Loading...
HomeMy WebLinkAbout21422-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22355 Date MAY 24~ 1993 THIS CERTIFIES that the buildin~ Location of Propert~ 305 SECOND AVENUE House No. County Tax Map No. 1000 Section 67 Subdivision ACCESSORY PECONIC, N.Y. Street Hamlet Block 2 Lot 22 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 17~ 1993 pursuant to which Building Permit No. 21422-Z dated MAY 20~ i993 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 TOOL SHED "AS BUILT" UNDER AN EXISTING DWELLING ON PILINGS. The certificate is issued to EDWARD SEIDMAN & TRACEY REVENSON (owners) 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 ~ding Inspector lrO~J~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPAR?J~ENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N°.~o. 21,t2i~Z Date ........... ...~....~ ................................ , 19.~..~ Permission is hereby granted to: /.../.~.,~......~ .......... ~..~ .................. ~ ...................... -:..~..:~ ................................. ~ ................ ...~ ....... ~.....~ ........................... ~........~ ......................... .~, ......................................... ~ ................. remises I ated at .,~....~..~- ~,~c~,,e//_~ at p oc ........................................................................ : ................................................. ........................................................ ~ ~, .~..........m...~.~.T.~.~.~.. .............................................. County Tax Map No. 1000 Section ..... ~..2. ............ Block ...... ..~.....~:T.. ....... Lot No. pursuant to application dated .............. ~..~.. .......................... , 19..~...~..., arid approved by the Building Inspector. Fee $ ...................... Bdilcling Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ao 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 existin*g 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. 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 Date .~.'~ff~..~. .. · New Construction...~... .... Old Or Pre-existing Building ................. Location of Property....~.~.~. ..................... House No. Street Hamlet Onwer or Owners of Property.~-b ~7~.~.__...~. ?. ................... County Tax Map No 1000, Section....~..? ....... Block....~. ........... LOt...~..~- ................ Subdivision .................................... Filed Map ............ Lot ...................... Permit No Date Of Permit Applicant .............. Health Dept. Approval .......................... Underwriters Approval ....................... ., Planning Board Approval ...................... .. Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $CO~' ~ ~ ~3S~ ~ ~/ ......................, ~'~'~' ~ ~' ~ ............ APPLICANT ~- '~'~ ~ 3. Nature of work (check which applicable): New Building . [ ..... Addition .......... Alteration ... Repair .............. Removal .............. Demolition ..... : ......... Other Work ............... 4. Estimated Cost (Descrtion) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor .............. Ifg ' · arage, number of cars ............... · · 6 Ifb ........................................... · usiness, commercial or mixed occupancy, specify nature and extent of.each type of use ................ · ures, if ..... 7 Dimensions of existing struct any: Front ............... Rear .............. Depth ....... ight f St .... He ............... Number o ories ....................... ' .... ith It F ....................... Dimensions of s~me structure w aerations or additions: ront ........ Rear Depth .......... ight ' · ........................... ............. He ........... ,.. Number of Stories .................. 8. Dimensions of entire new construction: Front .............. ; Rear ............... Depth ..... ' ' ' ' Height ............... Number of Stories ................. ' ......... 9. Sizeoflot: Front ......... , ......... i.. Rear ...................... De th ..................... . 10. Date of Purchase ............................. Name of Former Owner ........... 1 1. Zone or use district in which premises are situated .................................... i ................ .12. Does proposed construction violate any zoning law, ordinance 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 ................. Address ......... Phone No ................ 15. I~ this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Town Trustees Permit may be required. ... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions f~'om property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. . . STATE OF NtgI~'PfOR~ / ! COUN-r¥ OF S.S ....... ~ ' g~luly sworn, deposes and (Name of individual signing contract) above named. says that he is the applicant (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 thisapplication are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ' Sworn to before me t~i~s~,_ T '~.,-- da f...~...~ ........... /~.~ .~. .... y o .... , 19~.~ No.~79~5 ~ ~/. ~ · ' ~m~l~d ~n S~ffolk CoU~ ~ ~ (Sipnature of ppplic~t) on =xp~re, U~m~ ~ tO~ /. . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... . .~.~.. ..... 19 ~..~ ' ..... Approved..... 19 Permit No.o~.~ Disapproved a/c (Build)rio Inspector) APPLICATION FOR BUILDING'PERMIT INSTRUCTIONS B~,~RD'OF HEALTH 3 SETS OF PLANS SURVEY CHECK .................. SEPTIC ~;~H CALL HAlL TO: a. This application must be completely filled in by Wpew~riter 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 o[ 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 mu~t be drawn on the diagram which is part of this appli- cation. ' i ' /c. ' The work covered by this appilication 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 sh~,ll be kept on the premises availabl0 for mspechon 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction oflbuildings, 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 authorized inspectors on premises and in building for ne~g"-~y inspe~eti~a/s. ' . ..... -- ' . (Signaturp of applicant or name, if ~a corporaltion) 1 ..55 .... .... (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 ~]~glAI~D. ~.~---D ~Adx] ~ 'T~o,~Y' ~ {=[Im--~J~~ ~$ ~01£D '"7 ..... (-'""" '~a[ o'"n the t'"' ' '~x'~roll'"~'%; la" '~est"i~l~"~~~.~ ~'-~'/~2~;t'~' ' If applicant is a corporation, signature of duly authori:~ed officer.' ' FE .E~J . I ~%~ ~%%,~ ~ NOTIFY BUILDING OEPARTfVIENT-AT ............................'.i...L~L;L, Lg.~'"[P~!Jt; ~ 'UFA 76,-,8ot ~ AM ~ 4 eM FOR THE FOLLOWING IN,PElION,: (Name and title of co~orgte o~f~,[~ ~t~ "' '' Builder's License No ....... ~5~ ~¢ ~u[,a ~, ~. ~ ~ FOR POUREDCONCRETE Plumber's License No. ~'[~ ~} ~'~ , ~ % ~ 2. ROUGH - FRAMING & PLUMBING ~ F~,:a~%~%~ ~[%%,~ 4. FINAL CONSTRUCTION MUST .... }Z" , ~ [~ ~ ,~,~ 8[ COMPLETE~OR C.O. E]ectrtclan s License No ........ ~¢:'}]'[~' ' 2~-?'~'~"~'~ ~[~[ ~ ALId CONSTRUCTION, SHALL MEET , . THE REOUIREMENTS OF THE N.Y. Other Trade s License No .................... STATE CONSTRLJCTION & ENERGY , 1 Location ofland on which propos~d work will be'done. 5. %~C~)~ll'f~ RESPO,SIBLE FOR House Number ~ Street Hamlet C Tax Map No. 1000 Sectioh ...; .......... Block ........... i... Lot ............... Subdivision ........ . ......... ~ .................. '. Filed Map No ............... Lot ............... (Name) 2; State existing use and occupancy 0f premmes and intended use and occupancy of proposed construction': .. ..... .n ..... ................