Loading...
HomeMy WebLinkAbout21305-zFOP~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22254 Date APRIL 9~ 1993 THIS CERTIFIES that the building Location of Property 1865 MAPLE L4tNE House No. County Tax Map No. 1000 Section 35 Subdivision ADDITION Street Block 8 Filed Map No. GREENPORT~ N.Y. Hamlet Lot 3.3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 30~ 1993 pursuant to which Building Permit No. 21305-Z dated APRIL 5~ 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 TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2USTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A FRED & JENNY SCHOENSTEIN Rev. 1/81 TOW~ O~ $OU~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted/to: . // / ..... ~...~..~.....~ .............. ...... ~~~......~.~.~ ....................... · ...~....~~~~i!...~..~ .~~ . ~o..~~ ~~~: .... ~:.:~~..~ ...... ~ ........ ~.~ ......... ~~.:~.~........~_/'.~...:......~ ................... at premises located at ..... ./.~..~..~....,....,..~..~ ........ Z-../..~. .................................................. County Tax Map No. 1000 Section .,.~..~... ........... Block ...~... ............. Lot No....~.. ................. pursuant to application dated .....?./...~..?. ....................................... , 19.~...~...., and approved by the Building Inspector. Inspector Rev. 6/30/80 .~ ~'-~ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN RALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be figled in by gypewriter 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. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 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. 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 t9 accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.O0 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.~.~C.~.. Old Or Pre-existing Building~ .... Onwer or Owners of Property ........ ' .~. ............... County Tax Map No 1000, Section ..... Block ...... Lot ................. Subdivision .................................... Filed Map ............ Lot ...................... Permit No..~./~.Q6:]..Date Of Permit ............................................ Applicant . Health Dept. Approval .......................... Underwriters Approval ........................ . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate....~...... Fee Submitted: $ .~.'..~. ~. APPLICANT 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ROUGH PLBG. FOUNDATION :)ND [ ] ~ULATION ./ FRAMING [/] FINAL REMARKS: OUNDA'TION 'OUNDATIOU (2nd) '~OUGH FRA~'!E & .PkUMB!NG iNSULATION PER N. Y. STATE ENERGY CODE FI~IAL ADDITIONA'L COMMENTS: Z -( FORM NO, 1 TOWN OF SOUTHOLD . BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ' ./ ' , TEL.: 765-1802 Exanline ............. , 19~.~... Approved.. ¢~.'~. ........ 1 93~. Permit No..~..d.~..~J..~. ~ Disapproved a/c ...: ................................. APPLICATION FOR BUILDING PERMIT , ' 0F HEALTH BOARD ......... "'3 SETS -'--.~SUR V£Y ................... 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 tot 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 which is part of this appli- ~cation. ' c. The work cover6d 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 wbrk. 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 piemises and in building for necessary ~sp~,~t~ions. - . , --' (Signature of applicant, or name, if a corporation) · .' (Mailing I~tdress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nam~ of owner of premises ..... /~..¢.' . .~ ............. (~ (as orate tax roll or latest deed) If applicant is a borporation, signature of duly autt?rized officer. (Name and title of cdrporate officer) Builder's License No .... O.~, ff~, ~. ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Loc~ti~n of land on which proposed work will be'done... ~,1..~..~..5 .... ~ ~-,/~-r~ .. (~.~X~-,.~. ........ .................... House Number Hamlet . . .(~. · .~.5 ........ Block.. ~/.O/.O ........ Lot .... ~.. ............. County Tax Map No. 1000 Section Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use gnd occupancy of proposed construction: b. Intended use and occupancy ................................... :. ~,' ..... ~...,.., ,~. ....... 3. Nature of work (check which ~Pplicable): New Building .......... Addition ...... Alteration .......... Repair .............. Re,oval .............. Demolition " ' Other Work ............ 4. Estimated Cost i (to be p~/id on filing this application) ' 5 If dwelling number of dwellin~ units Nun~ber of dwelling units on each floor If garage number of cars .... ~ ........ ' ............... If business, commercial or mix!d occupancy, specify nature and extent of each type of use 7 Dimensions of existing struct~ies if any: Front Height Nuinl~er of Stories ..... ' .......... Rear .............. Depth ............. Dimensions of s:ime structure ~{,ith alterations or addlti · , , OhS. Front ............... Rear Depth . ~ · ' ' · ................. ............ ,... Height ....................... Number of Stories ........... ' 8. Dimensions of entire new construction: Front .............. Rear ............... Depth ............... He,~,ht ............... Nu,m~er of Stones .. i ........................... .......... 9. S,ze of lot: Front .............. '.. Rear.. ............... Depth .... i:~..,.5 ...... I0. Date of Purchase ' ........ Name of Former Owner ................. I1. ' ' ' ..... Zone or use district in which p~emises are situated ................ /. ................ 12. Does proposed construction vio;lat~ ap,~.tzoning law, ordinance or regulation' ' . . W. '~..' i3 Will lot be regraded .'. ~.(,2¥~ ......... ' .......... ...... · .~../. v .rV~/... ~ ....... wni excess fill oe removed from premises: Yes 14. Name of Owner of premises .~d4¢O. ~.~fl.g .*~l~..T..e~..,, Address /..~' .~./~/.< .~,q.~A~.,. Phone No. ~.ZT. ~.. ,~.O.?.....~. ' Name of Architect ......... u Address ....... Phone No. Name of Contractor ...... /~ ....................... ; · · · ................. Address .................. ~.P~gt~ne 'No.., ............ ... 15. ' Is this property within 300 feet of a tidal wetland? *Yes ...... ~. N~. ....... · If yes, Southold town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whethe} existing or proposed, and. indicate all ~et-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. .. / Zo at, Lt. qo' ;2/o. o .,. _ouNy,_y OF..~-~'t~_TT~... I.K.. ~i~ . , ......... .07~'. ~' ~'- being duly sworn, deposes and says that he is the applicant (Name of individual signin} contract) ' ' ' bore named. . Ie is the .. i ..................... (¢ ) ........................... i ontractor, agent, corporate officer, etc. f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this pplication; that all statements contain'ed in this application are trne to the best of his knowledge and belief; and that the 'ork will be performed in the manner s~et forth in the application filed therewith. to before p? tpis i °tary Public,~ ~~Countv '. · CLAIRE t. GLEW ~ . ~ .... ~ ' .. . Notary Public, State of New York ~ .... · ......... No. 4879505 I ~. ~, (Signature of applicant) QuallfleiJ In Suffo k County r~/. Commission Exp!ree December 8, 19 ~ !