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HomeMy WebLinkAbout21671-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22639 Date OCTOBER 1~ 1993 THIS CERTIFIES that the buildin~ ALTERATIONS ? Location of Property 1555 BAYVIEW AVENUE GREENRORT~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Sectio~ 52 Block 5 Lot 11.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 9, 1993 pursuant to which Building Permit No. 21671-Z dated SEPTEMBER 22~ 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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ATI,AN GOODMAN (owner) of the aforesaid building. SUFFOLK ~OUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Inspector Rev. 1/81 FORM NO.~, TOV~ OF $OUTHOLD BUILDING DEPARTMENt TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .~.~.,..,~..,~ .......................................... at premises located at...../..~....~...~........~~<.. ~ ..................................................... CountyTaxMap No. 1000 Section ,.,.~.-,~....~. ........... Block ........ ~ ...........LotNo ...... ././..~, ./,.. ............ pursuant to applleation dated ,.?,Z...Z...7~_"Z..~.~, ................................ Building Inspeotor. Fee 19 ................ and approved bythe Rev. 6/30/80 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~I 765-1802 APPLICATION FOR CERTIFICATE OF O¢CUPANC~J~ ~ A. This application must b~ filled in by typewriter OR ~nk and ~,~h~ b~ilding 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 togographic features. 2. Final Approval from,Health Dept. of wat&r 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 6f 1% lead~ 5. Commercial 'building, industrial building, multiple residences and similar buildings I 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 Vpre-existing" land uses: 1.Accurate survey of property showing all property lines, streets, buiiding 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, C~rtificate 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 Building ....... Location of Property..Z .................. .... House No. Street Hamlet 0nwer 0wners of Proper ty.~ .~..~7~..~..~...~.~e...~..~h.~ County Tax Map No 1000, Section. . ~ .Block .......... Lot... ~ ............... Subdivision .................................... Filed Map ............ Lot ...................... Health Dept Approval Underwriters Approval Planning Board Approval ....................... Request for: Temporary Certificate...' ....... , .......... ~PLIC~T l,,S, -,~ · -~u,~ IIDATE lI C OM~4£NTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITION~L COMMENTS: © 2 BLDG. DEF'L ~' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .. ' ..,19q> Approved.. ¢.~..¢.5'. ........ 19~. Permit No....~./.~..?.~./ Disapproved a/c ..................................... BOARD OF HFALIH ......... 3 SETS OF PLA:tS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL .......... HAIL TO: (Bfildin=Jfispector) APPLICATION FOR BUILDING PERMIT r~ate .q'.': .c/:. 9.3. INSTRUCTIONS a. This 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ~. 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 w6rk. c. 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 Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuar~tlq~ 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 herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ...~.~.v. tfi~o>Ab>.~.: .~7...¢...~.,..-~.~....~. .......... -- ~Signature of applicant, or name, if a corporation) .... ~.'~.:.,9.% .... ~'.q.."L./)?..~..,. .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ........................................................ Name o owner o remises ............................................................. (as on the tax roll or latest deed) If app~~ti~n/signature o f duly aut[orized officer. ............ Builder's License No.. ~ H.~ ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. 15-.5-3 House Number -- Street ' Hamlet . . .J'. County Tax Map No. lO00 Section .............. Block ............. Lot ................ Subdivision ..................................... .Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~. ........ ~t:; ,%..:.L~,. ~ ................. b. Intended use and occupancy . ~.. > ..... ,,, ...~)~; ., ,, ., :,,. ',,,:,,: ....,,,,:? 3. Nature of work (check which ~pplicabie): New Building .......... Addition .......... Alteration ..... Repair .............. Removal .............. Demolition .............. Other Work ~e'"~ r,x ~ t" (Description) 4. Estimated Cost . G/,;/~,4'~4.',,-tu .......................... 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 mixqd occupancy specify nature and extent of each type of use ............... 7' Dimension; of existing structures if any: Fr;nt -/t. · } 1 ~/3r~ Rear .................... Height Number of Stories ' ' ', .r'~'... 'l. ................ Depth ............ Dimensions of same structure with alterations or additions: Front ................. Rear... Depth ' i Height Number .............. ~ : of Stories 8 DimensiOns ............................................................. · of entire new construction: Front Rear Height Number of Stories .............................. Depth ............. 9. Size of lot: Front ................... Rear .......... De-th .. ' ........... 10. Date of Purchase i .. ., .L' .... .~ .... ~' ................... one or use d~stnct In which pr~mlses are situated .... .I~/L~.~.,.O~. 4~/f/,%~/ ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: J..O. . . 13. Will lot be re,reded Isa. C} I .......... '~' ..................... ....... ~"lt ~ · · ~ · · ~ ............. WUl excess HII De removed from premises: - Yes No Is this property within ~00 feet of a tidal wetland? *Yes....~77.'.~..'~c ..... '~ · If yss, Southold %own Trustees Permit may be required, mo ......... PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing 'or proposed, and. indicate all set-back dimensions property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. ,,ATE'# 7~154802 g AM ~ 4 PM FOR THE FOLLOWING L FOuNDATiON ' ~NO REQUIRED FO~ POURED CONCRETE ~, ROUGH ~ FRAMING · pLU~BtNG- 3. iNSULATION 4. FINAL, ~ CONSTRUCTION ~UST BE cOMPLETE FOR ALL CoMSTRUCTION SHALL TME REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY cODES, N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEV~.Yr'r~IcF' ~" / t ~ i sis a ~(Name of individual signing contract) being duly sworn, deposes and says that he is the applicant above named· 40 Is the ....................... ~. ~:;....~ ..................... [ ............. ~gent, corporate officer, etc.) . ' .............. )f said owner or owners, ~d is duly uth~.to perfom or have perfo~ed the said work.and to m~e ~d file this ~pplication; that all statements contai ~d ~ this application are true to the best of his knowledge and belief; and that the ~ork will be perfomed in the m~ner s~t forth in the application filed therewith. ~wom to before me th~ ' .......... ~." '~ ..... daYo~''' ~~ .... ;19~ _ . ~°tawPubli~~~.~ County ~~~~ ~m ~uallfled in Surfak ~u~ ~~~ . No. 487~505. ' ' (~]~nat of apphc~t) m ~lon E~lrea De~m~r 6, 19~ ~ -- .