HomeMy WebLinkAbout21401-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22379
Date June 8, 1993
THIS CERTIFIES that the building.
Location of Propert~ 500 YOUNGS ROAD
House No.
County Tax Map No. 1000 Section 18
Subdivision
ADDITION
Street
Block 2
Filed Map No.
ORIENT, N.Y.
Hamlet
Lot 18
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 5~ 1993 pursuant to which
Building Permit No. 21401-Z dated MAY 11, 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 & INSTALLATION OF PATIO DOORS IN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to
JOSEPH &ANNE MARIE SOITO
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
'~ // ~ilding Inspector
Rev. 1/81
· 0~ NO. It
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No-N°. ~1401Z
Permission is hereby granted to: 4 ~ / ~
~/~ //~/
,o
~, ~r.~g., ~*ted*,..~ ...................... ~ ~ .......................................................
Co.nW Tax Mop ,o. ~000 Sec,o. ...... ~.~. ....... e,~k .~ ............... Lo, ~o. /~
pursuant to application da,ted ...... . .~.~...~. .................................... , 19.~., and approv~ by the
Fee
/ ~ding inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
~his applicat±en must be filled in by typewriter OH ink and submitted te the bn±lding
inspeeto~ with the follow£ng~ for ~e~ building or new nse~
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:
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 ..... /Z .~/~..~. ........
Location of Pro ert . ..~..~ ..... ~'~vq~'~'''' ...... ::~,~;;~iiiii i ii
New Construction .......... ; Old Or Pre-existin Building...
House No. Street Hamlet
Onwer or Owners of Property....~.~.~.~..~.~/..///~2~.. ~..~/~Z~...~.~./.~?. ~. .... .............. . ..
County Tax Map No 1000, Section..'/~............Block .... ~. ..... .... Lot.../,~.'. ............ . ...
Subdivision ................................... · Filed Map ............ Lot ................. . .. ..
z
Permit No.. .Date Of Permit .......... Applicant. ~/?) ~ ~'~
Health Dept. Approval....~./.~ ................... Underwriters Approval ..... /.~..~. ...............
Planning Board Approval..~.~ ..................
Request for: Temporary Certificate ........... Final Certicate...~. .......
Fee Subm±tted: $ ..........................
· ......... ............
APPLICANT
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION
FRAMING
REMARKS:
[ ] ROUGH PLBG.
2ND [ ] INSULATION
DATE
INSPECTOR
~ELD
/,~ ~.
~DUNDA~ION ( lstl
~OUNDATION (2nd)
~UGH FRAME &
-PLUMBING
~SULATION PER N. Y.
STATE ENERGY
CODE
FI;IAL
ADDITIONA'L COMMENTS
· / '~ .......................... TEL.: 765-1802
Examined .......... , 19 ~. ' ,
i
Approved ............. 1977. Permit No..~ .... '.~
Disapproved a/c .....................................
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
(~ildi~Fnspector)
APPLICATION FOIl BUILDING PEIIMIT
BOARD OF HEALTH .......
3 SETS OF PLANS .......
SURVEY ................
CIICCK
Date . d.P.7.~'./.Z-.. ?..~. ...... 19~.J.
INSTRUCTIONS
a. Tlfis application must be completely filled in by typewriter erin 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 muJt be drawn on the diagram which is part of this appli-
cations,
¢. ~The'work covered by ttfis application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Bu//ding Permit to the applicant. Such permit
shall b~ 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 IvlADE 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.
The applicant agrees to comply with all applicable laws, ordinances, building, code, housing code, and regulations, and
admit authorized ~spectors on premises and ~n building for necessary inspect~s._2 . . ....... ~.~...~...
(Signature of applicant, or name, if a corporation)
O
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, generai 'contractor, electrician, plumber or builder.
N~me of owner of premises
(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.
Plumber s L~cense No. . .......
Electrician's License No.
Other Trade's License No ......................
Location of land on which proposed work will be done ................................. ~ .......
