HomeMy WebLinkAbout21485-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building INspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22434
Date JULY It 1993
THIS CERTIFIES that the building
Location of Property 1300 GIN LANE
House No.
County Tax Map No. 1000 Section 88
Subdivision
ALTERATIONS
Street
Block 3
Filed Map No.
SOUTEOLD~ N.Y.
Hamlet
Lot 15
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 7, 1993 pursuant to which
Building Permit No. 21485Z dated JUNE 16, 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 ALTERATIONS TO SECOND FLOOR OF EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to
of the aforesaid building.
JOHN & ANNE MURRAY
(owners)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
PENDING - JUNE 24, 1993
Rev. 1/81
FOI~M NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
N£ 21485 Z
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date .......................................................... 19
Permission is hereby granted to:
............................
...... ~...~....~'~' -~'-.~ .........................................
..... ~.....-~.~.~,.....~:..,....z~./
to....~~./......,~~..~.'~ ........ ~..~~..~. ......
...........
............................................. ~...~..~ .................... ................................. ................................
CounlyTax Map No. 1000 Section ....~...~,.. ......... Block ..: ....... ...'~... .......... Lot No ....... ../~...~....'~... ..........
pursuant to application dated ....... ~/~,, ......................................
Building Inspector.
Pee s..Z.,%..,.~.
19..~..~..., and approved bythe
....... ~/ Buildl g p
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/~0 of i% lead.
5. Co~nercial 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 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 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
New Construction ........... Old Or Pre-existing Building .................
Location of Property...~.~ ................ . .~. ~.. ~. ........... . .~.~.~f~. ........... .
House No. Street Hamlet
Subdivision .............................. ...... FSled ~ap ............ Lot ......................
· 2 ·
Permit No.. .~. ..Date Of Permlt..d /~ ~J..Appllcant . ~m ....
Health Dept. Approval .......................... Underwriters ApproVal ................ / ........
Planning. Board. Approval ................... .. . . .
Request for: Temporary Certificate ..... .. .. . . Final Certicate ...........
Fee Submitted: $ ........................... . .
' '
FOUNDATION ( ls t)
FOUNDATION (2nd)
ROUGH FRAME &
,?LUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONA'L COMMENTS
FORt~ NO. 4
TOWN OF $0UTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No..Z..6.~.2.2. ..... Date ............... D~.c... 3 ......, 19.
THIS CERTIFIES that the building located at ... W/a .Glr~ .Lane ........... Street
Map No. Bay..Ea.v. en. Block No ........... Lot No..9 ..... Soul;hold...1~ .Z.. ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............ Aug. · 22.., 19. ?'.q. pursuant to which Building Permit No.
' dated .......... Aug...23 ..... , 19.7.h., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . Prl~z..one..£amily. dwelling .... (. firs.t..floo~, only., comple ~ad)
The certificate is issued to .J..o1~ .~.:. ~,~71r~e...I,I~trr~y .....0~ers. ....................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Departmen~ of Health Approval .D.e.c..3..19.7.h.-...by..R...V. ill~ ........
UNDERWRITERS CERTIFICATE No... Pznding. .................................
HOUSE NUMBER...~. 3.00. ...... Street ...~.i.n...L.a.~9 ..............................
Building I~spectoff
OF
OR
IS UNLAWFUL
CERTiFiCATE
OCCUPANCY
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION o TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH ~ FRAMING & PLUMBING
3, INSU[ATION
4~ FINAL. *_. CONSTRIJCTION MUST
8E COMPt. ETE FOR
ALL CONSTRUCTION SHALL MEET
THE REOUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & ENERGY
COiI~ES, NOl' RESPONSIBEE FOR
DESIGI~4 OR CONSTRUCTION ERRORS
APJ'RO~D AS NOTED
·
Building Inspector's Office
Town Clerk Building
Southold, N.Y. 765-2660
~ ~ l ; " '~} ......
~~~~ ~~ ~ ....... 7" '~'"
m ~ th~ di~m~ which i~ p~ ~E this ~li~ti~. E
york.
purpose whatever until a Ce~ificate of ~cupancy
~e issuance of a Building Permit pursuant to the
w York, and other applicable Laws, Ordinances or
~r for removal or demolition, as herein d~crlbed.
ilding c~e, housing code, and regulations, and to
inspections.
.... (Signature of oR~olicont, or n~ame, if a corporati;~i ....
f ~-{; '~_..--.. ,~..~ ~.¢.~,~$.¢.~ Dt~=, ~o~oLO
.... :~ (Address of opplicon,) { ~ 4 ~/
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
No ,
--
If qpplicant is a co,orate, signature of duly authorized officer. ~ ~re' ,, '"- '
...... ~ ....... .. ~ ,' %~
~ (Na~ a~ ~ co~or~te officeF) ' x' ~;; r ~-
Builder's Lic~se No, .;{b. ................ J, . .........
Plumber's License No ...................... 2 .........................
Electrician's License No. .: ..........................................
