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HomeMy WebLinkAbout21316-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22666 Date OCTOBER 20~ 1993 THIS CERTIFIES that the buildin~ ADDITION Location of Property 4150 NEW SUFFOLK RD. House No. Street County Tax Map No. 1000 Section 110 Block 8 Subdivision Filed Map No. NEW SUFFOLK~ N.Y. Hamlet Lot 31 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 1, 1993 pursuant to which Building Permit No. 21316-Z dated APRIL 7, 1993 was issued, and conforms to ail 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 APPLIED FOR. The certificate is issued to WILLIAM H. GAFFGA (owner) 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 FO~v,e NO. ~ TOWN O~ $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-°N? 21318 Z Do~e .... .~..... ....................................... Permission is hereby granted to~ , ~..~_' ....~:/~.....~.:.~/........ .~....~...~....../..~ .................................... .... ~~~ ...... ~ ..... :... z. ':~ ............ . , ,o ~~......~....~~....~~....~~:.....~ ~~..~~...~ ....... ~~ ........................................................... ,, ,~,~,,, ,=,,~ ~, ....... :~.~~~.:. ........................................ ....... .~.~ ~...~~~....~~ ~..=~..~~ ........................ co~ **~ ~op ~o. ~ooo s~.o~ ..... ~a ......... ~k ...... ~ ........... ~ Uo...~ .......... Building Inspector. Fee $..~~ ...... ............. Rev. 6~30~80 Form No. 6 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN HALL ~65-I802 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 to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: i. 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. 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%0~ f~ercial $15.00 ,. .. . Date ........ ...................... ,ew Construction ........ ~.. Old Or Pre-exist~ng Buil~in~ ............. ~... . t ion ~ ~aO ~--~.. ~-. ~ ~ ~' ~.~ ' ... ~-~.~ S~ .~..~..~..~...'' boca House No. Street Hamlet )nwer or Owners of Property ...... ~/./.~Z.~..~...o~....~..~-..~.~ ]OUnty Tax Map No- i000, Section...[!.©. ....... Block ...... ~ ........ Lot..'~. ~ ...... ~ubdivision .......................... Filed Map Lot 'ermit No~..~.~. !.~. ~..Date Of Permit ................ Applicant ............................. ealth Dept. Approval ................... · Underwriters Approval ianning Board Approval ..................... equest for: Temporary Certificate ........... Final Certicate ........... INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building In3pector Thomas Fisher Building lr~spector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-180Z OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 1, 1993 SCOTt L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Hr. Nilliam B. gaffga P.O. Box 124 Cutchogue, N.Y. 11935 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XXX XXX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (~-~e~/not on file.)$25.00 No Health Department Approval on file'i No final inspection has been ma~e. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PER~IT ~ BP 21316Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWq~ BUILDING DEPT. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION tST [ 3 ROUGH PLBG. FOUNDATION 2ND [ ] I~SULATION FRAMING [~']' FINAL REMARKS: ~/~ DATE ,INSPECTOR~/~'~? ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. iO~UNDATION2ND[ ] INSULATION MING [ ]FINAL REMARKS: ~'~T ~ DATE INSPECTOR ~OUMDATIOU (2nd ~ ~OUGH FRAME & .FLUMBING STATE ENERGY CODE FI;;AL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~'"'~ .................. ' - TEL.: 765-1.802 Approved, Permit No.~...~..~/. ~,/. Disapproved a/c ..................................... /'(Bui~Sg Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS CIIECK ...... . . . . .... HAIL TO: . 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 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 Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora 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 o~' demolition, as herein described. The applicant agrees to comply with all applicable taws, ordinances, building code/housing code, and regulations, and to admit authorized inspectors on premises and in b~ilding for necessary ins~2 9.0 ¢'1 . