HomeMy WebLinkAbout21346-zFOPS4 NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildinq Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22417 Date JUNE 25, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 400 ORIOLE DRIVE SDUTHOLD~ N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 6 Lot 15.11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 13~ 1993 pursuant to which
Building Permit No. 21346-Z dated APRIL 16, 19~3
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 DORMER ADDITION & ALTERATIONS TO 2ND FLOOR OF EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to
of the aforesaid building.
KATHLEEN McNAMAR~k
(owner)
SUFFOLK COUNTY DEPARTMENT OF ~TH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
PENDING - JUNE 24~ 1993
JUNE 2, 1993 - K&K PLUMBING & HEATING
Rev. 1/81
FORM ~0. S
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, H. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~N?
Permission is hereby granted to:
......... .~ .............. ~.~....~ ..... ~.~
~.~,. ............ ~ .... ~/,~ ......................................
.............
~' '~'~"~~2 ....... ~:'""'"~/~'""~': ........................................
at premises located at ......~'..~.~.. ...... ~~-.~....)~..< ..............................................................
County Tox Map No. 1000 Section ...... ~ ..... Block .....~ ............ Lot No ....... ./.~../../...
pursuant to application dated ....... .~.././~.... ................................ , 19.'~.~..., and approved by the
Building Inspector.
Fee *....~~
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to
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
Upre-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 - $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 $15.00
oate .May......27~.!??{ ...................... ... ...
New Construction ........... Old Or Pre-existing Building....J~. ............
Location of Property 400 0~0~e D~ve S0o~h0ld .
House No. Street Hamlet
McNam~
Onwer or Owners of Property.............K~ee~ ......................................... .. .. .. ..... .
County Tax M~p No 1000, Section ............ Block ............... Lot ......................
Subdivision ..... ~p~.~O~ .............. Filed Map ............ Lot .... ~ .................
Permit No ................ ~$~6Z Date 0f Permit. .... ~!~/?P ....... Applicant...~.~.~.~ .................
Health Dept Approval Underwriters Approval . .
Planning Board Approval .............
Request for: Temporary Certificate.
~ 25.00
Fee Submitted: ~ ...................
..... Final Certicate..~ .......
i..iii..,i
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
'Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone (516) 765-1802
SCOTT L. HARRIS, Supervisor
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southoid, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
MAY 26, 1993
DBH CONPANY
P. O. BOX 2130
GRgENPORT, NY 11944
RE: KATBLEEN McNAI4b~RA
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file. ~,
The check is ~mN~not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PEP24IT $ 21346-Z
Please contact our office on this matter,
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
CC: KAT~LEEN McNAMARA
TOWN OF SOUTHOLD
OFFICE OF BUILDIHG INSPECTOR
P.O. BOX 728 ·
TOWN 11ALL
SOUTIiOLD, N.Y. 11971
TEL. 765-1802~
~ E, RTI F I CAT I ON
than 2/10 cf 1% lead.
,:!' Sworn
tho.
to befor~ mo bhis
(plumber's
NOTARY PUBLIC, ~tate Of NeW
No. 4882799
Qualified in Suffolk
Commission Expires Jan. 20,,
;OU~DA'TION (1st)
'OUNDATIO~ ( 2nd )
kPOUGH FRAME &
-PLUMBING
.~;SULATIO}; PER N.
STATE E};ERGY
CODE
FI;;AL
ADDITIO~;A'L COMME~TS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] IN~.ATION
FRAMING [~..,~FINAL
DATE
7G5-~,802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [~H PLBG.
, [ ] FOUNDATION ?NO [~.]'INSULATION
[ v~'~MING []FINAL
REMARKS:
11.
12.
13.
14.
lS.~s this property located within 300 feet of a tidal wetland?
~If yes, Southold Town Trustees Permit may be required.
PLOT DIAGI~M
Locate cle~ly ~d distb~ctly all buildings, whether existing or proposed, and. indicate ~I set-back d~ension~ from
prop'~rty Hnes. Give street and block number or description according to deed, ~d show streei n~es and ~dtcate whether
interior or comer lot.
Nature of work (check which applicable): New Building Addition Alteration
Repair. ....... R~moval .............. Demolition .............. Sw~m~ingdp .;, , .....
Tennzs Court ......... Accessory Building, .,~ ....... Fence ....... Other Work; ........
Estimated Cost ...................................... Fee .....................................
(to be paid on filing this application}
If dwelling, number of dwelling units ............... Number of dwelling units on each floor .......
If garage, number of cars .....
If bnsmess. Commercial or inixed occupancy, specify nature and extent of reach ~ype of use .... .~
Dimcnsionsofexistingsttuctures if any: Front 36~ . . Rear .;,3fi. ......... Depth
tlciebt .............
................ NumbcrofStories .. 2 ................... ~ ............... ~
Vt ..... '
Dhnenslons same structure with alterations or additions: Front ........... ar .............
Depth ...2.7 ............... tlc g ~t ................. Number of Stories .% . ~., .........
Dimensions of entire new constmctiou: Front Rear Depth
lleiebt Number of Stories ............................... · ~ .......... .
