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Home My WebLink About21715-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22662 Date OCTOBER 18~ 1993 THIS CERTIFIES that the building. Location of Property 1475 SHIPS DRIVE House No. County Tax Map No. 1000 Section 79 Subdivision ADDITION SOUTHOLD~ N.Y. Street Hamlet Block 3 Lot 38 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER t~ 1993 pursuant to which Building Permit No. 21715-Z dated OCTOBER I5~ 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 CHIMNEY ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ARTHUR & TESSIE MACK Rev. 1/81 NO 21715 Z FOBM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL OOMPLE~ON Or THE WORK AUTHOR,ZEOI Date ............. Z,~./,,, ,/., ,~,,. .............................. 19..../?.-~.... Permission Is hereby granted to: Building Inspector. Fee $...~.~ ....... Rev. 6/30/80 Building Ins, )ector Form No. 6 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 kPPLICATION 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 2/10 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 ~lan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. Accurate survey of property showing all property lines, streets, building and unusual natural or topggraphic 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 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 $15.00 Data ......................................... ~','ew Construction ........... Old Or Pre-existing ~ui!dimg...~..~-~.%.~..c. .~..~..~.~ Location of Property ................. ~ ~a4~.~$. ........ O~t ...... .~.o~l- ~_..' ..... :..9 .............. ............ . House No. Street Hamlet 0nwer or Owners of Property ....... .~ ?.~. :'. ............. COUnty Tax Map No 1000, Sectzon ............. Block. ~-~ ~ 0 ~3 bdivision ~ 3'7~'~'~""~ C~'~°~' ~ Cu ........................ 9. Piled Map Lot i'ermit No ................ Date Of Permit ............... · Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... ?ce Submitted: $ ............................. - - PICONE ENERGY SYSTEMS ~ Rocky Point Road Middle Island, N.Y. 11053 ~16-924-0919 Billing N~ I ~ ~--~---~.---. Oob Name: .__~_ _ ' '---~ Add~ess :Z~~~]~_' ~dd~ess: Contact: C~oss St~e~ Diameter .. Height ..... Type of Installation: ~ ' An~ghor Plate ~__ Offsets: Yes__~___ No Chase: Flat Pitch--J~ Number of Flues__1 .... PIPE TAKEN USED RETURNED 24" ........... / 36" ........... ~5----' 60" ........... Offset .......... __l___- REMARKS: , LI - FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197~ TEL.: 765-1802 Approved ...... ./~./ff.~..., 197~.. Permit No. Disapproved a/c ..................................... . ~l/Shildm,,/o'Inspector) APPLICATION FOR BUILDING'PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY ...; .............. ClIECK HAIL INSTRUCTIONS 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 stkeets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is phrt 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 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. · - (Signature of applicant, or name, if a corporation) .... ?. ?..,. r..... (Mailing address of applicant) t [ 'i' -z; State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... A .dr..~'..04. q .ri....(~3...,...~... ~.'~.?...5.$. ~..~...~..,. /'% ~k C &/ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer, (Name and title of ~orporate officer) Builder's License No.' ......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. ~ O '% o iq I · APPROVED AS 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ~- TWO REQUIRED FOR POURED CONCRETE 2. ROUGH ~ FRA~NG & PLU~NG 3. INSU~T~ON FINAL CONSTRUCTION MUST 8E COMPLETE FOR ALL CONSTRUCTION SHALL MEET ~HE' 'REGU~EMENT$' OF' 'T~E 'N.Y: · I. Location of land on which proposed work will be done .................... ...................................................... COOfiS.' · NOT' 'R~ONSIBbE · llouse Number Street ~ OR CONSTRUCTION ERRORS County Tax Map No. 1000 Section .. ~ .~ 7.'.9 ~ ...... Block . ~. ~.'P.9 ...... '... Lot .9.'~.~,~. ~ ......... Subdivision ~ ~ Y O~ ~ ~ ~ a 0 ~ 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 ...... . . _ . ~ ~ _ b. lntended use and (~ " o 6~ ~o~-~ C~,~ ~ ¢~.~ . .......... ................................ .3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .... ; ...... Repair Removal ...... Demolition ..... :. . Other Work {~ [[ ~riO ~'. o t:~ ..... (Description) 4 Estimated Cost . Fee ! (to be paid on filing this application) 5. If dwelling, number of dwelling units ... I ' , Number of dwelling units on each floor .... If garage number of cars I '¢. ' 6. If business commercial or m~xed occupancy, specify nature and extent of.each type of use ........... 7 Dimensions of existing structures if any' Front Rear Depth ' · Height Nuint~er of Siories .........' ( ................................... ' Dimensions of shine structure v~ith alterations or additions: Front ................. Rear ................. Depth ' ' Height ' Number of Stories 8 Dim f ti tru ' · ensions o en re new cons chon: Front .............. : Rear ............... Depth .............. Height Number of Stories 9. Size of lot: Front ......... , i ......... ~.. Rear ................ i Depth 10. Date o urchase ...t '. ........ .~r ....... anoeo o er Owner I Z ~e ict i h p ~mi it d ./.~77..5.. .......... ' .......... 1. on or use distr n whic r scs are s uate ....... . ............ 12 ~at ni g 1 ~{ gui /q~o ............... · Does proposed constructionvio eanyzo n aw, ordina ce or re ation: .............................. 13. ',gill lot be regraded ....... '..: ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...i ............ , .... Address ......... .......... Phone No ................ · Name of Architect ' Address Phone No Name of Contractor ' Address . Phone No ' 15. Is this property within ~00 feet of a tidal wetland? *Yes ........ No.....~.... · If yes, Southold Town Trustees Permit may be required. · PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines· Give street and block mmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S~S COUNTY OF ................. Z~ r,-.-c ~.~ ,.., ~_. ~ ~ ~ & c. (<' being duly sworn, deposes and says that he is the applicant (~ame of'i]l-~lividual signiag c'ontr~ct) ' above named. lie is the .................... . .. .......... . ............................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly ianthorized to perform or have performed the said work and to make and file this application; that all statements contained in this'application are (rue to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this / '...day of ..'..' .... 19 .~.~ Notary Public, · unty HELENE O. HORNE I' · ..... Notar~ Public, ~;tate of NewlYork ............... .z ................ No. 4951304 Qualified in S~Jffolk Coufity d.~ 4 '--* (Signature of applicant) . . Commission IF×?iro~ M? 22, ] O