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HomeMy WebLinkAbout22121-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 8-23099 Date JULY 14, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 2140 DEEP HOLE DRIVE MAITITUCK, NY House No. Street Hamlet County Tax Map No. 1000 Section 123 Block 4 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 25, 1994 pursuant to which Building Permit NO. 22121-Z dated JUNE 9, 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 AN ACCESSORY SHED "AS BUILT" IN THE FRONT YARD AS APPLIED FOR. The certificate is issued to THOMAS A. PALMER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A zu Building Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AAUTHHlORIZED) Date . 19..`... N° 22121 Z / Permission Is hereby granted to: ©..~,.....?1 ..../.9..j-.......... to........ `-!!.'~.Cz7............,r~?1 .................~c~J o 1.. ............./"7t ...........5;;rl f-... !?i)............. y./....................................... I............................ at premises located at........... County Tax Map No. 1000 Section Z 3......... Block Lot No. vT................ pursuant to application dated 1 .........rZ 19...?~.... and approved by the Building Inspector. Fee$...-J~.a~~ . wilding Inspector Rev. 6/30/80 a Form No. 6 1 MAPPLICATION TOWN OF DEPARTME BUILDING DEPARTMENT TOWN HALL 765-1802 FOR CERTIFICATE OF OCCUPANCY A. 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. B.1 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. 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 Buildine - $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 ..S/.{..~ / New Construction..... Old Or Pre-existing Buildi g. _ Location of Property. .o2 j.1 p Q Pr~'i P, . , , , , , , J.V-J4 T T) J ~ x House No. Street Hamlet Onwer or Owners of Property...... ,q Grp County Tax Map No 1000, Section..O Q.3...... Block P O 4......Lot..00..f Subdivision....... .............................Filed Map............ Lot...................... Permit No O.R.IgR J .i ...Date Of Permit ................Applicant............................. Health Dept. Approval. .........................Underwriters Approval......................... Planning Board Approval / Request for: Temporary Certifica Final Certicate....v Fee Submitted: 6........... QUO 4513 0 APPT.TCAN ';zl'SUFF0L4' ar, Town Hall, 53095 Main Road y Z Fax (516) 765-1823 P. O. Box 1179 . .g Telephone (516) 765-1802 Southold, New York 11971 .f. 0! ~ypl ~ ~a OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD July 11, 1994 Mr. Thomas A. Palmer P.O. Box 218 Cutchogue, NY 11935 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 # 22121-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. f FL 11D.:D i OHMLNTS x•-' m,. FOUNDATION _ (13t) .fl Ul f. FOUNDATION m (2nd) - 2.' .'.OUCH FRA[iE d< . - O -PLUMBING = or Vl y 3. ~ m cn ~a INSULATION PER N. Y. STATE ENERGY CODE i C_. p 4 FI:7AL ADDITIONAL COMMENTS; x" H A \1. H Nrk) m y -4 \ tv m _ y . ~tn1v . . . . . . . . . . . . . 111LL1 f ~.fif Depth ~;.~,~r:v............. . 10. Date of Purchase . v r :'i. . ,yam! N,Ame of Former Owner t`cfiiu .art i . S 11. Zone or use district in which premises are situated /S.`fsJ 12. Does proposed construction viola a any zoning law, ordinance or regulation: .!~/L) . 13. Will lot be regraded (1.......,I........ Will excess fill be removed from remises: ~G Y s^ Nod 14. Name of Owner of premises .T{k /~/Z tr3ln.: [','Address FJ.~ flhone No..4.~. Name of Architect Address Phone No............... . Name of Contractor ~ r' ..........:...Address ...................Phone No. 15. Is this property within 300 feet of a tidal wetland? *Yes........ No..L 1 *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether, interior or corner lot. a J4C Dee.rf~cLe. j< c / /L t'- ffu9'~ r STATE OF NEW 11 S.S COUNTY OF~.~r^?.7I 1 . JA/V& t.../ being ua/y sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. worn to before me this Cr~ ~7 ^....1. ....day of -7...... 