Size of lot: Front ...................... P, ear ...................... Depth
Date of Purchase ............................. Name of Former Owner ........................
Zone or use district in which premises are situated
D.o, gl
es proposed construction violate any zonin aw, ordinance or regulation: .......... ,,,:., .
~V. dl lot ~be_,regraded ...... :,' ',,'~ .... t,- :, .......... Will ex~c~,~s ~J.l~b~,rem,oved from premises:' Yes .,.
~ame olrOwnerofpremises K.~..~..e,.e,~ lvlcNct~a~c, AAA .... qUO o~,co,~e~ wz. D M,, ' '
Name of Architect ....................... .. .. Address ................... Phone NO ........ '
N,'une ofContractor . ;/)B~ £0 ........ ~... Addre~o443 ~wcn St., Orpz .... 4'77-2'2'2'3
STATE OF NEW YOP, J{.
COUNTY OF, .S.~f.~.°.Z.~i...
Richard Israel
.............................................' · ' · being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is tile e.o ~td~e~O~
(Contractor. agent, corporate officer, etc.),
of said owner or owners, and is duly authorized to pe,rform or have performed tlre said work and to make and fil~ this
app[ication: that all statcmests contaiscd in this applicatim~ are true to tile best of Ills knowledge and belief; and that the
work will be perfomled in tile marmot set forth in tire application filed therewith.
Swam to before rile tiffs
NOtary Public, ........... ~. ~ ..... County
t, lo. ~2799
Commission Expires Jan. 20~
A ~ 197~
........ day of .... P
(Si~atur~ of applicant)
LDG. DE~ T. I
TOWN OF SOUYHOLD
Appro,'ed .....
1~, Permit
Disapproved a/c .............
FORM NO. 1
TOW~V OF SOUTHOLD
BUILDING DEPARTMENT
]'OWN IIALL
$OUTItOLD, N.Y. 11971
TEL.: 765.1802
BOARD or ItEALTtl
3 SETS OF PLANS , ....... ~.~
SURVEY
C.Ec ..........
SEPTIC FORH
NOTIFY:
c^ u , .V ........
HAIL TO~ '.
5,j3,u il d in ~j, fs p e~: t o r) ....
APPLICATION FOIl BUILDING PERMIT
INSTRUCTIONS
Date . AphSLe. 13, 1993 19
a. Flus appllcat,on mast be coimpletely filled in by typewriter or in
plans, accurate plot plan to ~cale. Fee according to schedule, t
sets of ink and submitted o the Building Inspector, with
b. Plot plan sho~ving location for lot aud of buildings on premises, relationship to adjoining premlses or p bbc streer~
n
or areas, and giving a det.~led description of layout of property must be drawn on the diagram which iS part of tiffs nppli.
cation. ' .
e. The work covered by tiffs al?pl carton may not be Commenced eFore ~ssttanee or Braiding PermiL
d. Upon approval or this application, the Bt Idmg inspector will issued a Building Permit to the applicant. Such pemfft
shall be kept on the premises availal01e for inspection throuNmut the Work.
e. No building shall be oecu,,i~d or nsc-' ' ' '
,., u m whom or in part for n.ny purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS IIEREBY blADE to the Buildin De . ,
fin,Id,nc Zone Ordinance of the Town of Sot tbold S~f'-,i-P~t.m.-e.n-! r.o,r th.e. ls?Uanc~, of a Braid!nc Permit pursuant to the
Reeulations for the construction Of buildir Cs, additions or alt '
, ,-,,,,. '...runty, prow 'forK, ann other apphcable Laws, Ordinances or
7be appbcant agrees to comt~ v w ~h .n .... ,:~ ,. .. eratmns, or for removal or demobtion as herein '
......... m,,,~ao,e .aws, oramances, bu,ldmg code, hous,n,4 code, and regulationd~S;:dbetdt;
admit authorized inspectors on pren~ises and in building for necessary inspections.
(S~gnatnre ut apphcant, or name, ,f a corporauon)
(Mailing address of
State whether applicant i~ owoer, lessee agent, architect, engineer, general contractor, electricifi~, plumber or builder.
gen~ eO~or i
Name of OWner of premises .... ~.~e~.
~ (as on the tax roll or latest deed) ...................
f apphcant ~5 a corporaHon, signaln{e of duly authorized officer.
(Name nnd title of torpor'ate officer)
Builder's License No .........
Plu n[ r's Li N
Electr'cmn's License No
Otb rTr de's Li N
Location of land on which proposed work will be done:
400 0~ole D~ve I ,,,, ~".'
So.hold
Ilouse Number ~ .....................................
i Slreet ''''' ..... ,,,, ........ ,..
' Ilamlet ' ' '"
OUn al) · ~C 0 I ................ ~JOOk
Subdivision ~Fhpo~ M~do~ ............. Lot. ,({',~,.., '
.............. ~ .................. Eiled Map No
(Nan]e) ' ' ............. I ut ......
St~te existing Use and occupancy or premises and in/encled use and occtmpaney of proposed constrtlclloR:
A Existing and [ Single fa~y ~g
· use occupancy ...........
· talc occupancy ...... ' '