HomeMy WebLinkAbout21476-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22469 Date JULY 22, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 1725 OAK DR. & 520 WEST SHORE RD.
House No. Street
County Tax Map No. 1000 Section 80 Block 1
Subdivision Filed Map No.
SOUTHOLD, N.Y.
Hamlet
Lot 49
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JURE 1, 1993 pursuant to which
Building Permit No. 21476 Z dated JUNE 9, 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 OPEN SHOWER ADDITION TO EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to
of the aforesaid building.
MARJORIE H. KRUEGER
(owners)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED JULY 6~ 1993 - PERFECTION PLUMB. & HEATING
Rev. 1/81
/~uil~ing Inspector
FORM NO.$
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ......~../~. ...............................................
~1476 Z
Permission Is hereby granted to:
....................
,-~,~ ......... d..~,.,~,,,.l,,-.,,~.~.,~,.~,,~ ,.v.~/./~...~,,,~/,,~,, ~ ...................
Coun~'rax Map No. ~000 Seot,on ....... ~.. ........ B,ock .............. l ........ LotNo ...... ~ ..............
pursuant to application dated ...... ~.../~.. ....... i ................................ 19....~..-,,:-'-'-'-'-'-'-'~....... and approved by the
Building Inspector.
~ee
Rev. 6/30/80
TOWN OF SOUTHOLD
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
1II2/
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 Healgh 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/l'0.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
"pre-existing" land uses:
1.
April 9, 1957) non-conforming uses, or buildings and
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 Inspec{or 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 Building -.$100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
l--
Date ... ~Z~..~../.~. .........
New Con tru' S ction Old Or ..... //~'/"/f' ............
........... Pre-existing Building ....... z... .......
Location of Prop erty.. 47a~.. Q~..~J.~a .... 5~.~i~0 ~R,,. ,~7'*~. . Z~ ~7 I... ~. ~' ~ . f/~ r~
House No. ~'~O Street~/~ ~- ~, Hamle~ ....
· Onwer or Owners of Property ........ ~.~.[~'~..~.~~ .. .
County Tax Map No 1000, Section ..... ~.~ ...... Block ..... / .......... Lot .... .¥~ ..............
Subdivision .................................. Filed Map ............ Lot ........
.... Date .~/~./~3 .... ~f ~ ~
Permit Of Permit., ~ .Applicant/~z/~.~J~.f....~.~ ~.~.f~ ~.~.~..~.
Health Dept. Approval ....... .r ~ ........~./~ ..... Underwriters Approval ..... ~./~ ...............
Planning Board Approval ..... ~./~.''''''.'..'.
Request for: Temporary Certificate ........... Final Certicate .........
Fee Submitted: $ .........................
TO~¥b[ OF SOUTIIOLD '
OFFICE OF B UILDIHG INSPECTOR
P.O. BOX 1179
T'O~vN HALL
SOUTHoLD, N.Y. 11971
TEL. 765-1802
Date_ ~.~
Building Permit No.~7~
Plum~ber ~ ~ ,
tp~ease prznt;"~------
'I certify that the solder Used in the Water supply syshem
Contains less than 2/10 of l%'lead.
~ _day of
NOtary Public, -~ ,~ \o\~____.Coun ty
FOUNDATION
(lst)
FOUNDATION (2nd)
ROUGH FRAME &
.?LUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
Building 40--SUNY, Stony Bro6k New York 11790-2356
~J ~.t-~ I ' ;'-' / Thomas C. Jodlng
Based on ~he ~nEo~mat~on you have submitted, the ~ew ~o~k
ironmental Conservation has determined that the parcel
project is: '" ..
Greater than 300' from inventoried tidal wetlands.
~ Landward of a substantial man-made structure
greater than 100' in length which was construcfed prior ~o 9/20/77.
Landward of the 10' above mean sea level elevation contour
gradual, natural slope.
on a
Landward of the topographic crest of a bluff, cliff or dune which is
greater than 10' in elevation above mean sea level.
Therefore~ no permit is required under the Tidal Wetlands Act (Article 25
of the E~vironmental'Conservation Law)'. Please b~ advised, however, that
no construction, sedimentation or disturbance of any kind may take place
seaward of the !0' 'contour or topographi~ crest without a permit. It is
. your responsibility to ensure that all'necessar~ precautions 'are taken to ...... ·
prevent any sedimentation or other alteration or-disturbance to the
ground surface or vegetation in this area as a result of your project.
Such precautions may 'include providing adequate work area between the
10' contour or topographic crest and the project (i.e. a 15' to 20' wide
construction area) or erection of a temporary fence, barrier, or hay
bale b~rm. ' '
Please note that any additional work, or modification to the project as.
described, may require authorization by this Department. Please contact
this office if such are contemplated.
Please be further advised that this letter does not relieve you of th~
responsibility of obtaining any necessary permits or approvals from other
agencies.
Very truly your~t .....
Deputy Regional Permit
Administrator
:t
4
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION SST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ~NSULATION]
FRAMING [,/] FINAL
REMARKS:
INSPECTOR~~'~-~/
Examined ~h .......... , 19 ?.,-,~ '
Approved..~ ....... 19~. Permit No..~.../(.~. ?..~.
