HomeMy WebLinkAbout21344-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22511
Date AUGUST 9, 1993
THIS CERTIFIES that the building
Location of Property 1425 CENTRAL DRIVE
House No.
County Tax Map No. 1000 Section 106
ADDITION
MATTITUCK, N.Y.
Street Hamlet
Block 2 Lot 31
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 12, 1993 pursuant to which
Building Permit No. 21344-Z dated APRIL 19, 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 ADDITION~ 2ND STORY AND DECK ADDITION TO ONE FAMILY DWELLING
~he certificate is issued to EMANUAL FRANGAS AND WIFE
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING 813447/93
PLUMBERS CERTIFICATION DATED AUGUST 9, 1993
/~u~f~ding Inspector
Rev. 1/81
FOB3~ ~qO, 0
TOWN OF SOU'/HOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NgN? 2134~Z
Permission is hereby granted to:
...... ~..~:~ .2 ..............................
-~.....~~...~..~.~....~~......~~.~
~, premises' ,~a,ed at ~~....~~.~~
............ ~~~ .....................................
Co..~ ro~ Mo~ No. ~00o s.~.o....~.~ ....... .m~ ........ ~. ....... ~o~ No ...... ~ .............
pu~uant to application dat~ ..... ~..~ ............................
Building Inspector.
Rev. 6/30/80
Fo m No. 6
765-1802
~PLICATION FOR CERTIFICATE OF OCCUPANCY ~~.~Ut'~{OLD_
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:
I. 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 fo~).
3. Approval of electrical installation from B6ard of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Co~ercial 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 requirement.~.
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 appli.cant.
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 $15.0q, Co~arcial $15.00
~e~ gons~ruc~toa ........... O~d Or Pre-extsEtng~t~dtng,,~~~ ........ .
House No. Street Hamlet
Onuer or Owners o~ ProperEy ...... , ...........
.................. ............ ........... ............... t ......
Health Depr, Approval ........................ ~nder~rSrers Appro~al,~
Planning Board. Approval .......... . .. ;,,,, .... ,.
Reques~ for: Temporary Certificate ........... F~nal
TOWN OF SOUTIEIOLD
OFFICE OF BUILDi?IG INSPECTOR
P.O. BOZ ;28
TOWN HALL
SOUTHO£D, N.Y. 11971
TEL. 765-! 802
CE R T I F ICAT I Ot~
Building Permit NO.
{please print)
(please print)
I certif.y that the solder used in the water supply system
contains less than 2,/10 of 1% lead.
(plumber's signature)
Sworn to before me-'this
Nota'.7 Pub'~ic, ~ ~ Lb,. County
ANTHONY J. ENRIGHT
Notary Public, b'~tate of New York
No. 4979701
Co Ou.alE. tedin Suffolk County ,~
mm~ssion expires April 8, 1 ~
7GSJ.802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [~INAL
DATE ~//~///~'~'~' INspECTOR~-/-'~/
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] ~.SULATION
FRAMING [//J FINAL
BUILDING DEPT.
DATE
INSPECTION
[ ] FOUNDATION 1ST [~/R~UGH PLBG.
765-X802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION XST [,--]--ROUGH PLBG.
[ ] FOUNDATION ZND [ ] INSULATION
[ ~'[~MING
[ ] FINAL
~UND^TIO:! {2nd)
~UGH FRAME &
-PLUMBING
~SULATION PER N. Y.
STATE ENERGY
CODE
FIHAL
COMMENTS:
~-~ MA'P
LOT
C. A'PTA I H
M ATTITIJ~i.K
INLET
TOWH OF'
.,,¢I0 IJT H 0
,~LIFFOLK,
~/~ I"= 36'
Exa nined .............. 19
Approved ................. 19... Permit No ......
Disapproved a/c .....................................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
TEL.: 765-1802
( B~filding ,l~'fsp e ct o r)
APPLICATION FOR BUILDING' PERMIT
B~ARD OF HEALTH .........
3 SETS OF PLANS
SURVEY
CIIECK .
CALL ...................
MAIL TO:
INSTRUCTIONS
a. Tiffs ap~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 o£ buildings on premises, relationship to adjoining premises or public sti'eets
or areas, and giving a detailed description of layout of property mu~t be drawn on thc 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 i~sued 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 Certificatd of Occupancy
shall have been granted ~y 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.
Thc applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspection~ /~ W~,¢-__~ .
......... ............
-- ' ~. d?"F2 o/[e~ , (Signatur~ of applicant, or name, if a corporation)
.. ............... : ......................... ' ....
~2Y~ Z/¢'?-.~"~ (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder.
(a on ti~ 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 ...................
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
Cotmty Tax Map No. 1000 Section ./. :*. ~. .......... Block ~ ' Lot .~. / .... ' ....
Subdivision .............. ' Filed Map No ............... Lot ................
(Name)
'~ State existing use and occupancy of..Eremises add intended use and occu anc of vrovosed ~o ruc ' '
-' ... P y _ _ nst tmn.
~ pair .............. RemOval ...... : ....... Demolition~ .: ........ Other Work
4. Estimated Cost ...... ' · escr on
! (to be paid on filing this application)
5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each
If garage number of cars ' floor
If business, commercial or mixed occupancy, specify nature and extent of,each type of use
7. Dimensions of existing structures, if any: Front ............. . · Depth ......... ~.. ~..
Height ............... Numlber of Stories ..... i .. Rear .............. ' ...................
Dimen ionsofs'~e tu ewlthalte rio dditio :Front
s a struc r ra ns ora ns ............
8 De ..... :t? ,. , .Height · · ...... ,..,,m,o~luxatones ., ........
Dimen ion of t]ren trpct n: F ........ "
· s s 'eh ewcons lo rant .............. ; Rear ............. De
Height ' Numbe f St ties ' pth
9 Siz of lot: Froht ..... . .......
10 Date of Purchase ~ .......... Depth .................
........... , ......... ~ ........ ,. Name of Former Owner .......
I 1. Zone or use district in which pre,mises are situated ......................
12. D°es pr°p°sed construction violate any zoning law, ordinance or regulati
13. dl Io regra .' ' ', ,"~L;,,' :.5-~:~ · · Will excess fill be removed from premises: ., ,
14. t,~ am e o ~ uwner o ~ p rem]scs/,t ~wT~://~ ~7.,7././t.~. ~.,¢,Add ress : .... Phone'
Name of Architect ....... , ............... Address ................... Phone No.
15.' I.s this property within 300 feet of a tidal wetland? *Yes ........ No ........ " ...........
· If yes, Southoid T.'own 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. ,ye street and block number or description according to deed, and show street names and indicate wh~ther
interior or corner lot.
STATE OF NEW YORK,
COUNTY OF ........
........... ~..'~/. · I/~,Z,-~ · · .' ......... being duly sworn, deposes and says that he i~ the applicant
(Name of individual signin~ contract)
~bove named. .
age t, cor'p ae fi .......... .
,f said owner or owners, and is duly authorize-e-e-e-e-e-e-e-e-~Uto perform or have performed tl~e said work and to make and file this
pplication, that ail statements contained ' 1 ;o.~.,-,..
· m t ho -vp.cauon are true to the best of his knowledge and belief; and that the
~ork will be performed in the manner ~et forth in the application filed therewith. '
,worn to before me this . !
.................... day of.. .. '
:Otary Public ...........
........ County · ,
, ~o. 4822563 SuffolkCounly~/J- · ' ' ' ' (Signature of applicant)