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HomeMy WebLinkAbout22358-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspectgr Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22438 Date JANUARY 4, 1995 THIS CERTIFIES that the building 45MAPLELANE Location of Propert~ 55200 MAIN RO~D House No. ACCESSORY Street Hamlet County Tax Map No. 1000 Section 62 Block 2 Lot 4.1 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 1, 1994 pursuant to which Building Permit No. 22385-Z dated SEPTEMBER 26, 1994 was issued, and oonforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is AN ACCESSORY STORAGE SHED AS APPLIED FOR. The certificate is issued to SOUTHOLD TOWN HISTORICAL SOCIETY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ 22358 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORI~)~. z ~,e .......... ~,.f~ .................... ................................................... ~..~~Z,'.~',~..,' ............ ; ...... ;.,; ......... Oo.,~ToxMo. No, 7000 Seo~on ....... ~.~ ...... B,ook.....~ ............... Lo, No, .,.,M.,'..,.,/.. ............. .................... ~ ................................... and approved by the Building Inspeoto~[~,~ Building Inspector Form No. 6 TOWN HALL '; !ii APPLICATION FOR CERTIFICATE OF OCCUPANCY ,' ~ .DEPI ~ i~ I~WN OFSOUTHOtD ~ This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 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. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 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 ail 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. :. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinging pool $25.00, Accessory building $25,00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existinR 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 $15.00 Date ~.. ~. ~ ~ZD ]~ ew Construction.../.5.'.., Old Or Pre-existipg Building ................. /ne . . ocation of Property.~P~.' .... .f'~ ............ .~. /~/.~./.~...~..~.~/~ ............. ,~/~?f~/.~/~O ........ House No. Street Hamlet nwer or Owners of Property.. ~..~.~.Z~.~ .~-/~. .... ~./$~./~. ..... ~.~bf~3~. ..... OUnty Tax Map No 1000, Sectzon ...~.~Z...Bloc ~" h ~ ' · ..... k ................ Lot ....... f ........... ~bdivision .................................... Filed Map ............ Lot ...................... .... Applicant..~.~?.~..L./.)...~./.S/~ ...~.~..~..~... -~alth Dept. Approval ........ ~..~. ............. Underwriters Approv'al ...................... .~/..~.. . lanning Board Approval ...... ~....~ . ~qme~t for: Temp~a~y Certificate ........... Final Certicate..f....~.... ee Submitted: $...!.~. .~ ?..~. ................. ~-, .' ~' Town Hall, 53095 Main Road P. O. Box t 179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 23, 1994 Mr. Robert H. Pettit Southold Historical Society P.O. Box 1 Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is 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 # 22358-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. ULATION ?ER'~. STATE ENERGY CODE ADDIT'IO~A'L CO!-hi~E~/TS: 765-1~)2 BUILDING DEPT. INSPECTION [ ] FO/uI~ATION IST [ ] ROUGH PLBG. [),-J/FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~] FINAL REMARKS: Disapproved a/c ..... FORM NO. 1 '.. TOWN OF SOUTHOLD" BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1"1971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY .................. CIICCK . · . · A ,O T,ON ORBU,,D,NG'PERM,T ' INSTRUCTIONS : a. T~s application must be completely filled in by ~pewHter or in ink and submitt0d to the BulldOg Inspector, with 3 sets of plans, accurate plot plan to scale. Fee ~ccording to schedule. ,." b. Plot pl~ show~g location of lot and of buildhgs on premises, relationship t~ adjoining premises or pubic streets or areas, and giv~g a det~led description of layout of property mu~t be drawn on the diagram which is pa~ of this appli- cation. ' c, The work covered by t~s application may not be commenced before issuance of Building Pemit. d. Upon approval of this application, the Building Inspector will issued a BuQd~g Pemit to the appUcant. Such pemit sh~l be kept on the premises avaQable for ~spection throughout the work. e. No bulldog shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate' of