Other Trade's License No ................ ..(~...J'....'....'.Lr..~.; ........ ~ ~ ~ i4 ~'~ ~ ~ ~T SU ~ ~
1. Location of land on which proposed work will be done. Map No.: .., .................. ~: , Lot No ~.~,.....'. .
Street and Number ~/~..~.~..L~.~..~.~:.~.~.~.~.~../.e...~'~.`~.~L~```z~`.~.}..~.~.~
Municipali~
2. State existing use and occupancy of premises and intended use and occupancy ~f proposed construction:
a. Exisiting use and occupancy .................................................................................................................................
b. Intended use and occupancy ~ ~*~¢/ ~~¢.
~7
f d~ ' ~ .o ' '
~ , , ~ , FORM NO.
,, ~ .~ TOWN OF $OUTHOLD
,~,,~ . ,, '~ ~t~,,:~'i BUILDING DEPARTMENT
~/ TOWN HALL
' ~ SOUTHOLD, N.Y. 11971
?:'" TEL.: 765-1805~
~xaluined .........
Disapproved a/c
. /(Buil~Ing Inspector)
APPLICATION FOIl BUILDING' PERMIT
B~ARD OF HEALTH
SETS OF PLAr{S ~ .....
SURV£Y .
/ ~IAIL TO:
INSTRU~fIONS
a. This ap~lication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 2
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan sliowing location of lot and of buildings on premises, relationship to adjoining premises or public sti'eet.~
qr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli
c. ation.
c.- The work covered by th/s 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 permil
sba/1 be kept on the premises available for inspection throughout the work.
e. No building shali 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, 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 all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
~ pp' , r ame,/ifa corporation)
(Mailing address of--/'applicant)
State whether applicant is o_wner, lessee/agent, architect, engineer, generai, contractor, electrician, plumber or builder.
Name of owner of premises .....................................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.'
.' (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 ................................. :
· ' ' .£o ,2.
........... / o F~o ~ .
Itouse Num bet Street Hamlet
,000 ...........
Subdivision ........ . ............................. Filed Map No ............... Lot
(Name) ...............
St~}e existing use and occupancy of premises and intended use and occupancy of proposed constructiom
a. Existing Use and occupancy ..... ~/~,l~:;,
b. Intended use and occupancy ... ~ ·
'3. f ( .hifihe[a hcable): New Building .. ...... '.., Addition .......... Alteration .........
..... · ' m al .............. Demolition .. ~ ..: ........ Other Work .....
4 E timat d Co ~'t' 4~.a. O i ~ ~' .~ ~ (Description)
· s e st .
, ' (to be paid on filing this application)
5. If dwelling, number of dwellilie units , '
If ........ ' ...... '.. Nurhbcr of dwelling units on each floor ...........
· garage, number of cars ... i ........ '
If business, commercial or mix:ed occupancy, specify nature and extent of.each type of use ......
7. Dimensions of existing structulres' if any: Front .......... i.: Rear ............... De ......... ' '
, iDimensions ........................ ' ........
of shine structure. With alterations or additions: Front ........
Ddpth ' i .... ~I' ' ' .......... Rear .......
Height ... ·
8 .................. ~ ' ' ' ' ................ umber of Stories ' ~ '
· Dimensions of entire new cons!ruction: Front ' ' .....................
' Rear ' '. Depth
Height ' Number of Stones ..............
' Front '
10' Date of Purchase ......................................... Depth ......................
· . ......... i .......... '; · ...... ; Name of Former Owner ..............................
11. Zone or use district in which v}emises are situated
12. Does proposed construction violate any zoning/aw ordinance ....... :' '.' ................................
'I 3. ~ , m aegulauon ......
Will lot be reeraded ., . .................
Name of Architect ~ . .
......... ~ ................ Address .......... Phone No ..................
Name of Contractor ........ 1
' · ' · · Address ............. . ...... Phone No .........
t5. I.s this property within .300 feet of a 't'idal wetland? *Yes ........ No ......... ' ......
· If yes, Southold ~Town Trustees Permit may be required..
.... ! PLOT DIAGRAM
Locate clearly and distinctly ali buildings, Whether existing or proposed, and. indicate all set-back dimensions from
property, lines. G' ' '
tve street and blockinumber or description according to deed, and show street names and indicate whether
interior or corner lot.
S~TATE OF NEW~'O,RK/% /3 [//
' ' ' '%~'~'"~' ' '~' ' ' ')~/'~' ' '/' '~' ~' ' '~f·~ ' ." being duly sworn, deposes and says that he is the applicant
(Name of individual signin~g contract~
...ye named. :
teis the..' ~~C
~ (Contractor ........................ '
agent corporate officer ftc ) .....................
,f said owner or owners, ~d is duly mithorized to perfo~ or haw perto~ed the said work and to m~e and file this
pplication; that all statements contain~ed ~ this application are true to the best of his knowledge and belief; and that the
:ork will be perfo~cd in the manner s~t forth in tim application filed therewith. '
worn to befor~ b~is .
i'. .., .........
~ml.slon Expires D~emuTr