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HomeMy WebLinkAbout22100-z FORM NO.S 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 AUTHORIZED) Date ...(jy 19.g.. N2 22100 Z Permission is hereby granted to: 1 v~....9/1...c~.......~ur~rc............ la.. 'ap .....i....r.e sc ,~t! to b~rl....,....... x. . at premises located at.... lA.`.....9~-.....~1 s. pp County Tax Map No. 1000 Section /..a- Block Z.............Lot No....1.. z pursuant to application dated 6 19..4;/ and approved by the Building Inspector. Fee 5...7. Building Inspector Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 8-23824 Date AUGUST 21, 1995 THIS CERTIFIES that the building ADDITION Location of Property 620 OAK DRIVE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 80 Block 2 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 16, 1994 pursuant to which Building Permit No. 22100-8 dated JUNE 2, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to BLAINE & BEATRICE BURTON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A i Building Inspector Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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 12 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. 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 rleo` 11'4 New Construction......... Old Or Pre-existing Building......./.... Location of Property..... 620 OAX .,LQ ~k4.. e0 House No.p Street Hamlet Onwer or Owners of Property... FFP..9.?.~]~/;.[CC ~hl~T~JY County Tax Map No 1000, Section.. D4.d....... Block ...V^OZ .........Lot................... Subdivision ....................................Filed Map.. 6~ ~.....Lot...2 7:.3 J........... Permit No ................Date Of Permit Applicant Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... Fee Submitted: $.7"r C4. Q.c, `f~Q n ~(j APPLICANT tit I _ lr- lh- as I i !Y ~ i W z cr) I c9 0.1 1s I I I ~ I d I { "ANN I0 j` f t r a I r____ _ METT i iiI ' --aIIIIIIIIII IIII..y,A Q1 +'1 w G\ W r ti y 2 ~ ~ Q O N ~ O t I CD c ~ Z ) k ~I Q b ~ 0 P IT I R ~ ~ '17 ~o 3 - --------------q------------- - 16611 of1V ' ca aanv~ f•1AR- 9-93 T U E 1 0- 32 RICHARD A W I IJTERS P_ 0 1 1c) S "OAK DV.IVE" I - PV1VA7E ROAD] o 1T1 - N.2o•11,20"E. - 120.0 ` z Ul > -p I o0 ~2~j SAO ?x_ C m < 1 z -4 0A )b m Z t+l -D a q oO ~p V D m M ~U p 0 W N c Z ^u ~ m I -1 { Q 'Q n~ o ~ ~ II I m tevi ~1 00 w vi • n (p GO9 U ~~y+(r 1 I O L M 'ynll m; -i 7~,,•. ~ 5,20 ll 20 1Y. 120.0 $Y4 PRIVATE ROADWAY N y 11 f C 00 .4 a~ D•-100 • u 3: P- 771 In r to z'^ p pp7 f'~ DNS c I m{ x nl 0 F. n e y. uU X {z y~vr Itt 03 F m z''m Z Gm loD o m < nnUp IA + a'7S~ U 1 D h1 W !q >°-41 3C coo i 0.16 CA O •1 in IIl }V In O M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH P G. [ ] FOUNDATION 2ND [ ] IN ION [ ] FRAMING [ INAL [ ] FIREPLACE & CHIMNEY REMARKS: i? DATE INSPECTOR ' 4 M-1302 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL ~'z1Z REMARKS: 6- C~ DATE INSPECTO 1nLD l S.Z ION VAlu COMML:1v T.C. m I~ 0, FOU17 ATION (1st) y i FOUNDATION (2nd) 2. \ z o ROUGH FRAME & PLUMBING cn H 3. x m m INSULATION PER N. Y. .-3 STATE ENERGY CODE x 4. m '3 FINAL ADDITIONAL COMMENTS: r 07 k ro~ H R~ 9 ~ IV H\ H O z VA x m A~ • r b . m b H R BOARD OF HEALTH LS FORM NO. 1 .3 SETS OF PL A:7S t TOWN OFSOUTHOLD SURVEY MAY 160, BUILDING DEPARTMENT /CIIECK • . . TOWN HALL SEPTIC FORK SOUTHOLD, N.Y. 11971 BLDG. 7 Tto ExanOn d . OLD TEL.: 765-1802 t:oC I FY ; CALL 19. g MAIL TO: Approved L . 191 . Permtt No.. P . _ . Disapproved a/c . . . . (Bwidin~ pector) 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. 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 code, housin code, and regulations, and to admit authorized inspectors on premises and in building for necessary in ections. e (Signature of or name, if a corporation ...zo 0*A-149AI;!4 A<y...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Q.w.AI.EA . Name of owner of premises ~l-,q TA/GC 4L/,q//.?. 4 ...1?7.aX: QN (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. j~ekl. 41462k.- Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be done . . ......lP A. K...~ ! ...........517 N.y.......... Mouse Number r~ Street Hamlet County Tax Nlap No. 1000 Section Uo . 0 Block . 04 Lot 0 /o? Subdivision Filed Map No. ...431 Lot . ,21277.30 (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy el41 /fE . 11D M A • • • • • • • • • . b. Intended use and occupancy ....bE.0K .t.f 3. Nature of work (check which applicable): New Building Addition Removal Demolition they Wor Repau '(Destion) 4. Estimated Cost Fee g (to be paid on flin Win) wT ` I r . 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 of existing structures, if any: Front Rear Depth Height Number ofStories Dimensions of same structure with alterations or additions: Front Rear Depth Height f Number of Stories ..............e . 8. Dimensions of entire new constructionrFrettt .tN/Ar4..... 7• • •.'ikeer• • • • • • • • • • • • • • • Depth . s.r . Height y.. F9f-... Number of Stories ...--7............. `Y.. 5-. - . SfY.M?¢ fEFf.................... 9. Size of lot: Front /=B• Rear I.?G......... Depth Name of Former Owner ....?EAy•••••-•••••••••••. 10. Date of Purchase ........f1P°!4..Lp93 . 11. Zone or use district in which premises are situated R~f~!T~l• . 12. Does proposed construction violate any zoning law, ordinance or regulation: A/O 13. Will lot be regraded V • • • • , • Will excess fill be removed from premises: "VI14* 14. Name of Owner of premises Address Phone No............... . *_~a+.~ .........................'Addrem - Name of Contractor . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No 15. Is this property within 300 feet of a tidal wetland? *Yes........ No......... *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. 7s-.1 .a .:x:15 a:e aye :1FOURENIENTIS OF THE R!' 7*5- NOT RFSPONSIRLE r`,'7 ^~'_,i OR COKI`RLICMON ERROaS STATE OF N l S.S COUNT OF . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the Q (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. Sworn to before me th(s i, "1 y day of. . 19 Notary Public, County CLAIRE L GI_f W O~ ti ,wry Public. state of New Y et ~tgg7~9505 (Signature of applicant) COW December . mheton ExPireS f!