HomeMy WebLinkAbout21692-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the ~lilding Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22643
Date OCTOBER 6~ 1993
THIS CERTIFIES that the building.
Location of Property 1705 VILLAGE LANE
House No.
County Tax Map No. 1000 Section 107
Subdivision
ACCESSORY
Street
Block 11
Filed Map No.
MATTITUCK~ N.Y.
Hamlet
Lot 2
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 17, 1993 pursuant to which
Building Permit No. 21692-Z dated OCTOBER 5~ 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 ACCESSORY STORAGE SHED IN REAR YARD "AS BUILT"
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
RAYMOND & THERESA VAN ETTEN
Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22644
Date OCTOBER 6~ 1993
THIS CERTIFIES that the building.
Location of Property 1705 VILLAGE LANE
House No.
County Tax Map No. 1000 Section 107
Subdivision
ADDITION
Block 11
Filed Map No.
MATTITUCK~ N.Y.
Street Hamlet
Lot 2
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 17~ 1993 pursuant to which
Building Permit No. 21692-Z dated OCTOBER 5r 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 BUILT"
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
RAYMOND & THERESA VAN ETTEN
Rev. 1/81
FORM NO.3
TOll~l OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y.
NO- 21692 Z
BUILDING PERMIT
ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHOREEDI
ex
Date ............................................................ 19 ...........
Permission Is hereby granted tg~ · .
......... ~.../..~.~ ...... ~~...~...~..,,
.... Zz~ ...... ~/~.~.~.....~-. .......................
.... ~¢..'.¢.../.~. .~.... ........ ~..~....¢...../..L~ ........
to ........ ~~ ....... ~ ......... ~ ...... ~.,..i~...m.... ........ ~......~ .............
................. ~....~. .................... ~.~ ..............................................................................................
.... . . n.:. . . . . ..&. ;. . .:. . ., . . . . . . . . . . . . : . . . . ............
....... ~..J:......,~..,¢'z%. ........................................................................................................................
.................................................................. ~~.-z ...................................................................
atprem,ses,ooatedat ........... ..':Z~ ........ ~..Z..~ ....... ~.,.,~, ............................................
.............................................. //Z..~...~../z:..~<.. ~.~. ................... ~. .....................................................
CouniyTax Map No. 1000 Section ...... .~..~..~., ........ Block ..:....~..,~. ............. Lot No.....~.....~. .................
pursuant to application dated ............. 0~"~.....~..-.,....../..../~.. .................. 1 g....¢~.. ..... and approved bythe
Inspector
Rev. 6130/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Ae
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.
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 - $i00.00
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 ...S.~7~%~.~ .~ .....................
(ACCY' SHEDv~
New Construction..%TC. ....... Old Or Pre-existing Building .................
Location of Property .... ]2~.~. ................. ~il{~>.~. ~.~.; ............ .~.~/7.~f{~ ...........
House No. Street Hamlet
Onwer Owners of Property · ~
County Tax Map No 1000, Section../~.7. ........ Block .... ~ .......... Lot...~ .................
Subdivision .... V. ill~.. ~. ~,~. ............... Filed Map..~ ..... Lot.../.~ ................
Permit Xo...~J~ ....... Date Of Permit..99~:.P~.!~P..Applicaut..~%.~.A~..~.~.~ ................
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
equest for: Temporary Certificate ........... Final Certicate ........
Pee Submitted: $ ............................
:-'g.120V3 "' '" ............ .....................
- APPLICANT
Form No. 6
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% load.
5. Commercial building, industrial building/ multiple residences and similar buildings
and installations, a oertificate 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 Cectificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
Foes
1. Certificato of Occupancy - New dwolling $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 $I5.00, Commercial $15.00
(DECK) Date ............... ... ...... .
xx
New Construction ........... Old Or Pre-existing Building .................
House No. Street Hamlet
0nwer or Owners of Property. ~Py~. ~ ~$a .~. ~.. ............................ . .. . .
County Tax Map No 1000, Section../~.~ ........ Block .... ~J .......... Lot...g .................
Subdivision .......................... F$led Map ....... Lot ...................
Health Dept. Approval ........................ · · Underwriters Approval ...................... . . .
Planning Board Approval '
/
Request for: Temporary Certificate ........... Final Certicate...Y. ......
Fee Submitted: $ ........~..~..,~'5 ~ ' . ......
q't/ ......................................
A~PPLICA_MT
MAIN ROAO
lOT /$
~ ? OF
"VII t A G~- I~I~NO~"
AT AIATTITUCK
TOWN OF SOUTHOID
SUFFOLK CO ~tf
CEr~TI,~*IED TO ~
SOUTtlOLD S,~VI4/G5'
CHICAGO T/T£E /HSU~ANC~ CO
donack associates
[and surveyors and
consulting engineer.-
3J3west main street
riverhead,new york
{516) 369-1717 (212) 746-302C
'donack assocR]tus
I~md surveyors uhd
313 wesl moJn 5h'~ul
riverhedd,new york IlOOI
(516) 369-1717 (212) 746-302t)
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ..... ./.~.~.. ..... , 19 ?~.
