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 ~.