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HomeMy WebLinkAbout21675-z r FORM No. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22660 Date OCTOBER 15, 1993 THIS CERTIFIES that the building ALTERATION Location of Property 6645 PECONIC BAY BLVD. LAUREL, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 126 Block 10 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 13, 1993 _____pursuant to which Building Permit No. 21675-Z dated SEPTEMBER 23, 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 ALTERATION & ENCLOSE SCREEN PORCH ON EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to JOSEPH P. SHERIDAN JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - OCTOBER 14, 1993 PLUMBERS CERTIFICATION DATED N/A ~t Buil ing Inspector Rev. 1/B1 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) a 2 N Date ...........I.j 19.../ 21675 Z Permission Is hereby granted to: 3P~w~ES....P© '.,......Gr/=....:....89...K7......... to.....fi4TF: ........E.?c lost..........44 F?.~1.......e?......nr..sr!^~6......... 4 m%/y........,.ti!CG.? i9J ......../~Ki osE 1° 5..,.:•,,~ at premises located at.... ....(0,1...j. c nllG ( r. : County Tax Map No. 1000 Section ~~..i~ Block `0...9.... Lot No. .....cr. 0 pursuant to application dated A0/...r........................ 19.... and approved by the i Building Inspector. Fee S ` r Building Inspector Rev. 6/30/80 Form No. 6 )3y^-SS33 TOWN OF SOUTHOLD BUILDING DEPARTMENT " ` TOWN HALL N i ' SEP 131993 765-1802 4u' 7QfPJfx1 O6° X4 CF APPLICATION FOR CERTIFICATE OF OCCUPANCY s w 'A 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 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-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 4 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 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 Date ~ rr..f3~AC .3 . . New Construction........... Old Or Pre-existing Building. Location of Property.../°5./~ ~~Ju!?e.~-.......... House No. Street Hamlet Onwer or Owners of Property..~ose/~f} $~eJ~iDRrl County Tax Map No 1000, Section..... a......Block k U .......Lot.....a Subdivision ....................................Filed Map............ Lot...................... Permit No ................Date Of Permit Applicant Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... Pee Submitted: $ `Naal91Q~ APPLICAN• -d A7. E %OUNDAT204 (1st) 5UNDATION (2nd) m ` ROUGH FRAME & I U` -PLUMBING II y 3 II ~ n [27SULATION PER N. Y. I n H STATE ENERGY II CODE FINAL ADDITIONAL COMMENTS: S • H y O m rq y ` J yq, p h~ C N s m n ~ (e i T n \ x z Cll ' xl ~a m M' I ~z - .r) N { z T rF , w ~W -o I \ I ~Q z'73 - -o.5, a 3 i 3 3 0 ~ C 6 3 ci~ I g_ '4. d~ygM POLLAK N. °23 5 'E. MOM 8 MAP OF P~ ? -T Y - - N N SUVcY.C F~R_ i__.'.J - I ; LA %A L_ L- I ~ J ice.. Q A° LA'UP L_L . w TOWN Of. SOtJ 1<f:i N, t~:Y. I n dftn N O Er~tgtbnn~ York~f $yy gowrm map not i V* rnA verve .4 snot Gtl~O "4setl stet Oat I 93 ± - a a• tree Copy..cc be c„Udead I hoica. I STORY w ~Ne tl . and pe hereon-. L"un /r aoPare h ~rvey FR. O. H ~InOlnsy WtCc, nv. (.t his tho I ';a-Icy itl0 .-323 PCH. I IWeq. Guarer c-sjc icroira ln.•tl- ~ tlwtato-nsmdo~ua~ `e".b'" ~ OF NFK, U ytP~o ~Nl~io~ - I ° SE.C p~c~ LA D SV LAS. 3.23'50"W. t00. \ APPROX. I'' ' To SPAY AVE. - PECONIC BAY ec''I kVAR.U j GUARANTEE-,D TO PHE SOUT-HOLD SAVINGS BANV f AS SJ V-V EYED OCT. 2711972 SCALE -QG'°? ° AN yY! 50N n°MONU^(1 N7 LICENSED LAND SURVEY GRE.'ENPG:2T, N.Y. BOARD OF HEALTH FORM NO.1 3 SETS OF PLANS TOWN OFSOUTHOLD SURVEY !!t ShI 31993 ~f BUILDING DEPARTMENT CHECK _ TOWN HALL SEPTIC FOR:I SOUTHOLD, N.Y. 11971 - . 1i5"d4C°si i'?_• TEL.: 765-1802 NOT I FY ; CALL _ Examined Z0_3....... o,'~~/........ 19 9., t•IA I L TO Approved 19Permit No_ /6,7S7?F.. Disapproved. a/c (Building Inspector) APFLiGATiON FOR 3UILCING PERM? Date ~ 19/3 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. c. The work covered by this application may not be commenced before issuance of Building Permit. q. 