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Home My WebLink About21277-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22390 Date JUNE 15{ 1993 THIS CERTIFIES that the building Location of Property 535 BIRCH LANE House No. County Tax Map No. 1000 Section 83 subdivision ALTERATION CUTCHOGUE{ N.Y. Street Hamlet Block i Lot 27 Filed Nap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 8, 1993 pursuant to which Building Permit No. 21277-Z dated MARCH 19~ 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 INST~TJ.a~TON OF SLIDING GLASS DOOR IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BERTHA H. DAVIS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 · 0~ NO. ~ TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°-N.° 2127'/Z Permission is hereby gronted to: ~......~~ ........ ~~...~..~...~ ........ ~.~....~~....~.. ....... ~ ......... ..... ....... ............. ....................................... ~t pr~mi*o~ I~t~d ~t .....~...~..~ ...... ~ ........ ~ ....................................................... co~ ,~ u~ uo. ~oo0 s~.o~ ....... ~.~ ....... ~k ...A .............. to, Uo....~ .......... .... ~u~u*nt to dat~ Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN HALL ii!i ~ 765-1802 This application must be filled in by typewriter OR ink and submitted to the hu~l~in~~ 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 f~rm). 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 plan requirements. For existing buildings (prior to April 9, 1957) non-~onforming uses, or buildings and '-'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildimg 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 Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinmling 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.OO New Construction ........... Old Or Pre-existing Building ....... r ......... Location of Property.~.~.~....~f.~.. ~..~.~ House No ....................... '~ ~'~-~" ' '""~'/'" ' · . Street Hamlet Dnwer or Owners of Property.. .. . ............................ 3ounty Tax Map No 1000, Section ........... Block ........... Lot.. ~ubdivision ............ Filed Map ............ Lot ............. ~ermit No . .Date Of Permit. ....Applicant. .. . ....... {ealth Dept. Approval ......................... Underwriters Approval ~lanning Board Approval ...................... ~equest for: Temporary Certificate ........... Final Certicate....~.. .... ee Sub~ : $.. .~ ..................... Co BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FRAMING REMARKS: FOUNDATION ZND [ ] INSULATION ~FINAL 765-X802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [,--}-FI~NAL DATE INSPECTOR OU~D^~ION (1st) OUNDATIO|~ (2nd) OUGH FRAME & .PLUMBING ZI~SULATION PER N. Y. STATE ENERGY CODE FI;;AL ADDITIONA'L COMMENTS: BUILDING DEPARTMFNT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 APPLICA)-ION FOR BUILDING PERMIT BOARD' OF HEALTH ......... 3 SETS O~ PLANS .......... SURVEY ................... ClIECK .................... SEPTIC FORH .............. O. L 6 ......... 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whichis 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 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 bqildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to' bOinpl'y with hll '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) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... . . ............................. .......... Name of owner of premises . .~~¢...~..~4.<!~ ........ ' ................................ (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.. 3.~. ~..~..,.~. ........ 1. Location of land on which proposed work will be done.~..~'.'~q]¢.?..... ~/f.~..7~.~..ff.e..,. rid. .... ~., .......... House Number Street Hamlet County Tax Map No. 1000 Section ...... ~'.~ ......... Block . .~ .... t ...... Lot.. ~.~ ............ Subdivision .~.~.. ~t//~; .................. 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 ....... ~... ~t~.. ~.' ............ ~,/".T~' '~-I~ ~o~ ............. b. Intended use and occupancy ..... ,. ;:c ;, .'~ ' 3. Nature of work (check which applicable): New Building ........... Addition .......... Alteration ...~. .... .. Repair .............. Removal .. . Demolltln,, ] ..; ............................ Other W~i'.'~ ............ ,~i '' ' ~'~: (Description) 4. Estimated Cost ........... i . .es.~ ................... Fee ....................................... ; (to be paid on filing this application) 5. If dwelling, number of dwelling Units ....... /. ....... Number of dwelling units on each floor ................ If garage number of cars" ' 6. If business, commercial or mi~edl'occupancy, specify n~ature and extent of each type of use ...................... 7. Dimensions of existing structure~, if any' Front . ' ~ ............... Rear.._ .............. Depth ............... H eight ............... Number of Stories ...................................................... Dimensions of same structure ~iih alterations or ad4itions Front ................. Rear .................. Depth i Hight ...... · ......... "..N robe fStori ' ' ...... , .............. e ..... U rD es ............... i ....... 8. Dimensions of entire new construction: Front Rear Depth Height ............... Number of Stories .............................................. 9. Size of lot: Front ............... Rear ...................... Depth ...................... 10. Date of Purchase ........... ~ ........ . ........ Name of Former Owner !!. 7,, ~u~ ','+"'* .......... ~-' ~- ~' .... :....,.~...,1~-; ........... ...... ' ....................... 12. Does proposedconstruction wolate any zonmg law, ordinance or regulation:.' ' ' ' . 13. Will lot be regraded . .4tJ/,q~. .'..i.: ....... ' ............................. '~-' ' ' i .... Will excess fill be removed from premises: ,,2/~t Yes No 14. Name of Owner of premises ~.1~./q~'-/"],~..1~.~..v',2..~. Address .-$-.~..,-~..~Jt~ ~ ~_za't'. Phone No. 7e.~. 7' ~,,~,~...~.. Name of Architect .... .~ ............... Address ................ Phone No ............ ;... Name of Contractor i~))i ./~/fft ]~1~. ........... Address~.,~.~'/,/geA~ ~d~.. PhoneNo. ..7.,~..~..4.o~.... 15. ' Is this property within 300 feet of a tidal wetland? *~es ........ No.~:.'''. · If yes, $outhold Tb~n Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all ~et-back dimensions from property lines. Give street and block ntamber or description according to deed, and show street names and indicate whether interior or corner lot. -- ND~II~f ~UI~x~IN'G OEPART~,NT- AT i 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: . ! 1. FOUNDATION TWO REQUIRED : FOR POU~IED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - ~CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY ; CODES. NOT RESPONSIBLE FOR : DESIGN OR CONSTRUCTION ERRORS STATE OF NE/W-qq3R~ /// e b COUNTy OF ~'~"~JT~{Pl... o.~,/. ,, ,l, /./ (Name of in&wdual s~gning contract) above named. ' being duly sworn, deposes and says that he is the applicant CLAIRE L, GLEW { Notary Publlo, State of NewlYerk No. 4879505 I Qualified In Suffolk County i;ommlsslon' Exp res. ,December ~,, 19d,.~("T (Signature of applicant) He is the ~ i.(Contracf~orp;rat~ offi~;;, 'e't ~.') ........................ . .... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in thi~ application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. Swam to before me t~.hi~//~ i ' .......... .. bl~ Notary Pu ..... ~.. '. County