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HomeMy WebLinkAbout21613-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22717 Date NOVEMBER 10, 1993 THIS CERTIFIES that the buildin~ Location of Property 870 CHESTNUT ROAD House No. County Tax M~p No. 1000 Section 59 subdivision ADDITION SOUTHOLD~ NEW YORK Street Block 3 Filed Map No. Hamlet Lot 4.2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 11, I993 pursuant to which Building Permit No. 21613-Z dated AUGUST 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A CARL J. & LISA ANN pARK Rev. 1/81 FORM NO.3, TOWN OF $OUTHOLD BUILDING DEPARTMENT ~'OWN 14AU. SOUTHOLD, N.Y. NO 21613 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ................. Permission Is hereby granted to: .................................. ........ ~o:...~....z2~./ ........................................ ..... ~~(......~.... z../g..,~/..., ........ Coun~y Tax Map No 1000 Seotlon.....~ ........... Blook...,,.,~,,.-~ .......... LotNo ....... ..~..-....~... ....... pursuant to application dated ................ ~/Z .......... : .............. 19.....~...~.. ...... and approved bythe Building Inspector, Fee ~.....,Z.~.~ ..... ............... ~ ......... i~'~Xi~;; ...................... Rev, 6/30/80 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: 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. 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-conforming uses, or buildings and "pre-existing" land uses: 1. 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. 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 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 New Construction .... ~ .... Old Or Pre-existing Build~[ZZ[~[ZZ]Zi].' .............. House No. Street Hamlet Onwer or Owners of Property County Tax Map No 1000, Section ......... Block... .. · -. ~....! ........ applicant .......... ~... r..-~%....'~. .. IIealth Dept. ApproVal .......................... Underwriters Approval ....................... .. Planning Board Approval ......... . .. ............ . / Request for: Temporary Certificate ........... Final Certicate ...........~/ O0 ?Ce Submitted: $ ....... ~ ..................... ...... ................... ~LICANT ' 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ~INAL REMARKS: INSPECTOR OUNDA~ION . UNDATION (2nd) ~OUGH FRAME & -PLUMBING ~SULATION PER N. Y. STATE ENERGY CODE ADDTTIO~IA'L C.OMHENTS: 37.7~ 38.3' · N/O/ , LEN M. CONWA ' /00 .J' TEST HOLE (48. 3 ) 151.82' MAP 152,4§'A CT CERTIFIED TO: LONG ISLAND MORTGAGE CORP. AMERICAN TITLE INSURANCE CO. ' CARL ,I. PARK '~ - .... /..' .LISA ANN PARK ,: SUFFOfK COUNTY DEPARTMENT OF HF. ALTH SERVICES $1NOLE ~AMILY DWELLING ONLY DATE~CT ;) ~_/~,q/~.S. R~. NO. ~--~-/~ The sewaBe disposal and water supply facilities for this location have been inspected by this Department and/or other ~and f~nd t~ tZ~atis~ory, chief~of Bureau of Wastew~ter Management ~ N.Y.S. LIC. NO. 49668 P.O, . SURVEY FOR LISA, PARK 'AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, I'O00 - 059 ' O~ - SCALE I"= 4'Or JAN. 3l, 1986 MAR. 16, 1987 Sept. Prepared in accordance with the minimum standard~ for title surveys as established by the L. h A. L.$. and approved and adopted for ~uch use by The New York State Land Title Association. of work (check which applicable: New Building . ~ ....... Addition ' ': · 3. Nature ) . . , . Repa/r .............. Removal .............. Demolition' . . .. · ......... Alteration .- } · Other~ork 4. Es~ma '~ ' ~000,00. ' ' ' ' ¢~[ 00.. (Description) t' tea t~osr ...................................... Fee.. (to be paid on filing this applicatioh) 5. If dwelling, number of dwelling units ............... Nu~hber of dwelling units on each floor. If garage, number of cars ................... ' ......................................... 6. If business, commercial or mixed occu;a~cy, specify Eat~ure and extent of each tv e of u 7. Dimensionsofexistingstmctures if.__ ~ . /_% . ~.jp se ............... Height . . ,Num~ ~?:vr°m''t'~'2- .......... Rear .~..-5 ...... Depth '~(D~ ~'" ......... er ut' Stories ...~.[..~. ............ ' .... · ..... Dimensions of shme structure with alterations or additions: Front ........ Depth .... ' ................ Rear .... ................... Hei ht ........... · ...... j · 8. Dimensions of entire new constmction:gFmnt ,~.. Number of Stones .............. . He g ~t Number . - ................... ~ear ............... Depth .... ~ ' ' ~,. Size oflot: brunt 't~'7'O'QO ' ' Rear /?5-._/, ~./ ~ , ' .............. . of Stories ...................... , .... ;"' ::' 'dt 5,; '3:;: .... .... I0. Date of Purchase '~/'~9~'~-5]'~'- ........................... weptn ..... .