Disapproved a/c '
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.; 765-1802
~BOARD OF HEALTH
/3 SETS OF PLANS
../SURVEY
jCIIECK ...................
SEPTIC FORH .............
r'~'~.~.//~.z "?4
HAIL TO:
. (B~ildi~Aspector) '
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date .............. 19¢.~.
a. Tiffs 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 st?eets
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 cheil 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 Ordinanqe~of,.~¢,.T.o~v~g.o~' S, outhold -Suffolk County New York, and other ap licable Laws Ordinances or
Re~ulahons, for the co~s'truett~5~5 ~' l~aild~gs, addmons or alteratmns, or for removal or demolition, as herein described.
The applicant agrees..to.c~o~pi~itb~,.alL, applicable; laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premis'es and in bqilding for necessaiT~i..nspectiqns.
(Sxgna~r~ of apphcant, or name, ii a corporatmn)
...(?.~..r.. ~a~. ,0~, ~.~ .o.~a,:.o,,. ¥, .t./. ~?/....
(Mailino address of applicant)t
State whether applicant is owner, lessee/agent, architect, engineer, generai contractor, electrician, plumber or builder.
o..~. ~..~,~'
'
Name of owner of premises .. ~.,..~U ~ ~. 6 ]~ ......................................
(as on the tax roll or latest deed)
If applicant is a corporation/signature Of duly authorized officer.
· ' (Name ~nd title of c;.~r..~.~ ;~ficer)
Builder's
License
No
Plumber s Lmense No ................... . .
Electrician's License No ....... .~./~ ...........
Other Trade's License No ..... .~./~
1. Location of land on which propdsed work will be done ................................. : ................
.... · -f..~ ~,.& .............. ¢~ .~. t~,,, ........ '...¢~ .~.~( ~l~.~. % .,~, )4 ,. II¢...>./,, ............ ·
House Nun ber . Street . Hamlet
ounty Tax i000 Section ,,.: .... ....... 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. E×isting ,se and occ,pancy .. ~.~ . .l~. t ~. . l
b. Intended use. and occupancy ....~./~1V & ~./~..
hPvli ) ' ' Additi '
-3. Nature of work (check which cable: New Building ......... on .......... Alteration .... ~ .....
4. Estimated Co~t ........... ~.:... ,..~. escr on
. I ' " (to be paid on filing this application
S.Lf dwemng, n.,mbeLofdwellin~ units ..... : ./. ....... Number of dwelling units on each floor ~ ).
. ngara, ge, numoerorcars ..
~. ~.busln.ess, co~nmercial or mi.xed occupancy, specify nature and exte~t'ofle'a~'*~,;,;,'2c',;~'~ ....... ,i) 2'i .........
t. ulmenmons ol existing structures if any' ti'rant . ,-, -.'r .............. /. ¢'a ..........
' Height ...... Nu-d 7~ -] ....... ~ ..... ;' 't'_ ~ear .............. Depth ..... ..
· ~D,menmons of same structure with a terations or additions' FronT' ........... A .....................
pth ........ · .... , .....
11. Zone or use district in which prlemises are situated ............... .............................. ~ ......
12. Does proposed construction violate any zoning law, ordinar{ce or regulation. ~a/g) ........... ' . ..
l'~ame of Architect ......... q ~./,.4 ........... Address ................... Phone No ........ :.~..
Name of Contractor ......... ,/!//. ~ ........... Address.· ............ .... Phone No ....... 'i ~..
15.' I.s this property within ¢0O feet of a tidal wetland? *Yes ........ " ....
· *If yes, Southold ~own Trustees Permit may be'required~ . i~o .........
· .-. i' PLOT DIAGRAM
Locate clearly and distinctly alli buildings, Whether existing or proposed, and. indicate all set-back dimensions faom
property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether
interior or corner lot.
APPA~/ED AS NOTED
,..#
NOTIFY BUILDING OEPART~ AT
765-1802. 9 AM ~ 4 PM ~OR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION ~0 REQUIRED
FOR POURED CONCRETE.
2. ROUGH - FRAMING & PLUMBING
', 3.~ INSU~TION
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR'C,O.
ALL CONSTRUCTION SHALL ME~
~E REQUIREMENTS OF THE N,Y,
~ATE CONSTRU~ION & ENERGY
~ES. N~ RESPONSIBLE FOR
}rATE OF NEW VaRI~
-ouN'r( OF... :: ....
. )
N ...... . being duly sworn, deposes ~d says that he is the applicant
(ame of individual mgnmg contract)
~bovenamed.. .
.................................. ' ....
agent corporate officer etc ) ..........
f said owner or owners, ~d is duly aluthorized to perfom or have perfo~ed the said work and to m~e and file this
pplication; that all statements contained M tiffs'application are true to the best of his knowledge and belief; and that the
'ork will be perfomed in the ~am~er s~t forth in the application filed therewith '
worn to before me this / ~ [ ' .
. '~ ,~ , , .
.............
~o. 472~89, ~ffo~ ~.n~ ,/ . -' ~ ~ ~X -- ' q ......................
,..pi~M,,3l,!~ , · , . ' ~Signature ofapplic~t).