HomeMy WebLinkAbout21555-zFORM NO. 4
TOWN OF SOUTBOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO Z-23702 Date J~-NE 13, 1995
THIS CERTIFIES that the buildin~ ADDITION
Location of Propert~ 205 GRANGE ROAD EXT. SOUTHOLD NY
House No. Street Hamlet
County Tax Map No. 1000 Section 75 Block 4 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 9, 1993 pursuant to which
Building Permit No. 21555-z dated JULY 23, 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 A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to
KENNETH & SUSAN MICKALIGER
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
(owner's)
N/A
N/A
N/A
~dilding Inspector
Rev. 1/81
FORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OU1HOLD, N.Y.
NO
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date....~.& .......................................... ~9~......
2:L555 Z
Permission Is hereby granted to: ,~ ,
~~..~~? ....... . ........ ~~~ ....... ~ ............ ~ ........
o,,,~m,,~,,o~o,.o,...~...~..~'~...~~ ...........................................
.............................................. ~~~ .............................................................................
co~v~.~uop ~o. ~000 so~,~ ....... 7~ ......... ~o~ ........ .~. ........... to~o ...... ~/ ................
pursuant to application dated ......~ .........................................
Building Inspector.
Rev. 6/30/80
1 9., .~....~.. ...... and approved bythe
Form l,Jo. 6
TOWN OF $OUTIIOLD
BUll,DING I]I'~PAI~'I'HEbIT
TOWN IIALL
765-1802
API'I. ICA't'ION FOR CERTIFICATE OF OCCUPANCY
A. This application must be fiLLed in by typewriter OR ink aad submitted to the building
iuspector with LIio £olLowing: £or new bniJding or new use:
1. Final survey of property with accurate location of al. 1 buildings, property .[iues,
streets, and unusual natural or topographic features.
2. Fin;ii Approval from Ilehith Dept. of w~ kef supply and sewer~ge-disposal(S_9 form).
3. Approval of electric~n[ installation from Bo~r(I of Fire Underwriters.
6. Sworu s~atement from/plumber certifying that the solder used iu system contairs
less than 2/10 of 1% lead.
5. Commercial buiidxng, industrial building, multi-'le r '' ,
· -~ac~ons,k,a certltmcate of Code Conpliaoce from architec - , g
respoas~ole for the building. .t or engzneer
6. Submit Pianaing Board Approval of completed site plan requirements.
B. For existing buildings (prior ~o April 9, 1957) non-conforming uses, or buiidiegs aud
'.'pre-existieg" land uses:
1. Accurate survey of property showing ali property lines, streets, building and
unusual naLural or topographic featnres.
2. A properly completed al)piica~ion and a conseot to inspect signed by the applicant.
If a Certificate of Occupaucy is denied, the Building D~spector shall stnte 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 525.00, Swinging pool. $25.00, Accessory buildieg 525.00,
Additions to accessory building 525.00. Busiuesses 550.00.
2. Certificate of Occupancy on Pre-existing Buildi[m - $[00.00
3. Copy of Certificate of Occnpancy - $20.00
Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy I ' '
- lesldent~al $15.00., Cotmnerciai 515.00'
~ew Construction ........... Old Or Pre-existin~Bu~]~iog ............
Location of. Property..~.. ,.., ..... . ..............
~ S ................
. house ,o, ~ treet llamlet
Onwer or Oune~s ,.,f Property... ~0~3~
County Tax Hap No 1000, Section .... ~ ..... Block ......... o . . ·
Su} divisi
................ lilcd Map ............ Lo~ ......................
Health Dept. Approval .............
Underwriters Approval ..............
'lannlng Board Approval ........................
/equest for: Temporary Certificate ........... Fiua~er~icace..~ .....
'ce Submitted. , 2S, /
~ ' ......... ''~' ~ ..............
~OU_~I;D A TI ON ( 1 s t )
'OUNDATIO:!
UGH FBA~-IE &
-PLUMBING
!~SULATIO~; ·
PER N Y.
STATE E~IERGY
CODE
FI;IAL
ADDITIO~A'L COMMENTS:
,,0
/,
BEAM LAYOUT FOR LEVEL 1
CUSTOMER -- KEN MICKALIGER
DATE 07/08/93 REF KEN
BEAM BEAM POST POST
LABEL LENGTH COUNT SPACING
A 14'9" 3 7'2 3/4"
B 2'9" 2 2'5 1/2"
C 10'9 1/2" 2 10'6"
Post spacing ts measured
Depth oF post-tn-concrete £ooters ---
cer~ter to-center.
36 inches.
1'6 1/4"
7/8"
8'9 5/8"
1'6 1/4"
BEAH LAYOUT FOR LEVEL
CUSTOMER -- KEN MICKALIGER
DATE 07/08/83 REF KEN
9'4 11/18~
4'1 1/~~
1'5 13/18'
1% 1/4"
4'8 1/2~
7t3~
1'6 1/4~
BEAM BEAM POST POST
LABEL LENGTH COUNT SRACING
A 6'4 1/S" 0
B 13'3" 0
C 11'11" 0
D 7'11" 0
Post spacing Ts measuped cente~-to-centep.