19 . (4 4oary Pu lie, C - . C County CLAIRE L GLEW ' ' ' ' Notary Public, State of New York (Signature of applicant) No.4879505 Qualified in Suffolk County Commission Expires December 8,18 BOARD OF HEALTH R FORM NO. 1 3 SETS OF PLANS IS TOWN OF SOUTHOLD SURVEY . BUILDING DEPARTMENT CIIECK . 7K4y 1994 TOWN HALL SEPTIC FORM . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t70<I FY PT CALL Exa F/ ! 0( T/ MAIL TO Approved ......(J/.~ , 19/. .'Permit No..a7 Z 7. 4LJ .2~_ _ • . Disapproved a/c fI S L; (Buil )ns ctor) APPLICATION FOR BUILDING PERMIT CnA Date . J..!~. 19 A 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. 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 ode, housing code,,p~d regulations, and to admit authorized inspectors on premises and in building for necessary in`. L L~~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) tare whether applicant i owner lessee, agent, architect, engineer, general contractor, ielectrioi 'oilbuilder. .yI......................................... a1~ ~ J / Pif.C9X4~~1/ 1........DATE:. dame of owner of premises (as on the tax roll or latestpi NOTIFY BUILDING DEPARTMENT AT applicant is a corporation, signature of duly authorized officer. 765-1802 8 AM TO 4 PM FOR THE I . FOWNNG INSPECTIOM . REWIRED UNDATION (Name and title of corporate officer . FOFoRPOUMCOMM OCCUPANCY OR 2. ROUGH - FRAMBW10 & PUMING Builder's License lvo. ...~.i . USE IS 3, INSULAXION I~ v `n I1 U 4. FINAL NAL - - CONSTRUCTION MUST Plumber's License No. WITHOUT CERTIFICATE BE COMPLETE FOR C.O- ' OF OCCUPANCY ALL CONSTRUCTION SHALL MEET Electrician's License No. . THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION Ik ENERGY Other Trade's License No . CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Location of land on which proposed work will be done . ) .L 10 D e(2plyazle .AR lnRTT..1/. ..N House Number Street Hamlet County Tax Map No. 1000 Section ..lv(• Block ...0 Lot .1. . Subdivision Filed Map No. Lot (Name) ;fate existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy SPY•~CC.C(~111J~t~••7...,D.Qe~95C . 1TJ.et~l Intended use and occupancy ...:So!-!q Le H1}2t i !P~~.~..~/!.~7> 3. Nature of work (check which applicable): New Building Addition r . Repair Removal Demolition oth (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'Mlj . If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ` 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories j............................... Dimensions of same structure with alterations or additions: Front Rear Depth Height Nu.yr of Stories . 8. Dimensiongf enve new construction: Front 1 Rear 9 Depth ls~.. ~ . Height ..`7 . Number of Stories , / h..; 9. Size of lot: Front Rear Depth n(4r;rl . 10. Date of Purchase Name of Former Owner . TpRni .G. r3Q.$........... . 11. Zone or use district in which premises are situated X.0 12. Does proposed construction viola a any zoning law, ordinance or regulation: . dv.. 0 . 13. Will lot be regraded . t? Will excess fill be removed f Tom peremises: 9C Y~ys No 14. Name of Owner of premises .77htrRS.11. rFZM G2Address PD.A ~4~ ~ttone No. a . 4. lf.c . Name of Architect Address Phone No............... . Name of Contractor Address Phone No............... . 15. Is this property within 300 feet of a tidal wetland? *Yes........ No..L~.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ,d ! ¢O ~f-eA L DR C7 Ewsr,~,~ \ b ~vMP oQ SeD z 9 a as ~~SF 7C I°- z I SYORy < / c ~Sa STATE OF NEW R r,q p 4r 3 gd'{- R, . COUNTY N! S.S ` r n 4 if m . , , , , , , , , .~..........r!f ` ieyng July sworn, deposes and says that he is the applica ([Name of individual signing contract) above named. I He is the w.a.lX (Contractor, agent, corporate officer, etc.) M of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file t application; that all statements contained in this application are true to the best of his knowledge and belief; and that work will be performed in the manner set forth in the application filed therewith. Sworn to before me his r ..day of 19 Notary Pu lic, .J ICV~/ ~l• . County ' CLAIRE L GLEW Nopry Public State of New York (Signature of applic No. 4679606 Cluallfied In Suffolk County Cammkabn ExPirea December 19