HomeMy WebLinkAbout21771-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22776 Date DECEMBER 9, 1993
THIS CERTIFIES that the building
Location of Property 965 CHAMPLIN PLACE House No.
County Tax Map No. 1000 Section 34 Block 4
Subdivision Filed Map No.
ADDITION
GR~ENPORT~ NEW YORK
Street Hamlet
Lot 14
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 29, 1993 pursuant to which
Building Permit No. 21771-Z dated NOVEMBER 10, 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 DECK ADDITION & SLIDING GLASS DOOR TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to
IsKENDER EREY
(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
//ldin~ Inspector
FORM NO.$
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
NO
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED]
Dote ............ ,,//..//e ..............................
21771 'Z
Permission is hereb,~ .ante.d to: ,
I£. ~. "
.... .o. . .~ . : ....... ~. .,.7. .~. . . ........ ~. Z./. .~ ~ 6 ....... d .~. . . . . ~. ./(. . ~ .......
.......................................................... ............ ~0~o.~ ....... ~ .................................
CountyTax Map No. 1000 Secflon,.....~.....~... .......... Block ........~., ,~.... ......... Lot No. ... ./,. ..~... ...............
pursuont to oppliootlon doled ............ ./, ..~?./,..~., ~- ........................ ] 9.....~.~.. ...... ond opproved by'lhe
Building Inspector.
Fe~ ~,.,2~.~ .....
Rev, 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANC~
This application must be filled in by typewr±ter OR ink and submitted to the building
inspector with the following: for ne~ 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 U~derwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of i% 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.
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.
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
Date ............................·
New Construction ........... Old Or Pre-existing Building .................
Location of Property... ~..~. .... ~. .............. ~.~.~..~.. ~.~., .......... .~ ~ .~.~ ~7
House No. Street Hamlet
Onwer or Owners of Property .... .~..~!~..~. ~.~ .~..... ..~..~..~.~... .................................. .
County Tax Map No 1000, Section....~.~ ...... Block...D..~. ....... Lot .... ! ~/.
Subdivision ................................... . Filed Map ............ Lot .................. ....
Permit No...~..I.?.?.(...~..Date Of Permit .....................
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final CertiCate...~.. ......
Fee Submitted: $...~.~.~.0..~ .............
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
December 8, 1993
Hr. Iskender A. grey
965 Champlin Place
greenport, NY 11944
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
Xxx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
XXX The check is 6e~-t~M~a~/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT % BP# 21771Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
19
19~A. Permit No~..J?.?.~. ~ . .
Disapproved. a/c .....................................
APPLICATION 'FOR BUILDING PERMIT
3 SETS OF PLANS , ~
SURVEY .._.~..,,,. .
Cl,ECK =====================
SEPTIC PORH
CALL ........ · .....
H^IL TO:
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 sti-eets
or ~reas, 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 ismance of Building Permitl -' . ~.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the p~emi~es 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 ivursuant 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. ..... inspecti~s._.~~j~.f ~.'d/~ ~-'~.x/',~//~.~ .... ~..- ...~~' -~..,F~ .. ~. ~.._~.~ '. ...........
. (Sionature~'--~0~ applicant, or name, if a <corporation)
· t,h, & ,, ¥..
(Mailing address of applicant)
State whether applicant is owne?ff, see, agent, architect, engineer, generai 'contractor, e~rl~[}Pj~r~ builder.
.Z~..Z~'~. ~.~,~ .' ~.~< '-'.~.,~.,~.~. .............. ~m%,?'.~:~~ _.4. ~;..~'~aj. "
(as on the tax ~oll~or latest'/t!~O~ 9 AM TO 4 PM FOR THE
If applicant is a corporation, signature of duly authorized officer. I~OLLOWING INSPE~flON$:
I. FOUNDATION TWO REQUIRED
: (Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No ....... ..................
Electrician's License No.
Other Trade s Lmense No ......................
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4, FINAL CONSTRUCTION MUST
gE COMPLETE FOR C.O.
ALL CONSTRUCTION SHAI~L MEET
THE REQUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & ENERGY
CODES, NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
1. Location of land on which proposed work will be'done ...............................
'.. ..........
I};useNumber · .... , ...~;/~; ................... Hamlet -- '"
cotmty Tax Map No. l'000Section . .~' .......... Block :~. .......... :... Lot./.~ .............
Subdivision Filed Map No ................
(Nmne) ·
Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .......... ~ .~ 7' "~ ' ' ' ' ~
· - i ]. w ouuaing ..... : .... Addinon .......... Alteration/~....
'i ' Repair ............ .. l/emoval '''~2:~''~.':.~ Den~o. li~.lon] ...... ;...~r:z..j..Otl~erWork..~.. ...... '..
4. Estimated Cost... ~f~. ~.; ' , ~ / t riptionl
5. If dwelhng, number of dwellin~ units ............. ,. umber of dwelling units on each floor ......
If garage, number of em . .~ .... ' .........
6. f business, commercial or mix,ed occupancy, speci~ nature and extent of,each type of use .~ .................
7. Dimensions of existing structures if any' Front . ~ ..... Rear '~ ~ . D
. g . · ............ nU~oer of Stories .~... ~ ....... '" ..............
~imensions ~e structure ~ith alterations or additions' Front ~ ........... ~'" ~;~ ..............
8. ~m,te new construction: ~.. Z~.~...; Rear .............. Depth ..........
.~ Height ~ . . Numh~r~ ·
· t /~ ~ ......... , .............. - .........
S~ze of lot Fron . ... - .
10. Date of Purchase .. ~,~ . ~. [~' .......... ~.~?-' ~'" · .~ ................
1 1. Zone or use district in whic emises are situated . · · ......
Does proposed construction vi(late any zoning law, ordinance or regulation:~ .......................
13. Will lot be regraded ...~. ~, .................... Will excess fill be removed from remises: . ' '
14. Nme of Owner of premises .~f~,': ~. Address ~~. ff~ P~ne No. ~ Y~.
Nme of Architect ......... ~ ............ .'. ·.. Address ................... Phone No .......
~' PLOT DIAG~ -
Locate clearly ~d distinctly ~1~ bulldogs, Whether existing or proposed, ~d. indicate ~1 set-back d~ensions fr~,m
property Hnes. Give street and block Inumber or desc~ption accord~g to deed, and show street nines and indicate whether
~te~or or corner lot. .
:OUNT¥ .. - I '
........ r
(Name of individual signing contract) .... being duly sworn, depose~ ~d says that he is the applicant
tbove named.
feis the.., ..................... l''' ~~.... .... .''' '.'' k;.' _k;; ......... ' .....
'
f said owner or owners, ~d is duly authoriz~m ~ ~ ...... , ....... '
~ ~- u..av~ purlu~ea tile salo work and to m
pplica[ion; that all statements contained ~ this a~lica+i ...... ' ........... ~e and file this
. ~ p~ ~ u~ a~u trH¢ to tile ocs[ OIHlS KnOWleO e and be ' · that the
ork w~l be perfomed ~n the manner set forth in the application filed therewith· . g her, and
worn to before me thi~ , '
.. ........
' ~laaL.Ot.~ ~' ' ~ ' / / Z -- .
o,k . ,' ...... '
. NO. 487~05 r . ' ' ' .............. ; t ..........
~mml~lon E~pire, D~embar
765-~.802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [] INSULATION
I'~//FRAMING [ ,3~1~L
REMARKS:
/
.PLUMBING
STATE ENERGY
CODE
FI;;AL
ADDITIONA'L COMME[;TS: