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HomeMy WebLinkAbout21988-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF O~Guw~CY NO E-22938 Date APRIL 11, 1994 THIS CERTIFIES that the buildin~ ADDITION Location of Property 1255 GOOSE CREEK LANE House No. Street County Tax Map No. 1000 Section 78 Block 8 Subdivision Filed Map No. BOu'£~OLD, N.Y. Hamlet Lot 9 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated M~RCH 28, 1994 pursuant to which Building Permit No. 21988-Z dated APRIL 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 DE~K ADDITION TO EXISTING ONE FAMILY D~ELLING "AS BUILT" The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 WILLIA~ & GBC~ ~PP N/A N/A Building inspector " TOWN OF $OUTHOLD BUILDING DEPARTMENf TOWN HALL SOUTHOLD, N.Y. N~ 2~988 Z BU~LDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: .... ~.~,~.~..z.....~..~;~ ~ ,4,~., ..~.~,...~x...../..~ ~T~ ............................................ ~....~.....~ ........ ............................................................................................ ...~.,:¢. ........... ~/~ ....... :~.. ...... ~:.~....: ................................................. Counh/Tax Map No. 1000 Section ....... ~7~::~' Block ~> Lot No. ~ pursuant to application dated .............. .~../...~..,..~,. ......................... 19....~..,~......, and appraved bythe Building Inspector. Fees ........ ..'Z~... Building Inspector Rev. 6~30~80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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, 1957) non-conforming uses, or buildings and Ppre-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 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.o, o~mmerc~l $1~00, C erci i $1 .00  Date ....................... New Construction .... Old Or Pre-existing~Buildi~g...~ ........... ~~ Location of Property.../~.~.~..J~.... -~.~.~ · · -[-~. · · -~. · · · .~%~....'.. i .... County Tax Map No i000, Section ...... /.~....Block ...... .~... ..... Lot .... .~.. .............. Subdivision .................................... Filed Map ......... ~,~.L~t ....... ~ · - · z · .~. Permit No ................ Date Of Permit ................ Applicant.~ .~.~.~~~~'~/~~ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ................ ... . .... Request for: Temporary Certificate .......... Final Certicate Fee Submitted: $~C,~ ~'~fl~ ...................... i ..... i.. j .~...~.~. ~''~~~ ~ 0 ~ ~C~ ~ ~' k___/ APPLICANT 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 April 7, 1994 Ms. Mary Ann Feavel P.O. Box 1659 Southold, NY 11971 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) No Underwriters Certificate on file. The check is not on file. ($25.00) Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on File. (All permits involvinq plumbing being issued after April 1, 1984.) BUILDING PERMIT # BP# 21988Z Please contact our office on this matter. your cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 7G5-~802 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH PLBG. FOUNDATION 2ND [ ,] IN~TION~ FRAMING [//] FINAL · ~-~ // /. ......... :P,/~.~ ~ © .... .. iNspECToR>~' Examined .... ~ ....... Approved .. ¢//. ..... TOWN OF ~OLD ., 19~..~ ., 19f/Permit No. c~/~f~J~'k;t FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORN .............. NOTI~Y~ ~ ~- . ..... C^LL .'2(,$.':~r..P.. MAlL TO: ffBuff[ding Inspector) APPLICATION FOR BUILDING PERM['[ 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, Orjg~mces or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as her, efn.,described. The ?plicant agrees to comply with all applicable laws, ordinances, building.c_o.de, housing codec, and re, gffJat~ns, and~ admi,~ authorized inspectors on premises and in building for necessary inspecti[ms' )"v/~/' '~'~~,/y~~_~,~(/~ .L~_~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plu-mber or builder. ..... ..... . ................... If applicant is a corporation, signature of duly authorized officer. ¢/(,c,~,,~ ~ (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ....... .,t ............. ,-~ ......... ,, .................. House Number Street Hamlet '~ . ~ ......... Lot .... County Tax Map No. 1000 Section .... ~.~.. ........ Block ...... ~ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a ~xlstlng use and occupanc :,3'~ '~. ~ ~ . , ~, Y ....... ~~ .... ~ ..... .~;,t ..... ~,~.' ~ ~.~"~t~ ........ b. Int . a ..... =. 3. Nature of work (check which applicable): New Building .......... AdditiOn .~. ~'~!..~-U~Al~e_.i~!.gh ..~ ... Repair .............. RemOval ....... Demolition ....... i: {,' ....urner we · ·. 1~. ......... " , (Description) ti ted ~J~ Q?? 4. Es ma Cost.. ' ......... Fee .~ ..... (t0 be~p~~application) 5. If dwelling, number of dwelling ¢nits ............... Number of dwelhng ~umts ~~.. ............. . If garage, number ofc~s ........ .................................................................. 6. If business, commerciai or mixe4 occupancy, specffy nature and extent of each type of use ..................... 7. Dimensions of existing structureS, if any Front .... Rear ..... DeCth. Heaght ............ Number of Sto~es .................................................... D~ensions of same structure with alterations or additions: Front ................. Rear .................. Dep~ .................... ~.. HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new const~ction: Front ............... Rear ............. .. Depth ............ . . . Height Number of Sto~es 9 Size of lot: Front ~ Rear Depth 10. Date of Purchase ........... ~ ......... . ......... Name of Fomer Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................... ' ...... 13. Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises ... ~ ................. Address ................... Phone No ................ Nme of Architect ........................... Address ................... Phone No ................ Nme of Contractor ........ , ......... Address ................... Phon~ No~ .............. 15. Is thSs property wlth~n ~b' ~' of a t~dal wetland? *Yes ........ No...~.. · Zf yes, Southold ~own Trustees Permit may be required. ~ PLOT DIAG~ Locate clearly and distinctly ~l ibuild~gs whether existing or proposed, ~d, indicate ~l set-back dhnensions from prope~y ~nes. Give street ~d block number or description accord~g to deed, and show street nines and indicate whether interior or corner lot. STATE OF NE~.--Y43R.~_ t' ~,~' cou ¥ pF ~r ~~ ~'~ ~ k deposes ~d says that he is the applicant ............ ~. · ..... .... , ........... , ............. being duly sworn, (Na~e of individual signi ag contract) above named. He is the ..................... .... ............................ of said owner or owners, ~d is dui authorized to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements contained ~ ~his application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner~set fort~,~ the application filed therewith. Sworn to before me this · ...~~:',dayo~.../~&~-...,19~~/Z- ~ . ~__." ~2~. Nora. Publif. ~>~:f~.~.~ .~.. County ' TM....' .. ~mmi~ion Expires Decem~r ,