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HomeMy WebLinkAbout22015-zFOP~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23589 Date APRIL 4, 1995 THIS CERTIFIES that the buildin~ ADDITION Location of Property 37770 COUNTY ROAD $48 House NO. Street County Tax Map No. 1000 Section 69 Block 4 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 10.2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~PRIL 8, 1994 ~ursuant to which Building Permit No. 22015-Z dated APRIL 14, 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 PORCH ADDITION TO FRONT OF AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. STEVEN & NANCY ROMEO SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/a N-320751 - JULY 18, 1994 N/A ~ / ~ilding ~spe~tor Rev. 1/81 FO~M BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, BUILDING PERMIT ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 22015 Z Permission Is hereby granted to: ~o.,~.~.~. ...... ~..!.~..,.....~.:.~.~N..~.~ ~-,,',~-~/;~,-~ .... ~...o..:.......~...~.../.../..u. ................................................ ...~:~ ........ ~...././.:~zz. ...................... ,o .....~:~.~.~: .......... ~ ....... ~./...~.,.~ ......... ~ ....... './:~,...,~:. . . . ~ . . ~ . . . . ~: .-.,. .~ ........ ~ ....... ~.>. . .~ .......... ~. ~ :/. .,.~. . . . . . ~ ~ . . : ...... ./Z.~.(.~,.:. ........ ~c ...................................................................................... .......................................................................... ~~ ........................................................... CountyTax Map No. 1000 Section ...~...~.. .............. BIock......~...,~,,.. ............ Ldt No'..,., .~...~...:..~......: ..... pursuant to application dated ....~..~....'~...~..: ....... ~ ......................... 19.....Z..,~..., and appro'ved bythe Building Inspector, FGG ~...~:....--'.~ ........ Building Inspector Rev. 6/30/80 THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1~)01093 BUREAU OF ELECTRICITY ~-- ES JOHN STREET, NEW'yORK. NEW YORK 10038 oote JULY 18,1994 /Ippllcatlon No. on file 84553094/94 N 320751 THIS CERTIFIES THAT STEVE & NANCY ROMEO, 37770 COUNTY ROAD, SOUTHOLD, N.Y. in the followlng locatlon; [] Bo~ement [] Ist FI. [] 2nd Ft. OUT Section Block Lot37 -~s examined on JULY 14,1994 and found to be in compliance with the National Electrical Code. 5 / 4 5 ' ~THER APPARATUS: DOROSKI ELEC. INC. 425 MONSELL LANE CUTCHOGUE, NY, 11935 LIC.#2941-E OENrd~AL MAN~[GF.E- Per. Fhis certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. ~ ,~ i ,' 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 "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 i~spect, 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 %15.00, Commercial $15.00 Date ...~.~.~.'¢.~../.?.~ ................... New Construction ....... Old Or Pre-existing Building...t~.. Location of Prope~].~.~.~.~ .......... .%~.~.~..~.~..]il]i]]]i]~W~...~ ....... House No. ~Street Hamlet Onwer or Owners of Pro ert County Tax Map No 1000, Section..~.~.~ ....... Block...~. ........... Lot...~.:.7~. ............. Subdivision '~-" Filed Map ~- Lot Permit No~~- ~ .Date Of Permit..~/~/~. .Applicant ~?~o ' ~ Underwriters Approval ~.~.~ Health Dept Approval .......... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ..... ..~.... Fee Submitted: $ .... .... .......................... . . . FOUNDATION ( ls t) FOUNDATION (2nd) 2. ROUGH FRAME & .PLUMBING e INSULATION PER N. STATE ENERGY CODE FINAL ADDITIO~I~L COM~E~;TS: UNDERWRITERS C~FICA,TE REQUIRED APPROVED AS NOTED ~OTIFY BUILDI~O D~Ph~T~T AT FOR ~URED CONCR~I~ 2. ROUGH - F~MING 3. INSU~ON 4. FINAL - CONST~ION ALL CONSTSUCTION SHALL ME~ STATE CONSTRUCTION.. O~UP~CY OR USE · UN~L 3. Nature of work (check which applicable): New Building .......... Addition . .,,)( ...... Alteration '. .... ~ .... Repair .............. Removal .............. Demolition .............. Other Work ............... " (Description) 4. Estimated Cost ...~.O..~..~ ............................. 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 ..... 