HomeMy WebLinkAbout21479-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22623
Date SEPTEMBER 28, 19~.~.
THIS CERTIFIES that the building
Location of Property 455 HOBSON DRIVE
House No.
County Tax Map No. 1000 Section 122
Subdivision
ACCESSORY
Street
Block 6 Lot 24
Filed Map No. Lot No.
LAUREL ~ N. Y.
Hamlet
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 4, 1993 pursuant to which
Building Permit No. 21479-Z dated JUNE 11, 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 ACCESSORY SHED AS APPLIED FOR
The certificate is issued to MABEL MILES
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
FORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y,
N_O
BUILDING PERMIT
(THIS PERMIT MUST Bi: KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZEDI
21479 Z Dc, re ....~Z ............................................
Building Inspector,
Rev.
and approved by the
/ ~' Building Inspector
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
~his application must be filled in by typewriter OR ink and submitted to the building
inspector wiih 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, i~dustrial 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 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.
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 accessor~building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $i00.00
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
Location of Property .................... . ....
House No. Street Hamlet
Onwer Owners 6f Property ~
County Tax Map No 1000, Section..../~ ..... Block ..... ~ ......... Lot.~.~.. ................
Subdivis£on ................................. .. . Filed Map ............ Lot ................... ...
Permit ..... Date Of Permit ................ Applicant .............................
Health Dept. Approval ......................... . Underwriters Approval ................... ..... .
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Su fa±rte : ......................
....................................
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone (516) 765-1802
SCOTT L. HARRIS, Supervisor
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
AI~Y 23, 1993
MAI)DIE MILES
MAIN ROAD, RT 2 BOX 13
MATTITUCK, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application ~or Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is k~not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Pluafoer Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT $ 21479-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITION[L COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FRAMING [ ~J~NAL
DATE
INSPECTOR
0005ON
Unauthotlzed atteratlefl or addition to this s
r of the NewYork State Education Law.
Copies of this eurvey rasp not bearing the land surve¥or'e
Inked essl et embossed seal shall not be considered to l~ a
valid
Guaranteee or eertilleafloOs indicated hereon shrill run
is preparod, and on hie
behalf to the title company, governmental agency end le~).~/'
ding and to the es~l(tnee~ or'the
fendteg institution. Guarantees or cert[fieatJnes ere
tYansferable to additional institutions or subsequent owtlers.
'~' ~REA '= 0.2060 ~CRE
SURVEY FOR
MABEL MILES
AT MATT/TUCK
TOWN OF £OUTHOLD
SUFFOLK COUNTY~ N.Y.
SCALE ~ I°%
II, CA Y 14, 198,5
REFERENCE~
EUARANTEED TO:
IND SURVEYOR
N,Y~$. LIC. NO.;'87~5
RIVERNEAD; N.Y.
FORM NO. 1
TOWN OF SOUTHOLD
~' SUILDING DEPARTMENT
TOWN HALL
" SOUTHOLD, N.Y. 11971
Disapproved a/c '
APPLICATION FOR BUILDING PERMIT
B~ARD'OF H~ALTH .........
3 gETS OF PLANS
SgRV£Y
SEPTIC FORH
CALL . . . ~..
Date ................... 19...
INSTRUCTIONS
a. Tkis 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 sfi'eets
.or areas, and giving a detaited 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 thc 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
BuiIding Zone Ordinance of the Town of Southold, .Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the co~)~lt,~¢O{~t~,~gs, additions or alterations, or for removal or deraolition, as herein described.
The applicant agrees to c0~pl~_with all applicahl~laws, ordinances, building code housing code and regulations and to
admit authonzed~mspeoto~. ~'n ~rermse~ a~rd~m BraRlmg for necessary ~nspecQons. . .
· , ~,~,* ~ ,;,~ (Signature of applicant, or name, if a corporation)
" (Mailing address of a~plicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.,:< - ','~ '~ ~;" ' '. ~ ' (as on the tax roll or latest deed)
If applicant is a c0fp~rat![5~ ?ignEture o~du, ly a0thofi~ed officer.
(Name and title of corporate officer)
;
Builder's License No ..... .~.../~. A/~./'~ ........
Plumber's License No .........................
Electmclan s L~cense No...~ ....................
Dther Trade's License No ......................
1, Location of land on which proposed work will be done ................................. ~ ................
........ ....... .........
ltouse Number Street Hamlet
County Tax Map No. 1000 Section ... :/~ ........ Block Z ' Lot.~. x7~
Subdivision ........ . ............. ~... ............ '. Filed Map No ............... Lot ...............
(Name)
2; State exist~ing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....... .~..~...~.../.'. ffT./~./.. ~. ]...Z~..-~.%Y5~2. ~: -7 AJJ &.. ..........................
b. Inten use and occupancy ........... · ......................... ; ,,, ...............
· 3 Nature of work (check which applicable) New Building Addition
Alteration '
Repair RemOval ..................... · .........
.............. ~ .............. Demolition ..... : .......... Other Work '?.~..gS~ .........
4. Estimated Cost .... .
....... ~ ..................... Fee ...........
! (to be paid on filing th~s apphcatmn)
5. If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ..............
· If garage, hum bet of cars ..... ' '
or mixed occupancy, ' ........................
6. If business, commercial specify nature and extent of,each type of use ......
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height Number of Stories ' .
Dimensions of shine structure with alterations or additions: Front ......
............ Rear .............. ...
D pth ~ Hight
Nub f St i '
8 D; .................... i" e ................... ,.. m ero or es ......................
· mensions of entire new construction: Front ............. : Rear ........ Depth ...........
Height Numb ofSto i .......
10. Date of Purchase ........... ~ ......... . ......... Name of Former Owner .......................
1 1. Zone or use district in which pr{mises are situated ....... . ................................
g 1 .............
.12. Does proposed construction vio e any zonin aw, ordinance or regulation: .............................
13. Will 16t be regraded ....... '. .................... Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .................... Address ................... Phone No ............ :...
Name of Architect ........................... Address ................... Phone No .................
Name of Contractor ...... : ................ Address ............ : ...... Phone No ..... ~ ...... '.',..
15.' Is this property within 3'00 feet of a tidal wetland? *Yes ........ No .........
' *If yes, Southold down Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly ali Ibuildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed and sho s ' '
mtenor or corner lot. ! ,~. , w treet names and ~nd2cate whether
APPROVED AS NOTED '
765-1802 9 AM '[0 4 PM FOR THE
FO~OWING INSPECTIONS:
1. FOUNDATION ~0 REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
' 3. INSULATION
4. FINAL CONSTRUCTION MUST
BE COMPL~E FOR C.O.
ALL CONSTRUCTION SHA~ ME~
THE REQUIREMENTS OF THE N.~
STATE CONSTRU~ION & ENERGY
CODES. N~ RESPONSIBLE FOR
DESIGN OR CONSTRU~ION ERRORS
STATE OF NEW YO.R-K,
co u ¥ 5
./£/¢. .4. .-e. . .J:. . . ,:
(Name of individual signing contract) being duly sworn, deposes ~d says that he is the applicant
above named.
He is the
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly ~authorized to perform or have perfo~ed the said work an~ to m~e and file this
application; that all statements contaioed ~ this'application are irue to the best of his knowledge and belief; and that the
work will' be perfomed in the ~ner ~et forth in the application filed therewith. '
Sworn to before me this ~
................... .....
Term ~pi~ May 31,19 ~q ' ,