HomeMy WebLinkAbout21662-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23095
Date JULY 13, 1994
THIS CERTIFIES that the buildin~
Location of Property 280 BENNETT ROAD
House NO.
County Tax Map NO. 1000 Section 40
Subdivision
ACCESSORY
GREENPORT, NY
Street Hamlet
Block 5 Lot 1.3
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 1, 1993 pursuant to which
Building Permit No. 21662-Z dated SEPTEMBER 18, 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 ABO~E GROUND POOL WITH ATTACHED DECK AND
NECESSARY FENCE ENCLOSUP~ AS APPLIED FOR.
The certificate is issued to
SCOTT & DIANE MULVANEY
(owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N319187
PLUMBERS CERTIFICATION DATED
N/A
J~/NE 29, 1994
N/A
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF O~uumAN~Y
No Z-23096
Date JULY 13, 1994
THIS CERTIFIES that the building
Location of Property 280 BENNETT ROAD
House No.
County Tax Map No. 1000 Section 40
Subdivision
ACCESSORY
GREENPORT, NY
Street
Block 5
Filed Map No.
Hamlet
Lot 1.3
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 1, 1993 pursuant to which
Building Permit No. Z-23095 dated SEPTEMBER 18, 1993 (AMEND 7/5/94)
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 STRUCTURE (GAZEBO) AS APPLIED FOR.
The certificate is issued to SCOTT & DIANE MULVANEY (owner's)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N318975
PLUMBERS CERTIFICATION DATED
N/A
JUNE 29, 1994
~A
Rev. 1/81
FOBM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HAIL
$OUTHOLD, N.Y.
BUILDING PERMIT
~ 2166~ Z
Permission Is hereby granted to:
~~.,~ ~....~~. ~..
...~~~.....~:~ ........ .:.,:.~ _, _
,o ~,-', .~...~...,~~....i~...~~~
.,~....~~.~.......~~~....~.~.....~
...~ ....... ~:~...~.~ ................................................................................................
CountyTax Map No, 1000 Section ,.,~ ........... Block .......... ~ ........ Lot No....~..¢.,.,-,~. ............
pursuant to application dated ..~ .~../. ............................................ 19.....¢~,....-~....., and approved bythe
Building Inspector.
~ PAID $35.00 - CE~862 -
~.~~~ .............................
2 CO~S. ~qOI~O f ~ Building Inspector
Rev, 6~30/80
~ ~ Form No. 6
TO~ OF SOUTHOLD
BUILDING DEPARTMENT
765-1802
~PLICATION FOIl CERTIFICATE OF OCCUPANC~_____r~~
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 installatiou 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.
, B.. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
l.'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.
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 to accessory building $25.00. Businesses $50.00.
2.Certificate of Occupancy on Pre-existin~ Buiidin~ - $100.00
3.Copy of Certificate of Occupancy - $20.00
4.Updated ~ertificate of Occupancy - $50.00
5.Temporary Certificate of Occupancy - Residential~,~15.00, Commercial $15.00
New Construction..,' ..........................
.... Older Pre-existing Buildine ................
Location of Pro ert ..~.~.~. ~.~~ ~. ~L~P Y ..
Street ~ .................
...........
Subdzvzsion... - : ~.~
.... p~ ................. ~.~zzed Map ........ ;.Lo ........
..... ' ........
Health Dept. Approval .......................... Underwriters Approval .... .~ ..................
Planning Board Approval
Request for: Temporary Certificate ...... Final Certicate ...........
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTblENT
T0[~ IIALL
765-1802
~PPLICATION FOR CERTIFICATE OF OCCUPANC~~
A. This application must be filled in by typewriter OR ink and submitted to thc 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.
· B. For existing buildings (prior to April 9 1957) non-conforming uses, or buildings and
-pre-exlstzng 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.
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 to accessory building $25.00. Businesses $50.00.
2.Certificate of Occupancy on Pre-existing Buildinm - $100.00
3.Copy of Certificate of Occupancy - $20.00
4.Updated ~ertificate of Occupancy - $50.00
· ~/ Date ....~.~...!.~,~...~..~. .......... '...
New Construction .... ~ ...... Old Or Pre-existing Building .................
Location of Property...~..~.0....~.~...~. J/~ , 6 r~
............... *.~ ........... ~ ~''~ ......................
House ~ Street Hamlet
Onwer or Owners of Property...l~ ......... . . . .
County Tax Map No 1070, Section .... .~.~ ...... Block ..... 0.~.~. ...... Lot)f.~. .................
S bdivision.. .ek ,, d ' ·
' ' 'Lz ........................ ~ized Map ........... Lot[,..h ................
Health Dept. Approval ...............
...... Underwriters Approval
Planning Board Approval
Request for: Temporary Certificate.iiiiiiil.. Final Certicat~e~~ .........
.... . .............
76~-1~02
BUILDING DEPT,
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FRAMING [~L
REMARKS:
DATE ~'~/~//~ '*sPECTOR~~/
7G5.'1802
BUILDING DEPT.
INSPECTION
FOUNDATION IST [ ] ROUGH PLBG, ,,.~
FOUNDATION ;ZND [ ] INSULATION~ ~ ~
DAT£~~~ INSPEL~TOR~~
FOUNDATION ( ls t)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
This distinctive, shingle-styled beauty offers a rustic
charm all its own.
Enhance your backyard decor with..