Depth oF
post?n-cpnc.~ete Footeps --- 36 ~nches. C~ ~( /(.5
7GS-~80Z
BUILDING DEPT.
INSPECTION
INSPE~
BOARD OF HEALTH .........
~ ..... ~ , FORMNO. 1 ~3 SETS OF PLA,VS .........
ltl)~~}>~i~ ~-' ; Town oF so~o~ ~ ..................
II.~ .......... su~LD~NG pePARTmeN~ .... /c,~c~ ...................
Ilgl JuL - ~mo ~ow..~ ~,-~o,~, .............
IIl~l --'~ ,~Q SOUTHOLD, N.Y. 11971
~ u~.~..r:.~ . TEL.: 765-1802
! ~~:.- ' -~ , ' ~. ~.~-- (~ .....
7~ / _ - ~ . ~/~~ ...................
Disa r v "/' ' ' ' .................
pp o eQ a/c ..................................... .
(Building Ins~cto~
~PP[ICATIO~ FOB BUIkDI~G PfiBMIT
Date .................. , 19...
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 s6'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 i~sued 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 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, b/fllding code, housing cod,e, and regulations, and to
admit authorized, inspectors on premises and in building for necessary i ..o~ .kTf~~pectiOns. ,k~ffl//~ ~ ~/~ .//~~:.A'~'~0~
-- . / (Signature of applica'fft, or,,~n~a corporation!
. . ~,~ :..~¢xx..'~' - ./.¢~....,5..o~/.4....~/,(....L/~/..
(Mailing address of appilcanty
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..... .~.m ac .r-:. i .
N~imeorownerorprem~ses ...~% ~, q~ $..t:C,Sa,~ W'), ~;C/~.J~.~¢C ...................
If api~lic~nt is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.. .... .D..iQ..Df.C .............
Plumber s License No ....... ' ..................
Electrician's License No .......................
Other Trade's License No.. ....................
1. Location of land on which proposed work will be done .......... ' :
c~ . ..'. ¢~?.~.n
lt~use Nmuber . Street Hamlet
-~¥ ,
County Tax Map No. 1000 Section ... :O.Q..~. ......... Block .................. Lot ..................
Subdivision..,.~.%~..~.&.CJ2r~C..17~.~¢.5 ............. Filed Map No. ~.0~.~ ........ Lot..~..: ........
(Name)
2: State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~.~ I '
d~t~ ,..
b. Intended use and occupancy ................ · ...............................................
3. Nature of work (check which applicable): New Building .......... Addition . .¢." ....... Al~ration ..........
Repair Removal ......... Demolition Other Work 2'..'. ...........
· .. (Description)
4. Estimated Cost /.~-~C, ' . ........ ...... Fee ......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... ~ ..... Number of dwelling units on each floor ................
· If garage, namber of cars .............. .--:- ........................................................
6. If business, commercial or mixed occupancy, specify natur~e and extent of each type of use ....-- .................
7. Dimensions of existing structures, if any: Front ~.~ .~./~Q ~.. Rear .... ........... Depth ...............
Height ............... ,~Number of Stories ...................... [~ ...............................
Dimensions of shine structur~ with ~}~ra~ions or additions: Front ,~?Nu~.m/.'l~:~; ~;~;sRear ..................
Depth .... ' .................. igh .......... :;~ ....... ·. ' ........... ; ..........
8. Dimensions of entire new construction: Front -.-~. ~/.../);S... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. S~ze of lot: Front .~ ~.em . .. Depth . v- .... ~ .............
12. , or i . .
13. Will lot be regraded ....... .~7.... .................. Will exj[:ess fill be _removed ?om.premises: Yes. ~ No
14. Name of Owner of premises ~.qO~.'It~../33~ C~1~¢.~ Address .~..Q :"/>-~0y./.~ .o~...-~...~,.¢:P'hone No. 7~.. ~.7/..r-~..,,~t...
Name of Architect ........................... Address ................... Phone No ............ . ....
Name of Contractor .......................... Address ................... Phone No ................
15.' Is this property with±n 300 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fror,~
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
?~5-~802 ~ ~qN; TO ~ PM FOR THE
1. ~f;~ ~L')ATIO[,~ 'Fr~/) REQUIRED
' F(~;:: POURED CONC:XETE
8F COr¢$PLETI~ F'~h CQ,
ALL CONSTRUCTION ~HALL M[~
TNE REOUIREMEN~S OF THE N.Y.
STATE CONSTR~LICTtON & ENERGY
COUES. NOT RESPONSIBLE FOR
DESIGN OR cONSTRUCTION ERRORS
STATE OF NE1, K, '
_
..... ~(~. S~.~q....z~....~ .L!,./~..C4~. [[ ~.~(.... being duly s,vorn, deposes ~d says that he is the applicant
(Name of individual sJgnin~ contract)d
above named.
He is the ......... ~ ~ ~
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly authorized to perfom or have perfo~ed the said work and to m~e and file this
application: that all statements contained M this application are true to the best of his ~owledge and belief; and that the
work w~l be perfo~ed in the m~ner set forth M the application filed therewith.
Sworn to before me t~s ~.,,.
............ .~~ .day of .~~~.., 19%
... .........