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Home My WebLink About21684-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold~ N.Y. CERTIFICATE OF OCCUPANCY No Z-22855 Date JANUARY 28~ 1994 THIS CERTIFIES that the buildin~ Location of Property 4 PETERS WAY House No. County Tax Map No. 1000 Section 6 subdivision ADDITION FISHERS ISLAND, N.Y. Street Hamlet Block 2 Lot 3.6 Filed Nap No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 24~ 19~3 . pursuant to which Building Permit No. 21684-Z dated SEPTEMBER 30, 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 FOR CONSTRUCTION OF MASONARY CHIMNEY ~ITE FIREPLACE INSERT AS APPLIED FOR. The certificate is issued to THOMAS & CARMEN SUEDMEIER (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ..... UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FORM NO.3 TOWN OF BOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 21684 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~y~ ~-~ ~... ~ ............................. ......... CountyTax Map No. 1000 Section ......... ~. ........... Blook,...~ ................ Lot No. .... .~..~.~. ............. pursuant to application dated ....~/.,~'. ........................................ Building Inspector. ~ee *...,~~ 19....?...'~.. ..... and approved bythe Rev. 6/30/80 Form No. 6 TOWN OF SOUTIiOLD BUILDING DEPARTMENT TOWN I~LL 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 ~o 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. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00', Alterations to dwelling $25.00, Swin~ning 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.O0 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, Coramercial $15.00 Date../..~.~.~/.~. ~ Xew Construction.......~... Old Or Pre-existingBuilding ........... Location of Property ''?.' ........................................... House No. Street Hamlet )SWer or Owners of Prope~ty.~./~..M~..~. ................................. .- .................. ;ounty Tax Map No 1000, Section. ........... Block ................ Lot ..................... . 'ermit;ubdivisi°nN~ ~'~-~ 'D e Of ................. at Permit ....... Applicant .................. !ealth Dept. Approval .......................... Underwriters Approval ......................... '!anoing Board Approval ........................ eq,cst for: Temporary Certificate ........... Final Certicate ........... ee Submitted: $ ......................... ............... ~0 ~ S5 APPLICANT FOUNDATION {1st} FOUNDATION (2nd) ROUGH FRAME & PLUMBING a. INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 31ft FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .... , 19. Approved ........ 1 Permit No. Disapproved a/d I (l~ding Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ....... ? ........... CllECK .................... SEPTIC FORH .............. CALL ................... MAIL TO: Date ................... 19... INSTRUCTIONS by typewriter or in ink and submitted to the Building Inspector, with 3 a. This application must be completely filled in sets of plans, accurate plot plan to scaie. 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. d. Upon approval of th~s apphcaQon, the Building Inspector will issued a Buildmg Permit to the applicant. Such permit shall be kept on the premises availableI 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 Towh of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of ibuildings, 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 authorized inspectors on premi, es mid in building for necessary insp~- (Mailing address of applicant) State whether applicant is owner, lossee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signatur~ of duly authorized officer. (Name and title of corpor rte officer) Builder's License No. .~..~.. Plumber's License No ......................... Electrician's License No ..... Other Trade's License No ....................... I. Location of land on which proposed work will be done ............................................ ..... House Number Street Hamlet ~ O ~, ~, oo 50o O. County Tax Map No. 1000 Section ................. Block ................. Lot ................. Subdivision ................ ................ Filed Map No ............... Lot ............... (i, iahl;) 2. State existing use and occupancy ?f premises and intended use and occupancy of proposed construction: ¢ a. Existing use and occupancy . .I ........................... · ................... b. Intended use and occupancy .i~./.tl/.~.. t~&-- .~.~-'~..~ /Z ~'~ .~ .~.~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............ Removal .............. Demolition .............. Other Work. C*~J./..Ah AY..~..~. 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 ........................................................................ 6. If business, commercial or mixed occupancy, specify nat¢,~ and extent of each tyl~ of use ............. ~ ....... 7. Dimensions.~}efiisting structures, if any: Front..3~..~..'P... .... Rear . .~'~'~.'..:./2. ....Depth .~..~.~.?: ./Y ...... Height . .,Dr-~ .......... Number of Stories ... ~ .............. ,~ .................... .~g~' ........... Dimension_.s ~of ~m,e structure with alterations or additions: Front . ~. ~'/"'/-.. Rear 7- ~- ' .......... Height... ........... ;; ............ a. Dimensions of entire new construction: Front../. ........... Rear.. ~ .... Dep't~' . ~ Height ............... Number of Stories .......................................... ..-,, .......... 9. Size of lot: Front .... . .].(9..0...~.~z..~_.., ...... Rear .... ] .~...~.~...'~.: ....... Dep~h ...~,.~.'7.¢:..~. ........ 10. Date of Purchase ./3/t.~. ;~) . ].~'.~./. ............. Name of Former Owner l,g..~.9'~..~.~. ?. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or mgulation: ../,~.O ......................... 13. Will lot be regraded . ./k, rL~ ............ ' ....... ~ ...j~ill excess fill be removed from premises: Yes 14. Name of Owner of premises .'~/~.Op/./~.~.....,~(YL~,gfl~...~A~aeYess ................... Phone $o~./.~. ~..r~.~-'~ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Pho. ne~ .............. Is th±s property w±th±n 300 feet: of a t±dal wetland? ~Yes ........ No. ~ ...... *If yes~ SouthoJ. d Town Trustees Perra±t may be requ±red. 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. FOI~ Pr)tiRED CONCRETE BE CO~?~PL,Ei~'E FOR C.O. ALL CO~E;TRUGION SHALL MEET S'TAI'E CONSTRUCTION & ENERGY COOES. NCr RESPONSIBLE FOR 8ES~GN OR CONSTRUOTION ERRORS STATE OF NEW YORK, S S COUNTy OF. C .t.g. ...... ' .... .-T~O..v~..~.%.."~ .~.L?,..e..~..vy~e. te.' .r- ................... being duly sworn, deposes and 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, 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 ........ .~. .............. day of....~. P.~.~..~. ke.. Notary Public ................. '-~'~ '/'/~' 'x ..... '. . _rJ .......... t 'x · ~,. ...... ,;r.~ ~ ........................... M~RY lt. ('"ANKIEW~Z ~ (Signature of applicant)