Approved ...... ./¢.-~.....,19~.. Permit No..~.././_a.¢?..~...
Disapproved a/c .....................................
INSTRUCTIONS'
. /(fl3u~ffing Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .........
'3 SETS OF PLANS .........
~--~SURVEY
CIIECK ................
SEPTIC ~;RM ''
NOTIFY:
CALL
MAlL TO:
a. This apl~lication 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 st?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 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 South01d, .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, building code, housing code, and regulations, and to
admit auth°rized inspect°rs °n premises and in building f°r necessary i~e3i°~2 ~ '
........ ........ -,... 771 ................
-- (Jig'~i~re of applicant, or name, if a corporation) '
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. ..................
Nameofownerofpremises .~. .~ur. todd .~.~D. .~:7~.~. o. lO/~"~ pF.~.. .~.j / '~ (as on the tax roll or late~$~ BUILDING
If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
(Name and title of corporate officer) FOR POURED CONCRETE
; 2. ROUGH - FRAII~ING [% PLUMSII~IG
Builder's License No.' ............ : ............ 3. INSUL~I'K)N
4.. 'FINAL CONSTRUCTION IMUST
' ' 8~ COMPLETE FOR
Plumber s Lmense No .........................
/%L~L CONSTRUCTION SHALL M'EET
Electrician's License No. · THE REQUIREMENTS OF THE N.Y,
...... . ....... ,.~A,E CONSTRUCTION & ENERGY
h , . CODES, NOT RESPONSIBLE FOR
Ot er Trade s L~cense No ...................... Dg':,Y, Gt,~ Oa CONSTRUCTION ERRORS
1. Location of land on which proposed work will be done ..................................................
... 17.o35'. ............... .V.l. fl¢.a.. ..... ' ..... ...............
ltouse Hum ber Street Hamlet
County Tax Map No. 1000 Section ...: ./.0. ~. ......... Block .... /lI. ' Lot...~. ...............
Subdivision .... V!I.~.$..~...~..,4./?O. fd Filed Map No.. ~.~. ~ ........ Lot .../.~. ..........
(Name)
Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...................................... ,.,, .........-~ .................. '.
b. Intended use and occupancy .... ~.--~,- .... .i:~., . , '~-'""""""'~, ~ '"'
.3. Nature of work (check which applicable): New Building .......... Addition ~ ....... Alteration ..........
Repair .............. Rembval .............. Demolition .* Other Work
". ,. , . (Description)
4 Estimated Cost '
....... :.': Fee
(to be paid on filing this application)
5. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ...............
If garage number of cars '
6. If business commercial or mixed occu ant '
. ~ p y specify nature and extent of.each type of use
..... · ·
7. Dnnenmons of exmting structur s, if any. Front ........... Rear ........ Depth ...........
Height ............... Number of Stories .. O.~,.~. . '
Dimensions o~f~sa.me structur~ w~th alterations or a~dmons Front r-/~.:
Depth .... ~ /4 ........... ... Height ..... '~'.'~.,: ......... ... Number of Stories..q~.e.. ..... ; ..........
8. Dimensions of entire new constrUction Front Rear : Depth
Height Number of Stories
9. Size of lot: Front .... /.O0, O.t~t .. Rear ]~_/7.,~~ ' ~.1! /~..~.
· · , .......................... Depth ~ ............
10 Date of Purchase ' Name of Former Owner
11 Zone or district in which premises situated ............
. use are ...................................... ' '
12. Does proposed construction' vioIate' any zomng' law ordinaace or regulation: ............
13. Will lot be regraded ....... : .' ................... Will excess fill be removed from premises: Yes No
14 Name of Owner of premises Address Phone No
Name of Architect . Address Phone No
Name of Contractor ......... i ................. Address ............ ' ...... Phone/No ............ ' ....
Is thio property within ~00 feet of a tidal wetland? *Yes ........ No..~. .....
· If yes, Southold %own Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all i buildings, whether existing or proposed, and, indicate all set-hack dknensions from
property lines. Give street and block :lumber or description according to deed, and show street names and indicate whether
interior or corner lot.
15.
STATE OF NEBI.,-¥ORK.b ~ /[ ~ S
_
· · ~~ }~ .~ ~ .... '... ........ being duly sworn, deposes ~d says that he is the applicant
{ (Name ~findividual signing contract) '
above named.
(Contractor, agent, cor'porate officer, etc.)
of said owner 'or owners, ~d is dui, I authorized to perfom or have perfo~ed the said work and to m~e and file this
application; that all statements contai ned ~ this'application are /rue to the best of his knowledge and belief; and that the
work will be perfomed in the m~ner ~et forth in the application filed therewith·
Sworn to before me thisz.
Nm~ Publ~, State bf N~ Yo~ _ ' 'f ~ ....................................
' No 4879505
~mml~lQn ~lr~e O~m~r 8, 19~ .