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. .... .... .o.f. .... ..................................... . ........................... N~me of owner of premises . .~. ?.(~..~.~,-,.~,. ....... .V.~ ...... .~?.~...-~.~..% ............ .......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... O..~. O..e-~.. ' Plumber's License No ............... . .......... Electrician's License No ....................... '-' '~ ~" ~ Other T ade s License No.. ................. Location of land on which proposed work will be done. .~ } SO ~,-~ So{~o~ .......... .C~, ................... ~e~ .~U2~.~)~ .............. Itouse Number Street Hamlet Couhty Tax Map No. 1000 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 ...................................... b. Intended use and occupancy ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '"' .......... '' :',[,f~ he ~'~', ' ~P:'.m,:*~ ' .,':~-,.,*~e'~ ............ .3. Nature of ork (check which ap hcable): New Building .......... Addition ...... Alteration .. ; ..... Repair .............. RemoVal .............. Demolition .... : .... Other Wor~. ,. ~ ~ (D ipti ) 6..o..0.. escr on 4. Estimated Cost r ............. Fee .... (to be paid on filing this application) 5. If dwelling, number of dwelling dnits. .............. . Number of dwelling units on each floor.. .............. · If garage, number of cars ..... i .............................. 6. E busin.ess, commercial or mi.xedI .................................... occupancy, specify nature and extent of,each type of use .............. 7. Dnnens~ons of existing structures' if any. Front m,~, n ~. ' ' ' ' ' ' Hlght ............... NumDer of Stories ................................. · Dimensions of shme structure with alterations or additions: Front · · . Rear .............. ~D.epth ..... L ............... !. Height ........... . ........ ,.. Number of Stories .......... '. 8. Dimensions or entire new const~ ...... ction: Front .............. : Rear ............... Depth ............... Height ............... Number of Stories ............ - . .. 9. Size of lot: Front ........... ~ ~.. Rear .......... ~... Depth ................ DateofPurchase ' I. . ~, ..... · ..... 10. ' ......... i ...... ' ........ .. *name oI i~ormer ~wner ............................ 11. Zone or use district in which premises are situated ............................................. ~... ..... .12. Does proposed construction violate any zoning law ordinance or regulation: 13. Will 10t beregraded ........ ;..i., .................Willexcessfillberem0vedfrompremises: Yes No 14 Name of Owner of premises , Address ' ' ........... ~ ........................... Phone No Name of Architect I ........... · ........ Address Phone No Name of Contractor .......... I. .. Address ................... Phone No ................ 15. 19 this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes,~Southold T~wn Trustees Permit may be required. ... j ?LO D AORAM Locate clearly and distinctly all ~uildings, Whether existing or proposed, and~ indicate all set-back dimensions from prope ty fines. Give street and block n,gmber or descnptmn according to deed, and show street n~es and indicate whether interior or corner lot. . . ., ~ ~ , . APPROVED AS NOTED i ' \a,VV ' OLLOW,NG'NSP CTIONS: 1. FOUNDATION ~ T1AtO REOL~IRED · . ,"., ~[ -- ' / FO~ POURED CONCRETE ~ -. I:~,,,1x 4, FINAL - CONSTRUCTION ~T ,~, ~ oZ~l~ , . . 8ECOMPLETEFORC.O. , ) ~ ~ .' ALI. CONSTRUCTION SHALL ~EET ' ;~1. THE REQUIREMENTS OF TH ,N,Y. ' . ., ,~ ~ ' STATE CONSTRUCTION & El CODES. .NOT RESPONSIBLE DESIGN OR CONSTRUCTION El STATE OF NEW.,yO,I~o\,.t COUNTY OF,..-~d FY2',...'E'.... ERGY (Name of individual ' . , being duly sworn, deposes and says that he is the applicant signing contract) ' above named. (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 tree to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. ' Sworn to before me this Netal¥ Publlo, State of New York ........................ No. it952248, Suffolk ~un~.~ , (Signature of applicant). Term ExPlre~ June 12; IL~,.~