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Home My WebLink About21469-zFOI~M NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF No Z-23144 Date AUGUST 4, 1994 THIS CERTIFIES that the building Location of Propert~ 4045 DELMAR DRI%~E House No. County Tax Map No. 1000 Section 125 Subdivision ALTERATION Street Block 4 Filed Map No. Hamlet Lot 1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 26, 1993 ~ursuant to which Building Permit No. 21469-Z dated JUNE 8, 1993 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 CONVERT LIVING AREA BACK INTO AN ATTAu~D G~/~AGE AS APPLIED FOR he certificate is issued to JOHN & HELEN PICINICH of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A / ~ildlng Inspector Rev. 1/81 FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N-° 21469 Z BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ....................... / '-"~ , ..... ~..~.......~~.. ....... ~,, ..................... ...,(?~.~..~...,...~.~.z.'. ¢ount¢ Tax Map No. 1000 Sectlon ,..Z~.~. ........ Block.......~..~....~.. .......... Lot No .......... pursuant to application dated ......... ~..'¢~... .................................. Building Inspector.~ Fee~....Z~,~' 19..~,.~.'.. ........ and approved by the Rev, 6/30/80 _ ~" Form No. 6 . TOW-N }~LL 765-1802 ~ ~D' J 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 lihes, 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '-'pre-existing" laud 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 i. 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.T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 .. . 'New Construction ........... 01d Or Pre-existing Building... . House No. ......... ' ' ' '{ .... '' ........ ' Street Hamlet Onwer or Owners of Property... County Tax Map No i000, Section .......... Block ............. Lot ...................... Subdivision ................................... Filed Ma .... ' P Lot Permit No Date Of Permit ' nt.~.{ ............. · ............... Applica ........ · ................. jIealth Dept. Approval .......................... Underwriters Approval ...... ?lanning Board Approval ........................ ~equest for: Temporary Certificate ........... Final Certicate....Y ..... eeSubmi=ted: $ ................... ... ". APPLICANT FOUNDATION {1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ]'65-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION FRAhlI~G [~NAL DATE INSPECTOR.r/~~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] I~JLATION FRAMING [/,,]'FINAL REMARKS: DATE Approved.. ~./~. ......... 19~..~. Permit No..~.~ Disapproved a/c ..................................... FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 APP CATION FOR BUILDING PERMIT BOARD OF' HEALTH ......... ,~3 SETS OF PLANS .......... SURVEY ................... CI1ECK .................... SEPTIC FORH .............. 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 Occupahcy 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 Colmty, 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 aB applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed 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 ofpremises ............... ICTIC' tv iC.~ . o,- ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth.,orized officer. (Name and title of corporate officer) Builder's License No... (~.(.,0..XO..~ ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be' done .................................................. .. House Number Street Hamlet County Tax Map No. 1000 Section ..... /M%~.C ..... 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 use and occupancy ........ 4 .(4).~.~ :i.'.0~ ................................................. b. Intended use and occupancy ...................................................... ; property lines. Give street and block m interior or corner lot. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work ............... .~.~ I · (Description) 4. Estimated Cost. .. .O..O "'i ..... Fee ..... (to be paid on filing this application) 5. If dwelling, number of dwelling ulnits ........ · ..... Number of dwelling units on each floor ................ If garage, number of cars ...... i... )i. ~FgC.. :. 6. If business, commercial or mixed[occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuresi if any: Front ............... Rear .............. Depth ............ ... Height Numfier of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth Height Number of Stories ' 8. lmenmons of entire new constru, ctmn: 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 ..................................................... 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.. Name of Owner of premises .... ! ................ Address ................... Phone No ................ Name of Architect ........... i ................ Addres~ ................... Phone No ................ ' Name of Contractor .... ! ............. Address ..... ., ............. PhoneffNo ................ Is this property within 3~0 feet ~'f a' tidal wetland? ' Yes ........ No...q ..... *If yes, Southold T~0wn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all. t uildings, whether existing or proposed, and, indicate all set-back dimensions from tmber or description according to deed, and show street names and indicate whether STATE OF NEW, YORK,ff .................... : ................ being duly sworn, deposes m~d says that he is the applicant (Name of individual signin~ contract) above named. . (Contractor, agent, corporate officer, etc.) 3f smd owner or owners, and is duIy ~uthonzed to perform or have performed the said work and to make and file this ~pplication; that all statements contained in this application are true to the best ofhls knowledge and belief; and that the york will be performed in the manner sgt forth in the apPlication filed therewith. gworn to before me this ........................ day of ............ ,19.. Xlotary Public, Nota~ Publio, State of Now York ............................... Qualified in Suffolk County ~ ~ (Signature of applicant) Commission Expires May 22, 19