Occup~cy shall have been granted ~y the Building Inspector. , ' APPLICATION IS HEREBY MADE to the BulldOg Depmment fo3 the issuance of a B¢lding Pemit pu~uant to the Building Zone Ordinance of the Town of South01d, Suffolk County, New York, ~d other appUcable ~ws, Ord~ces or Regulations, for the construction of.bufld~gs, addJtions or alterations, or for removal or demolition, as here~ described. The appUcant agrees to comply with all app~cable laws, ordinances, bufld~ code, housing code, an4Jegulations, and to admit authorized ~spectom on premises and ~t build~g for necessary inspe~n~~ . , ~,,~__ (Signature of applicant, or name, if a corporation) (Mailin~address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generaJ 'contractor, electrician, plumber or builder. Nameofownerofpremises... . o..~ (as on the tax roll orlatest deed) If appl~ant is a corporation, signature of duly authorized officer.' (Name and title of co,orate officer) Builder's License No .................... Plumber's License No ............... . .......... Electrician's License No, Other Trade's License No .................. Ilouse Number Street Hamlet County Tax Map No. ] 000 Section .... '.~.g ~.. Block Subdivision . ' ~--~-- -~ .... Filed Map No. Lot ' ' (Name) ...................................... State existing use and occupancy or premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .4 ~,7~ O '3. Nature of work (check hlch applicable): New Building .~?."'" ' ....... 'Addition .......... AJteration ' Repair .............. Removal Demolition .. ; · · Other Work ......... ......... ' cscr tion 4. Estimated Cost i / .................... Fee ..... 5. If dwelling, number o f dwelli~g Units umber oF dwclllng units on each floor ..... i It garage, number of cars ......... . ......... i~ .... . .... . 6. If business, commercia or m ed occu-anc .o ' ........................... . . .'- g y, spemiy nature and extent of.each type of use ~/~ .... 7. nnensmns ol exmting stmctfires, if any' Front ............. Rear .............. D ................ ' ~ ' ' epth .... Height ............... Number of Stories ............. ' · .. Dimensions of shine structure with alterations or additions: Front .... ' · · · ................. Rear .... -aensmns o~entire new con~tmction: Front .~ .~. ~U. ~ Rear ...~6. ~ ...... Depth . eight . . ./~..W~...... Nu[mber of Stories ....... ~ ....... .... 9. ~ize of lot: Front .... ~.~.~.i~ ....... Rear · ~ · ~7. ' ............ ' ' 11. Zone or u~e district in which p ........ 'Name of Fd~er Owner late any zoning law, ordinan'ce or reg,~ation. ~ ............. Mq... i · '.... N~e of Owner of r '" ~:~q~" ~ ......... wm excess nn oe removed from re ' · , ' .............. Address ~u ,. ' ....... N~e of Contracto~ .... .. ~. · ................. rnone ~o ................ ' ' ' ................ Address ........... 'Phone No ..... ' 15.' I.s th~i~oparty w~thtn1300 ~eet o~ a ........ . .......... ~dal wetland? *Yes... yes,'Southold ~TOwn Trustees Permit may be required.'"''' No..~. · ,.. ] PLOT DIAG~ Locate clearly ~d distinctly ~ bulldogs, whether existing or proposed, ~d, indicate ~l set-back d~ensions from prope~y ~nes. Give street ~d block~number or description accord~g to deed, and show street n~es and indicate whether ~tefior or corner lot. , ~TATE or NEW YORK, :OUNTy OF ................. '' (Name of individual signing contract) bove named. lq· being duly sworn, deposes m~d says that he is the applicant is thc . ...... I ....... (~;'t ........ ~ ............... ' .............. (Contractor, agent, Corp a e officer, et .), . . ' said owner or Owners, and is duly anthor~zed to perform or have per£onned the said work and to make and file this ~plicafion; that all statements containid fl~ this application are true to the best of his knowledge and belief; and that the ork will be performed in the mannerse:t forth in vorn to before me this i the application filed theresvith. '" %2///¢ ./ i .... ....... "· )tau' Public, ,~:~../_~___../.~ · ~ ........... - ...."' 'x ...... ~.ounty JOHH KRAMER , . , NOT~Y PUBU¢, State of New York ................... No, 4658322, Suffolk County (Signature of applicant) Term Expires Feb. 28, /¢~ / / ,00 'PoP 0 C~ 0 o 0 .0-,9 o ©