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Home My WebLink About21913-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z--23064 Date June 24, 1994 THIS CERTIFIES that the building. Location of Property 210 WEST DRIVE House No. County Tax Map No. 1000 Section 59 Subdivision ALTERATION Block 5 Filed Map No. Street Hamlet Lot 29.2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 10, 1994 _pursuant to which Building Permit No. 21913-Z dated FEBRUARY 23, 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 REPLACE WINDOWS AND ADD SLIDING GLASS DOOR TO EXISTING ONE FAMILY D~T.r. ING AS APPLIED FOR. The certificate is issued to of the aforesaid building. DANIEL SCHWARTZ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner) Rev. 1/81 N/A N/& FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o~ ........... ~ ........... ~ .................... ,~.~, 21913 Z Permission is hereby granted to: xx,,,;,~,~.,..~x..~..,~.~:....~.:...~...~,..~..~,,, ~,,- ~ ...... £~,... ~.......x.t".~ ............................................... ...........~..~,'L..~.z~ ~ .xZ~.,C~~ ..... i ............ :...: ........ ' ......... ~'. ..................... ....... ................ ..~.¢.. ........ ~.~.~ ......... ~4 ....... ~:...-x..~,~. ...... ~.~. ....... ~.~?~..'~.~ ........... ....~.x...,.i~x ......... ~.~. ......... ~ ......... ~.4;:~.~.,.-..~ ........ d'~.~......~....-x..~ ................ Coun,~JaxMopNo. ~000 Sect~on.....~ ............ ~ock...~,~ ............ LotNo ...... ~..,F.:.~ ......... pursuant to application dated ....... ~/~.: ....... ..~...~. ........................ 1 9,..."~.Z~'.., and approved byfhe Building Inspector. ~ s......~': .r'.t'~. ...... /// / bL~ldJng Inspector Rev. 6~30~80 TOWN OF SOU~£11OLD BUILDING DEPARTMENT TOWN HALL 765-1802 *kPPLICATION FOR CERTIFICATE OF OCCUPANCY 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. 2. Final Approval from,Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, 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, t957) non-conforming uses, or buildings 'and ','pre-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 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, Swimming pool $25.00, Accessory building $25.00, 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 New Construction ......... Old Or Pre-existing Building House No. Street Hamlet Onwer or Owners of ........................................... County Tax Map No 1000, Section...~7~. ...... Block ..... O .~.. ...... Lot..~:~. ............ Subdivision .............................. Filed Flap ........ Lot ............. Health Dept. Approw, 1 ~/.~. ...... Underwriters Approval ~l.~..' ........ Planuing Board Approval .~.)..~. ........ Request for: Temporary Certificate ........... Final Certic~t'..~.. ....... Fee Submitted: $.. ~?..%'7. .... ~ .... " FOUNDATION FOUNDATION 2. (1st (2nd) ROUGH FRAME & FLUMBING 3. INSULATION PER N. STATE ENERGY CODE FI~AL ~L COMi-~E~.ITS: 765..1~02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. / FOUNDATION ZND [ ] I~ULATION FRAMING [//] FINAL INSPECT~/d~ DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. J//~/OUNDATION ZND L ] INSULATION FRAMING [ ] FINAL DATE I NSPECTO~///~/~~ , i 0 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c ..................................... ,.-7..' 2"/'- .-'-/5'7' / BOAKD OF HEALTtl ......... 3 SETg OF PLA;/S .......... SURVEY ................... CIIECK .................... SEPTIC r 0 R,'I .............. NOTIFY: CALL ................... HAIL TO: (Bu~4Jin= Inspector) APPLICATION FOR BUILDING PERMIT Date ......... 19... 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 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- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. C5'- - '/ 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 IvlADE to the Building Department for the issuance of a Btglding 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 apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. · ./E: N..o. t t~.e..'.~.~..~., ~ .~...77..-~..~..c-. ....... -- (Signature of applicant, or name, if a corporation) ...... .... : .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... -~?-~A~' '~' (-' 'Co' "'~' · ' '~'" ' '~'~-' ' .................................... IPPROY£D A~'NOTED ....... Name of owner of premises %~.~.&~~.-- ----~' ...................~A~,~,~{/~~-- B~U ~/?/~ . " (as on the tax roll or latest~)~73 NOT~ B~tO~NG DEPARTMENT AT lf~/p.~~, signature of duly authorized officer· 7~~ 1""2 "AM ~ ' P .... a THE ~ (Na~ and hte of co~orate ofncer) Builder's License No. ~.~...~.~ .......... 2. ~OUG~ , FSAMING & ~LU~BING u , . . ....................... 4 F~5~AL CONSTRUCTION MUST Pi tuber s Lmense No. ,,c COMPLETE EOR C,O. Att CONSTRUCTION SHALL MEET Electrician's License No ....................... THE REQUIREMENTS OF THE N.~ STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet ., County Tax Map No. 1000 Section .............. Block .............. Lot. ' ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing usc and occupancy ..t ~a~)~...~'.~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ............................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .~ ....... Number of dwelling units on each floor ................ · If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions et'existing structures, if any: Front. 4.~.]J~. ........ Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories .............. ': ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ....................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated .{.~.-X. xq ~.~...C~ ~ ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation:/kiG). .......................... ;~. 13. Will lot be regraded .V3c3 ........................ Will excess fill b~.removed from o. remises: Yes (.._~N~ Name o£ Architect ............ ~[ .............. Address ~'<d~,';*'d .... j) ?.~.5... Phone No ................ Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southoid Town Trustees Permit may be required· PLOT DIAG P, AM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property Hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 1.5. 'ATE OF NEW YORK, S.S ~UNTY OF ................. , · .{:. ;'...' .... '-. 3~ ........... ',~ ............... being duly (Name of individual signing c~tract) 'e named. sworn, deposes and says that he is the applicant the ................................ .-w:-.-.. ................................................. t, corporate officer, etc.) ! owner or owners~ and is duly anthor~ed to perform or have performed the said work and to make and file this ,.tion; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ill be performed in the manner set forth in the application filed therewith. '.o before me this .... /..c;.,..Z ........ __day°f '.q:X'... ~ ...... 19... J- ' ...... Notary Public, State of New Yo~ No. 4952246, Suffolk Cou~ Term Expires June 12,