
APPLICATION FOR CERTIFICATE OF OCCUPANCY i ..... '
~LDG. DHP%2
This application must be filled in by'typewriter OR lnk and submitted to the building
inspector with the following: for new buildtng or new use:
1. Final survey of p~operty with accurate locatlon of all buildings, property lines,
streets, and unusual natural or togographic features. '
2. Final Approval froa-Eealth Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation ~rom Board of Fire Underwriters.
~. Sworn statement from plumber certifying that the solder used in system contains
less than 2./10 bf 1~ lead.
5. Commercial bufldtng, industrial building, multiple residences and simllar buiidinga
and installationsj a certificate of Code Compliance from architect or engineer
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'a~d
Upre-existing" land uses:
I. 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 Buiiding Inspector shall stat~ the
reasons therefor in writing to the'applicant.
'' faiteratlions to~dwellmhg $25.00~ Swimmzn~pool $25.00, Accessory
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of .Occupancy - $50.00
5.' Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ...~./Y/f~. .............................
,ew Construction ..... i ..... Old Or re-existing Building..; .........
Location of Property...~.~.~.O, ........... ~.l,.~...~.~./..L).~ ....
House Ho. Street Hamlet
Onwer Owners of Property
County Tax Map No 1000, Section. ~. .Block ............ Lot ...............
Subdivision
.................................... Filed Map ............ Lot ......................
Permit No...~.. ~5~09Z~--- - · .~.~[.~...~
........... ~ace Of Pevmit.-/g~///~;'/ .Applican~.~/~..~.
Health Dept. Approval ..................... Underwriters Approval...~../~. ................
Planning Board a rov~l...~.l
Request for: Temporary Certificate...~..~ Fina~/~ate......~.... i
. ...............
~i~1~5 ~'~ ~"'~"'~-~ '~"~PL I CANT '
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 21, 1995
Environment East Inc.
P.O. Box 190
Peconic, NY 11958
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
The check is (outdated/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22504-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
:', THE NEW YORK BOARD OF FIRE'. UNDERWRITERS
10>~:}.093 BURE U OF ' ........
~ B~ JOHN ~TREET, NEW YORK, NEW YORK IOO3B .......
THIS CERTIFIES THAT , ' ~>: , , <-:' ~
o~y the elec*rlcal qulpment ~ ~scrl~ below and in~uc~ by tl~ applicant ~med on the a~ve application n~ tuber ~n .the prem~es o
'~ GATEHOUSE, 2870 PECONIC BAY BL~. , POLE$76/2, ~EL, N.Y. ' ~: ' ~.
~,,~./o{to,~.st,,..ao.~ ~ .~,..,~.~ ~ t.~Ft. ~ ~,,a ~'t. OUT .$~,,. : ~t~ , ~o~:: ~::
t~ examined on FEBRU~Y 27,1995 ' and found to be in complianve with the NaHonal Elect~cal Code, ',.
CODE
F'r;~L
Environment East, Inc.
3075 Indian Neck Lane
P.O. Box 190
Peconic, New York 11958-0190
516-734 -7474
765-~802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] I~JI,.ATION
FRAMING [~'j' FINAL
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND ,~SULATION
[ ] FRAMING
[ ] FINAL
REMARKS:
DATE/,~ ~'/~/~/,INSPECTOR
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.; 765-1803
Disapproved a/c ....................................
// (... i,,g nspector) /
A~,,L~OATION FOR BUILDIN6 PERMIT
80A~D OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ...................
CIIECK
7Oq'--
CALL
HAIL TO '
f 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 schedulp.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas,'apd, 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 issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the w6rk.
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 necessary inspections.
--' (Signature of applicant, or name, ifa corporation)
.... .ov. . .o. : . ?.'7 ...... ! .............
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engin~-'~, general contract~ electrician, plumber or builder.
Nfime of owner ofpreraises
(as on the tax roll or latest deed)
lof duly auth orized officer.
Builder's License No ...... ~..?..b".4..~..-~. ........
Plumber's License No.
Electric. ian's License No "'-"
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
House Number Street ~. Hamlet
I . .