¥. ' .... r"' 'r .......... ' ......... Name of Fo ' ' ........... Zone or use district in .... rmer O ncr ,6r'.~... . 11. ~. wlnch premises are mtuated zSt.. ~).,-1 am--~v '~'x~:~~' ': ...... 12. woes proposed constructi,,- ,;,,1~ . . ,.- - -r ....'" ''~" '/' ~'/t "~ .-,-~-~-~-.--v..-~ ....... '13. *m lot oe re=ractea ... P/ts.; .................... Will excess fill be removed from premises: .... y~" W'" '~' ' . - , "~5~, ....... any zoning law, ormnance or regulatidn: . .~. ............ ' ....... 14. NameofOwnerofpremises .~,,~.~...~.~ .... Address .~_70. ,"/~,t_75T~, .-t~ ....... sj} N Name of Architect t/ ' . ' ,s, · ~T,-i_J.~Tr'~;--.~-~ ,~7~,.. rnone ~'~o. ........................... ~uuress . .'.~.~././D.~.. Phone No . . " · Name of Contractor ..... "·" .... ~ ........... Address · 15. Is this property within 300 feet of a tidal wetland? *'Y'e's..'.' .... ...Phon~o ................ · If yes,'Southold Town Trustees Permit may be required. 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 NEW Y~.RF~,~ ~. S S .... ' '~Off'k ' ~*' ~ ~ ................. being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) - above named. He is the ..... . ................... ~.~ ~ ........................................ . .............. : (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfumed the said work and to m~e and file this q)plication: that all statements contained N this application are true to the best of his knowledge and belief; and that the .york will be performed in the ~Or set forth in the application filed therewith. ' ~wom to before me this ~ ~. .J. DEPT. TOV: ~}: $OUTHOLD ~ TEL.: 765-1803 Disapproved ~/c .............. : .................... . (Buil~n~ Inspector) '~ ~PPklC~TIO~ FO~ BHILDI~G'PE~MIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1 19RI BOARD OF HEALTH SURVEY ........... IIECK ............ SEPTIC FORH ...... : ate [ .iNSTRU6TIONS ' : a. This application must be comPletely filled in by typewriter or in ink and submitted to the Building Inspector, with ' t sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location ~f lot and of btiildings on premises, relationship to adjoining premises or public sti'eet or areas, and giving a detailed description of layout of property mint be drawn on the diagram which is part of this appli cation. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this applidation, 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 occupibd or used in whole or in part for any purpose whatever until a Certificate of Occupanc5 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 thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ot Regulations, for the construction o!f 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 author/zed/nspectors on premises and in building for necessary inspections. (Signature offapplicant, or name, if a corporation) :.. . (Mailing address of applicant) IIqT~' State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder· Name of owner of premises . .. ' (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 ..................... 1. Location of land on which propc ;ed Work will be done .... , ...................... ....... ' House Number . . Street Hamlet Couhty Tax Map No. 1000Sectkn ...:.~.~.'~.' ........... Block ............."~ ' .. Lot...~k.,..~.... Subdivision ......... ' Fil d M N L .... . ..... · ..... ' .... .......... e ap o ............... ot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use qnd occupancy . ...' ...... ~ .................................. b. Intended use and occupancy ........ . .......... . .... 5 ,, .'~. ,.-.,., ................. 150. 00' 0 ..< 0 AREA 30522 sci ft ¢'rf c~ / 48. 3 ) S. 47 °49 '40" 151. 82' MAP 152.45'ACT ./oI . LEN CONWA 29' 37' CERTIFIED TO: LONG ISLAND MORTGAGE CORR AMERICAN 71TLE INSURANCE CO. CARL J. PARK ,LISA ANN PARK .: SUFFO£K COUNTY DEPARTMENT OF HEALTH SERVICES ' . $1NOL[ FAMILY I)W£LUNG ONt¥ DAT£ ~H..q. Rl~. NO. ~ The sewaBe disposal and water supply facilities for this location have been inspected by this Department and/or other ~ci~.and f~nd t~, b_ehsati~ory. .~'~A~¢- ~, ~ ,,~ ,, Chieflof Bureau of Wastewater Management SURVEY FOR LISA , PARK 'AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, lO00 - 059 03 - SCALE I% 40' dAN.51, 1986 MAR. 16, 1987 Sept. I, 1997 Prepared in accordance with the minimum standards for title sur~eys as established by the L.I.A.L.S. and approved and adopted for *uch use by The New York State Land ~'ltle Association. 86.- 124 A ~.