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HomeMy WebLinkAbout21611-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall $outhold, N.Y. ~RTIFICATE OF OCCUPANCY No Z-23092 Date JULY 12, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 5050 STILLWATER AVENUE CUTCHO~UE, NY House No. Street Hamlet County Tax Map NO. 1000 Section 137 Block 2 Lot 13 Subdivision Filed Map No. Lot No, conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 5, 1993 pursuant to which Building Permit No. 21611-Z dated AUOUST 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 AN ACCESSORY BUILDING (S~ED) IN PJEA~ YABD A~ APPLIED FOR. The certificate is issued to (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Bev. 1/81 ~/A I~/A - ' ~uilding Inspectoy FORM NO.3 TO¥~IN OF $OU~HOLD BUIt. DtNG DEPARTMENT IOWN HAil SOUTI~Ot.D, N.Y. No_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21611 Z Permission Is hereby grantecl.~. ....... 7.),~.~ ........ ,.~.,.~.~,~ ....... ~,.,...~.~ ........ .... ~ ........ ~.~.~.......~, ............. to ~,~. ,,~.,....,~ at premises located at ......................................................................... ..m ................ -, ......................... ............................................................... .~L~.~,~o.~..~. ......... ~,,,~..,. .................................... CounlyTox Mop No. 1000 Section ,,,~,.~,.~..,--"-- ........... Block ...... ,,,~,,,,,~,, ........... Lo~ No ...... .~,..~,,. .............. purs~an, to ap~,,c~,,on dated ~/~ ....................... ~*..~.~- ..... ~n~ ~p,eved byt~e Building Inspector, /¢/ Buffding Inspector Rev. 6/30/80 b TOWI~I I~': ~1~1~01.~ 765-1802 _ ~PLICATIDN FOR CERTIFICATE O~ OCCUPANGY' A. 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: 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 installatioe from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. S. Co~ercial 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. , B. 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. Feas l. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swiping pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existinR Buildinm - $i00.00 3.Copy of Certificate of Occupancy - $20.00 4.Updated ~ertificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Co~ercial $15.00 ...... ......... ~ ~onsnructmon ..... f ..... Old ~r Pre-existing Buildin~ ................. ........................... ~reen f/ Ha~et County Tax Map No 1000, Sec~io~...j~.l ..... ~ioc~ ....... ~ ........ ~ot.../.f ...... Subdivision ................................. Filed Map ....................... '' ' Lot Permit No ....... Date Of Pe~it...~/~ ........... Applicant .......... · ................... Health Dept. Approval ........................ Underwriters Approval ............. Planning Board Approval... ~' . ..... Request for: Temporary Certificate ........... Final Certicate ........... 765-X802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] IN~TION [ ] FRAMING [/_~]~'INAL REMARKS: ~ ~ ./ ~UNDAT~O~! BOUGH FRAHE & -PLUMBING (2nd) ~SULATION PER N. Y. STATE ENERGY CODE FI;;AL ADDITIONA'L COMMENTS Exami~ FORM NO. '1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11~7~1 TEL.: 765-'1803 Approved ........ , 19 ~' 5. Permit No..~. Disapproved a/c .................................... ............... ,.. · , (B~ai~i. ~ecto) APPL~CATION FOR ~gU~LDING P~:R~I'F Regulations, for the construction o~ buildings, additions or alterations, or for remov) The applicant agrees to comply with all applicable laws, ordinan~. ~dina~codeff~ admit authorized inspectors on premlses ~nd m b~ilding forneces (Mailin B~3ARD OF H~AI..TH ......... 3 SETS OF PL.',.i~S ......... CIIECK SEPTIC F O RI'I CALL MAIL TO: ~te officer) ' q8 CAP..L /10 io, a. Existing use and occupancy . b. Intended use and occupancy Other Trade's License No ..................... 'ff'//~ - ~q'"j(~ Location of land on which propolsed work will be done : House Nmnber ' . ) Street Hamlet Cou'nty Tax Map No. 1000 SectiOn . ', ~ Block ~ Lot .... Subdivision ........ . ........ , ...... . .... . ......... '. Filed Map No ............... Lot ............... Name) ' . Stat~ existing use and occupancyi of premises and intendpd use and occupancy of proposed construction~ If applicant is a corporation, signatm e of duly authoriied officer. (Name and title of corpm Builder's License No ........ Ph~mber's License No ....... INSTRUCTIONS , . This apphcat, on 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 bflildings on premises, relationship to adjoining premises or public st?eets ,or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issnanee of Building Permit. d. Upon approval of this applicgtion, the Building Inspector will i~sued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughont the work. e. No building shall be occupied or nsed 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 M~DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the To~,n of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or  demolition, as herein described. ~eg~tations,_~ and .... to State whether applicant is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder. ................ O. Name of owner of premises ~. ... . ,. ............................... . (as on the tax roll or latest deed) 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ....... ~.. Repair .............. Removal .............. Demolition .... : ......... Other Work ' '" · <~ ..~,~. ~ . (Description) 4. Estimated "'~' " ': ........................ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor · If garage, namber 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 shme structure with alterations or additions: Front ................. Rear .................. ~D.epth ..... ~ 7 ' ~ ............. Height ....... ,..i: ........ ;.. Number of Stories ' . 8. ~a .mensmns o~e~.n~t~ire.n~.ew construction: Front.., lO....~.... . Rear {q ~ ~ ' ~' ',~ .... ~' r't~ ...... Height . .~/~ ?/g... J.... Number of Stories ....... /. .... ' ............. ep ...... ~,...._, ....... 9. Size; of lot: Front ...................... Rear ..................... Depth ............ i*.. '.'"). 10. Date of Purchase ..n.[.~.q ......... .~.... ........ :~Name of Forr~er Owner ... ~[~. .............. 11. Zone or use district in which premises a:e situated ~.t/T¢.~O(~g ~ ' ' I 12. Does proposed construction vi,ol, a~te any zoning law, ordinance or regulation' 13. Will lot be regraded c/ . ' ........................... ....... · ~.' ................ ~. Will excess fill be remove fro re is ' es No 14. Nmne of Owner of premises:~[~t<~/ '~,¢~.'~¢)~.~.~.~l~ddress C~. (, &l&-~q41tf ............... ~.'..t~ :7~t':. *-raone .mo; Name of Architect ........................... Address ................... Phone No ................. Name of Contractor .......................... Address 15.' Is this property within 300 feet of a tidal wetland?('iCy'e's.~ ........ PhoneNo .......... . ....... · *If yes, Southold Town Trustees Permit may be r'e~r~d~ ..... No ......... PLOT DIAGRAM : 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. STATE OF ~EW Y..QI~I~,. __ COUNTY OF .... .... S.S '~'ff~'~ ~1~ ~ ~ ................... · ......... being duly sworn, depds~s ~ says that he is the applicant (Nmne of individual signing contract) above named. iHe is the ..... . ....................... <~,~o ~k~('.. · ', (Contractor agent corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi~ application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed/Ln-t.,he manner set forth in the application filed therewith. ' Sworn to before me ~s ) , ..... o/do. ?b-'. -3'o -v '- ......, . . '· ........ . . . . . .-:. . . .