' ' 0 ' ' .........
House Number . Street Hamlet
Con'nty Tax Map No. I000 Section :]['~'. .... Block
~ '" · ................. Lot .............. ' .....
Subdivision ........ . ............................ '. Filed Map No.
(Nanm) ........... -... Lot ...............
State existing use and occupancy of premises and intended. Use and occupancy of proposed construction:
a. Existing use and occupancy ...................................... ~... ..........................
b. lntendeduseandoccupancy r,4~te 7
'3. Nature ofwor check whic cable): New Building ..... ~ · · · tion Alteration w~'''"
Re r .............. Removal .............. Demolition ..... : ......... Other Work ...............
4. Estimated Cost .f i,t t, aD . i : ...... ' .... i. ' (Description)
......... t ........ ,... Fee ...... ...............................
5. If dwelling, number of dwellin~ units I (to be Paid on filing this application)
ICg j ............... Number ofdwelling nnits on each floor.
· arage, number of cars ................ · ..............
7' a rmtx occupan ,spec nature an extent o eacl e o use. ·
g tm if Fr &~......Re .d..~ ....... '...- · ..c ..... , .....
· tufas, any: ont ...... ar .
H 'gl /..~. N tnb fSt i /.. - ..... D pth
el It ..... . ...... n ero ores . e
Dimension~hme structure with hlterations or additions: Front .¥P..c&.q .'2.,,t.q~ ..... Rear . .~p.c. tlq o.b.e..or .....
Depth · · ~ He oh, . ~ ot~'~,( ...... .'. · Number of Stories .~.~ct~a,~.~.4~ '
8. Dimensions of entire new construction: Front .... ~..~. .... :Rear
. Depth . .~.~. ......
· Height ... ~..~..e~...,Fyff?.. Number of Stories.. ' ~ ~ cfi a ,~ ~-e,/ ........... ,
9. $izeoflot' Fro'~t I . · ,. .
10. Date of Purchase ., ;.Z' ........ Depth ...........
1 1. /-,one or use aistrict in ' ' · rm ............................
winch premises are s tuated . · · · ·
12. Does . · ' . ..............................
. proposed construchon wo;late any zoning law, ordinance or regulation' .~Xt o
13. Wtil lot be regraded ~to . . ...... · .........................
14. k~___~,-, ~ '''."'~.l'...''2''.: ............ wm excess fill be removed from remises Ye
~,un~ muwner olpremmes .o.i .~. ~.qtto AA,~ .... -.,'
Name of Archit0ct . "i)' ........ 'c ............. Address ............
NameofContractor 4~tfft. F't~ ~,. b'"j..Phone .
15.' Is this 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 ~llJ buildings, whether existing or proposed, and. indicate all set-back dimensions from
property tines. Give street and block ~umber or description according to deed, and show street names and indicate whether
interior or corner lot. ,
· i
(Name of individual signin, contract)
bove named.
. ~BPJL"(W~D AS NOTED . -~
N~:I~' BUILDING DEPARTMENT AT
7654802'9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1, f:OUNDATION TWO REQUIRED
FQR POURED CONCRETE
,2. ROUGH - FRA~ING & PLUMBING
'3. INSULATION
4.. FINAL CON,qT~UCTION MUST
SE COMPLETE EOR C.O. ..
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSISLE FOR
DESIGN OR CONSTRUCTION ERRORS
being duly sworn, deposes and says that he i; the applicant
is the . ... t, or~¢'rtt z/~ ,/ "
(C or, ag offic ) .........................
: Ontract ent, cor'porate er, etc.
said owner or Owners, ~d is duly ~uthorized to perfo~ or have parroted the said work and to m~e and file this
*plication; that all statements contain6d ~ this application are true to the best of his knowledge and belief; and that the
rk will be perfo~ed m the manner s0t forth in tlm application filed therewith. '
,yom to before me this
.......... /.~. ~ ....... day of
..... , .