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Home My WebLink About21572-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22523 Date AUGUST 12~ 1993 THIS CERTIFIES that the building Location of Property 1420 MIDDLETON ROAD House No. Street County Tax Map No. 1000 Section 41 Block 2 Lot 3 Subdivision Filed Map No. Lot No. ADDITION GREENPORT ~ N.Y. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 21, 1993 pursuant to which Building Permit No. 21572-Z dated AUGUST 3~ 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 DW~LT.ING AS APPLIED FOR The certificate is issued to MARJORIE M. BUNYAN (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 /~uild ng 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 COMPLEllON OF THE WORK AUTHORIZED) 21572 Z Date ....................... ~ ......................... 19.....,~..J~.... Permission is hereby granted to: .... z~,~..~:i~ ......... ~.:.....~/..~ .... .... l~.. ...... z~.~..~.z~.L,~.~...~:_.../..~-z: ...... d.~.~ ....... ~./,..: ......................... /, ....... .~.~..: ........ ~ ........ ~.f..~.~. ......... ./...~..,...,z..~,,z ........ za.. ....... ,~ ....... ~,~.~-.....~,,~ ..~.~.//.z~.~.. ............ ,~: ............ ../..,,~././..~.~z.... ~ Cou~ TOX Mop NOI ] 000 S~''O~ iiiii~Z .......... B'ock ....... ~ .......... LO~ NO ...... ~ pursuant to application dated ..................... "'-2 J'~ ~/' .~t...~. ...................... Building Inspector. F~ s.....2~.~... 19....,~,,~.. ..... and approved by the ~ ~' Buildfng nspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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: i. 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 plan requirement.~. 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 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 i. 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 ...... I~O. MIPP.~.%O~.~P.AP. .'... GRE~NPORT, NEW~O.RK. House No. Street Hamlet Onwcr or Owners of Property ...... ~R~p~.~.~. ................................. County Tax Map No I000, Section .... ~1 .Block... ~ ...Lot 3 .......... Map ............ Lot ..................... Subdivision .......................... Filed . . 21572Z AUG ], 1992 MARJORIE B~NYAN Permit ~o ................ Dace Of Permit ...... ' .......... Applicant ............................. Health D I Appro al U~der ricers Appr val · Planning Board Approval ............. ~ ........ .. Request for: Temporary Ccrtificate ........... Final Cercicate ........... Fee Submitted: $ ..... $25.00 August 6, 1993 Marjorie M. Bunyan 1420 Middleton Road Greenport, N.Y. 11944 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) (PLEASE SIGN & RETURN) No Underwriters Certificate on file. XX The check is 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 # 21572-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. to ~bOl I IA FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .......... 19 Approved .... 19 ~. Permit No. .~1~7 ~ ~ Disapproved a/c ..................................... ./(B~iildmg Inspector) APPLICATION FOR BUILDING PERMIT · INSTRUCTIONS BOARD OF }t~'ALTH ......... 3 SETS OF PL,/liS ......... CIIECK ................... SEI?T lC FOIh~l ............. 1': O'T i P¥ ~ CALL .................. Date ................... 19... a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with sots 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 sfi'eet c~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appfi 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 permi 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 Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herehi describec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in building for necessary i~sve~ctions. , /9 · . .... -- . (Signature c~j(pplicant, or name, if a co~9~ation) .......... ih ili:i re' of applicant) U is/X~ l~ssee, agent, architect, engineer, general contractor, electrician, plumber or buildex State whether applicant · Name of o,vner of premises .... .~...~..~ · -~--.~.. ............................. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate office~ Builder's License No Plumber's License No ........................ : Electrician's License No ....................... Other Trade's License No ...................... (as on the tax roll or late 706-1802 ~ AM TO 4 PM FOR THE FOLLOWING INSPECI1ON~: 1. FOUNDATION o ~ REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET · THE REQUIREMESFrS. 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 ....., ............................ : ............. ., · House Number Street ,~/ Hamlet County Tax Map No. 1000Section ...: .......... Block ........ ~ .... i... Lot ..... ~ .......... Filed Map No. Lot ...... : ....... Subdivision ........ . ............... - ..................... (Name) 2; State existing use and occupancy of premises and intended use and occupancy of proposed construction: · o. Nature of work (check which applicable): New Building ..... ;~.. Addition. teration ....... i.. Repair .............. Removal , Demolit' . Other Work .{. ......... ; .... · . . (Descripti~pt)/ 4. Estimated Cost . .~...~..~.'--~ · ' ............... Fee ..... 75 .'-~. ·~.- ................ '; ..... ~ (to be paid on filing this appti~a~,~. ~ 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ · If garage, number of cars .......... / ............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of.each type of use '~ ' ........... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of s~me structure with alterations or additions: Front ................. Rear .................. Depth ....................... Height ........... ' ......... ·.. Number of Stories ...................... 8. Dimensions of entire new construction: Front ..... .J ~'. .....: Rear .... ./; .o ........ Depth .../.? .......... Height ............... Number of Stories ................................................. .-~ ..... ~. Size of lot: Front ......... , ............ Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ..................... : ....... 11. Zone or use district in which premises are situated .............. ' .................................... 12. Does proposed construction violate any zoning law, ordinance or regulatmn: ........................ ~ .... 13. Will lot be regraded ....... : .................... Will excess fill be removed from premises: Yes ' No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address .................... Phone No ................. Name of Contractor Address Phone No . Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yas, Southold Town Trustees Permit may be required. PLOT D1AGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-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. rAT OF l// S S :OUNTY OF, .~.~Ot~..-X...'-J-~. · {.~ 'D .-' - ....... ~.a.C.~o~, ~. ~.~-9~ ~ .......... heine duly sworn, deposes ~d says that he is the applicant (N~f individual signing c~ntract) ,ore named. ................ '. ..... · ....................................... .............. (Contractor, agent, corporate officer, etc.) said owner or ownem, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this plication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ~rk will be perfo~ed in the manner set forth in the application filed therewith. 'om to before me this ............ ..... ~ ~ ~ ' ' '- ........ (Si f applic~t) ~l~ ~n ~u~