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 Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant 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 herein described. The applicant agrees to comply with all applicable laws, ordinances, bujlplirrg code, housi g code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins eeAl (Signaplica t, or n e , if a cor o hon) q6 6V A (Mailing address of applicant) State whether applicant is owner, lessee, 'ant, architect, engineer, general contractor, electrician, plumber or builder. Caw Alm... 5 X~~ r~ . . . Name of owner of premises ..........ter (as on the tax roll or latest$ ~j Mr., # If applicant is a corporation, signature of duly authorized officer. FEE: BY., ~ NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO A PM FOR THE (Name and title of corporate officer) FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED Builder's License No FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION Plumber's License No. 4. FINAL - CONSTRUCTION MUST ICE COMPLETE FOR C.O. Electrician's License No . ALL CONSTRUCTION. SHALL MEET Other Trade's License No . THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR 1. Location of land o which proposed work will be done. /.........f~ S3! N OR.CONSTRUGTION.ERRORS. [-louse Number Street Hamlet County Tax Map No. 1000 Section Block ~U........... Lot. . Subdivision Filed Map No. Lot (Name) 2: State existing use and occupancy of premises and' ended use and occupancy of proposed construction: QSI a. Existing use and occupancy . b. Intended use and occupancy 3. Nature of work (check which applicable): New Building , . , Addition Alteration Repair Removal Demolition Other Work T (Description) 4. Estimated Cost P0 0,0 Fee , . (to be paid on filing this application) S. If dwelling number of dwellin' units . . . Number of dwelling units on each floor , . If garage, number of cars .I r • r , , 6. If business, commercial or mixdd occupancy, specify. nature and extent of each type of use , , , r , , , , , , 7. Dimensions of existing structurles, if any: Front . Rear Depth . Height Number of Stories . Dimensions of same structure with alterations or additions: Front Rear . Depth . . II... Height Number of Stories . 8, Dimensions of entire new construction: Front , , . Rear . .Depth Height . Nurirber of Stories r . . 9. Size of lot: Front Rear , Depth . . . 101 I.. Date Zone of or use Purchase district in which premises ' • • • • Name of Former Owner ....r... • •aresituated,,,,,,,,,,,,,,,,,,,,,,,,.•.• .12. Does proposed construction remises P volate any zoning law, ordinance or regulation: . . of be regraded 1314.. Name lot Owner of . . • ' ' • ' • • • • Will excess fill be removed from premises: Yes No {,,.rr„r,r. Address .Phone No. Name of Architect : . . . . . . . . , , r Address . Phone No. . Name of Contractor . Address . • • • Phone . • • 15. Is this property within 300 feet of a tidal wetlands *es No *If yes, Southold town Trustees Permit may be required. 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. I - I, 44 wx'~ h' • I T~f STATE OF NEW *&IM, S.S COUNTY OF... . .r..p • • • • • • • • • • • . • , being duly sworn, deposes and says that he is the applicant (Name of individual si ni g contract) above named. He is the......... ,0 ,Uj!).e4_ (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 this 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 in the manner set forth in the application filed therewith. Sworn to before me this r ........2. ..day of . ..p.Krvs~........... 19 i Notary Public, Count ^f Vey~ D0I-OaES B. 6NANT00I1 . . .~NOTAftY PQ.JLIC OF t.'TN s~!ISEV (Signature of applicant) MY COIoiIt JSSI0NI EXIMiLS x/22/4:3