Flare 6" Category
,,iMMEDIATELY"
UPON ~OMp[.ETION
BEFORE %~fATER"
MIDDLE ROAD
tor (~
TA = 20,714 sq. ft.
SURVEY OF
LOT 3
VISION OF~ CEDARFIELDS
(C. R. 48)
V 71' ~8' ~0" E
NORTH OR MAIN ROAD
75.04*
BUFFER
75.00' S 75 ° 31' .~3' W
"' ~t~ .... ,,rc~
BENNETT ROAD
Lor (~
H. $. REF.. NO. §0 -SO- 52
Examined
SEP - 3 1993
DEPT.
SOUTHOLD
FORM NO. 1
OF SOUTHOLD
ILDING DEPARTMENT
TOWN HALL
UTHOLD, N.Y. 11971
TEL.: 765-1802
Disapproved a/c '
APPLIGAIION FOB BUILDING PERMIT
INSTRUCTIONS
B~ARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ...................
CHECK ....................
H^IL TO:
Oate ..................
a. Tkis 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 lot and of buildings on premises, relationship to adjoining premises or public sti'eets
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 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 permit
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 Occupancy
shall have been granted by the Bu!!d!~g ,~ns~ector.
' APPLICATION IS HEREBY 'MADE to the Building Department for the issuance of a Building Permit pu,~uant 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 hezein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized, inspectors on premises and inbuilding, for necessary. ' ' i~il~fiature.insv~c~i°ns:~-'-~'~---~ ' ~'~'~' '~' ' 'bf ~p~'ki~ant, 6r name, ...................... if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
Name ofownerofpremises 5..d~.~.. ~ ')'~" (a~so '' '
he tax'roll or latest ~eed)
If applicant is a corporation, signature of duly authorized officer.'
(Name and title o~corporate officer)
': ..............
Builder's License No.
Plumber's License No ....... - ..................
Electrician's License No .......................
Other Trade's License No ......................
Locationoflandonwhichproposedworkwillbedone.~ fbCF)~'t.,Tl~ f'~./. .~.f'.~..~. f~.,p'
ltouse Number . . Street Hamlet
County Tax Map No. 1000 Section '~ Block ~'~ ' Lot
Subdivision....~.~.~ ~'~) ........... . .... '. Filed Map No. Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... '~J~..~ .................... ~ .............. ...................... '.
b. Intended use and occupancy .... ~ ~ ~;~ O~x ;:~'~;~:..:d~ g~ ~
'3. Nature of work (check which ~PPlicable~. I~,,,], n,a~;,,, ' i,~d. ! ' ,. C/ ,' '
~ , ....... -,,,-s .......... .,xeamon .......... Alteration ,. .........
Repair .............. Removal .............. Demolition .....; ......... Other Work ...............
-~ ' a'~'~ (Description)
4. Estimated Cost . ...~., .~.~..,~:~,. ........................ Fee . .~,~./. .............................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .............. ., Number of dwelling units on each,floor ......
· If garage, number of cars .... i ....... ' ..........
6. If business, commercial or mixed occupancy, specify ture an ten o h e o use .................
typ
7. tmenstons ot existing structures, if any: Front ............... Rear .............. Depth ...............
D ..... na d ex t f.eac f
Height ............... Number of Stories ................
D~menmons of same structure, with alterations or additions: Front Rear
Depth ' ~ Height ....................................
~ ' Number of Stories ' '
· Dimensions of entire new construction: Front
' Rear Depth
Height Number of Stories .................................. · ...........
Size of lot: Front ' Rear ..... ' ............................
Date of Purchase .......... 'i ................................ Depth ......................
................... ' ........ .. Name of Former Owner .............................
Zone or use district in which pr~mmes are situated .................
Does proposed construction viD ate any zonin aw, ordina ce or regulation: ............... Ztd.~. .............
Will lot be regraded ........ ' ................... Will excess fill be removed from premises: Yes No
Name of Owner of premises ~ Address
...................................... Phone No ............ ;...
Name of Architect ~ '
......... ~ ............. Address Phone No
Name of Contractor ......... ! ................. Address ............. ...... Phone No ............ ' ....
I~ this property within BO0 feet of a tidal wetland? *Yes .... '.'... No .........
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly alli buildings, Whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block humber or description according to deed, and show street names and indicate whether
interior or corner lot.
UNDERWRITERS CERTIFICATE
REQUIRED ·
15, '
76~.1802 ~ A~ ~ ~ pM FOR TH~
FOLLOWING ~MSP~CTIOMS: .
L FOUNDATION ~ '~O REQUIRED
F:Ot{ POURED CONCRETE'.
BE COMPLETE FOil C.O,
ALL COHST~UCTION SHALL
THE flEOUiREMENT~ OF TH~
STATE CONSTRUCTION ~ ENERGY
CODES, NOT RESPONSIBLE FOR
DESIGN OR CONStrUCTION ERRORS
STATE OF NEW YORK,-.. SiS ' '
COUNTY OF..~. :d.~.~d--... :.. j
........ . ,
~Name of individual signin irlc} .......... being duly sworn, deposes ~d says that he is the applicant
above named.
He is the
(Contractor, agent, cor'porate officer, etc.)
of said owner or owners, ~d is duly authorized to perform or have perfomed tbe said work and to m~e and file this
application; that all statements contai~ ed ~ this'application are flue to the best of his knowledge and belief; and that the
work w~l' be perfo~ed in the m~ner s:et forth in the application filed therewith. '
Sworn to before me this
............