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 ~ !