County Tax Map No. 1000 Secti(~n . . .' ............. Block ... ,Q ............ Lot .............. ~.
Subdivision ...................................... Filed Map No ............... Lot ...............
(Name)t
2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n:
a. Existing use and occupancy ........ i? ...... .~ ............................ ~ ....
b. Intended use and occupancy .(~...*~.. .~. . . .L~..< I ,¢'AJ
3. Nature of work (check which appilicable): New Building. ......... Addition .......... Alteration ....
Repair .............. Remo?l ............. Demolition ............ Other Work .............
(Description)
4. Estimated Cost ./~.fi .~.(~ ~ Fee .............
' !~ (to be paid on filing this application)
5. If dwelling, number of dwelling uJiits ,, .]. ........... Number of dwelling units oil each floor ................
If garage, number of cars [,
6. I°' ' ialormi d~c ............................ '~ ............................
I ousJness, commerc xe cupancy, specify nature and e~ype of use
" Dim ' sol 'sting tructur "fa F ..x,.~Rear ..... JJ D pth .............
t, enslon exl s es Ii ny: rent.. . ..... e ....... '
He'ght~ ............... Num bar o f Sternest, Ig.j(~ .................. i .........
tl}~'o~s..Front ..12.111111 Rear .....
Dimens'ons of s st ' ' ' ......................
anle ructure wi .....
Depth ..................... ;~ .......... Number of Stories .............
8. Dimensions of entire new constru~q6fi..' Front .............. Rear ........ . Depth ' '" ......
He .... gl ' · ' ..............
~ It ............... ~'{ber of Stories ............................
9. Size orlot: Front · · · ~.'.' iiii ........ .~.~,;~ .......................
'0 Dte ~"u ' ¢>~ ...... ] .... ~~' '~ [. ',?'_'_'__"_',-k .... u,~v .......................
~ . a o~r rcnase ............ , ....... . ......... Name of Former Owner .............................
11. Zone or use district in wliicb prein'ises are situated
. . I , '' %.- ............. ~ .......... [ .........................
12. Does proposed construction vi~lat? any zoning law, ordinance or regulation: ...L~. ¢~ .......................
13. Will lot be regraded ...... .~..Q .". ....~ .......... Will excess fill be removed from premises: Yes
14. Name of Owner ofpremises(~gf~.~...~,~,~... Address .~..c..~O~W.~3~O.~. Phone
Name of Architect ............ i ............... Address .................. Phone No ................
Name of Contractorl~..~ ...... i .............. Address .f~ -' .~../.q.°) .~?.C~.~. ~;..$~hone No. 7~..~..'.~.Y.~.~..,
tS. IS this property within 300 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold To~n Trustees Permit may be required.
'. ..../i PLOT DIAGRAM
Locate cl0arly and distinctly all bfiildings, whether existing ~r proposed, and, indicate all set-back dimensions from
nber or description according to deed, and show street names and indicate whether
property lines. Give street and block nu:
interior or corner lot.
TATE OF NEW YORK, S.S
O U~N:r-Y OF ................. i '
.c
(Name of individual signing cQntrh~ct)
)ore named. ,
........ being duly sworn, deposes and says that he is the applicant
FOLLOWING iNSPECTIONS:
1~ FOUNDATION .
4. FINAL C() ¢~7"11B Ji~T~ON
8E COMPI,ETE. F()f~ C,O, ~ '
ALL coNs'muc'rto~ SHALL MEET
THE REQUIREMENTS OF THE
CODE& NOT ~ES~ONSIBCE ~0~
)ESIGN OR CONSTRUCTION ERROR~
~orn to before me this
........ /.~. ............ day of..~
otary Public, ...... ~..
' LINDAJ. COOPER
Notary Publlo, State of New York
- NO,_4822563, Suffolk. County~
ferm expires December 31, 19__
..... x ...... County/
/
e is the ............. '
agon,t, corporate officer, etc.)
ho~ to'fo
, said owner or owners, and is duly aut rm or have performed the said work and to make and file this ,
)plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner set ~rth in the application filed therewith.