7 .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..-:-. ........... 7. Dimensions 93'existing structures if any' Front J/~ ¢ Rear ~-~ Ge D~nth J'~7 I ....... Hmght . .~.*....~..,,o. .... Number of Stories... ! .~ ..................... ' Dunensmns of same structure w~th alterations or add~tmns' Front ~.g ............ Rear . .~.~ .......... ~'-< 2.0 ' ........ Depth ...................... Height ......... , ............. Number of Stories... J.G. ............... 8. Dimensions of entire new construction: Front . J~. ......... Rear . ~.2...~ ......... Dep'th .. ~i'.t. .......... Height ...-. ........... ~Number of Stories....-~. ..................................... ~,~ ,~.;... 9. Sizeoflot Front ~.~.-.t r Rear .~57~ . nenth ~f~.~J~'5 ......... · ' ................. ~r' ~' ~ '!L~' 'i:~ .......... 10. Date of Purchase .J,]~.~ Nameof~orm~-r~ ...... ~c,,v-w~ 1 I. Zone or use district in which premises are situated.. ~s.. :. ~.~.. ............................ ~,~t~ ............ 12. Does proposed construction violate any zoning law, ordinance or r'~gulation: /Y'~. ..... ~.~?.'~. i 7. ~l?(i 13. Will lot be regraded ..... b/~O.. .... >q .............. Will excess fill be removed from premises: ~Yes 14. Name of Owner of premises ~ffq~,-. [(~: .-,~..-o ....... Address ................... Name of Architect ...... .-f ................. Address .................... Phone No: '... '5" ........ ~" ' Name of Contractor .~o~ .'~..-~...Ig.~.'~..t~.,s i ..... Address Ill.(...5o Phone No. 26.'7. 15. Is th±s property w±th±n 300 feet: of a t:±dal wet:land? eyes ........ bio ......... ~If yes~ Sou(hold Town Trustees Permit may be requ±red. 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. STATE OF NEW YORK, S.S COUNTY .............. o .......... ~.~l. '.~...c~.~(_...I .C~....v2~... .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..... ~47.c.~. &q .d~. ..................................................................... (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 tl~e manner set forth in the application filed therewith. Sworn to b~fore .......... · '-~-.: .......... day of..(~ ....... , 19 .~. ~.(- Notary Public, State of New York ........................................... No. 4951364 (Signature of applicant) Qualified in S~ffolk County ~,~ CommisoiOn Expire., M. ay 22, 19 .... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~ermit No. ,'~, .'~../.~..'~... BOAKD OF HEA 3 SETS OF PLANS ........... SURVEY ................... CllECK .................... SEPTIC FORH CALL · MAIL TO: Disapproved a/c ................ , ..................... ['~ [~ ~ ~ 0 ~ [~ I~] ( nspector) '8 Date .................. ,'19... 8LOG. OEP1:. INSTRUCTIONS TOWN OF SOUI'HOLD 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 ofilot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed descrip}ion 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 applicatlon, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available~for mspectmn throughout the work. e. No building shall be occupiedI 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, Suffblk County, Ne~v 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~ll applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. -- (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. Name of owner of premises ........ . .o.~.e:~.. . .O.V.~..~. .............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature] of duly authorized officer. (Name and title of co~ora~e officer) Plumber's License No ........................ Electrician's License No ....................... Other Trade's License No ..... ~ ................ I. Location of land on which propos ~d work will be do e ..... .~.~ ................................ House Number Street Hamlet County Tax Map No. 10130 Sectio~ ....O.~.~. .......... Block .... /'/ ............. Lot.../.~.'..Z:. .......... Subdivision ................. ~ ................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy 0f premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... t ............................