HomeMy WebLinkAbout21182-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22108
Date JANUARY 14~ 1993
THIS CERTIFIES that the buildin~
Location of Property 500 GROVE DRIVE
House No.
County Tax Map No. 1000 Section 80
Subdivision
ALTERATION
Block
Filed Map No.
SOUTNOLD~ NEW YORK
Street
Lot 22
Lot No.
Hamlet
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 7~ 1993 pursuant to which
Building Permit No. 21182-Z dated JANUARY 12, 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 NON-HABITABLE STORAGE ROOMS & BATHROOM IN ATTIC OF EXISTING
OWE FAMILY DWELLING "AS BUILT".
The certificate is issued to JAMES STAPHOS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
PENDING - JANUARY 12, 1993
N/A
/~ B~ilding Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N-°N? 2118J~Z
Date ............................................ , 19 ....
PermissioJ~ is hereby gra. nted to: ~ ~ /~
~/~ ~ ~_/~ ~.......~~.... ..............................
..........................................................................
at premises located at .......~....O....~......S..~.........~..~..~ .............................................................
County Tax Map No. 1000 Section ...... ~...~.. .......... Block ............. .~...... Lot No.
pursuant to application dated ...... ../../..~.. ....................................... , 19.?....~.., and
Building Inspector.
Fee $ ...... .7 .~.~.~,~.
approved by the
g Insl:/ector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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.
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
"pre-existing" land uses:
1.
April 9, 1957) non-conforming uses, or buildings and
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.
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling ~1~, 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 - $i0.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Location of Property ...................... ~.~.~...PEt ........... .~.~. ~..~.~..~.~.~.
House No. Street Hamlet
Onwer or Owners of p y ........................... ; .......................
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 .......... f Final Certicate...~.. .... ' -
--' ·
,.DRO/VED AS NOTED
NOTI~ B~G DEPART~ AT
765-1802 9 AM ~ 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATtO~- ~0 REQUIRED
FOR POURED CONCRETE
2,ROUGH - FRA~ING R PLUMBING
3.INSU~TION
FINAL CONSTRUCT~O~ MUST
8E COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N,Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE
FOR
SIGN OR CONSTRUCTION ERRORS
/o3
/05 ~_
THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~,
8(,)]J89~ BUREAU OF ELECTRICITY
85 JOHN STREET, NEW yORK, NEW YORK 10038
THI~ C~RTIFI~ THAT
only the electrical equipment ~ ~scrlbed belom and intmduc~ by t~ applicant ~med on the a~ve application number in the premises of
FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
DRYERS
SYSTEMS
E R V I C
NO, OF CC COND
PER
A, WO
OF HI-LEG
NO, OF NEUTRALS
AWG,
OF NEUTRAI.
OTHER APPARATUS:
elects'leal equtp~aellt in the
p~eatses ladkcated," "Do obvious
GENERAL MANAGER
This certificate must not be altered in any manner~ return to the office of the Board if incorrect, laspectors may he identified by their credentiols.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
· JAN-
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
BOAgD OF HEALTH .........
,~3 SETS OF PLANS ..........
,~SURV.BY ....... . .
'' ¢ ,~ TEL.: 765-1802
xami,;cd / .......... 197.
Approved...'~ ,-~. ........ ,9 .~. Permit No..~. z/.~..¢~.. /
Disapproved a/c .....................................
. (~dmg~t~):'~
APPLICATION FO~ BUILDING PERMIT
INSTRUCTIONS
CALL ...................
HAIL TO:
Date .............
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, relatio~'}hip to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be. drawn on the diagram which is part of this appli-
cration.
c. The work covered by tiffs 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
~all 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 of a Buff'ding 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.
/'he applicant agrees to comply with ail applicable laws, ordinances, building code, housing c9.8~, and regI~lations, and to
xdmit authorized inspectors on premises and in building for necess?y~/~..
(Mailing address of appl~zfit)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authvorized officer.
(Name and title of corporate officer)
Builder's License No.
Plumber's License No ......................... ;
an's N ' -
Electrici License o .......................
Other Trade's License No ......................
Location of land on which proposed work will be'done .............. .
House Number Street Hamlet
County Tax Map No. 1000 Section .... ~ .......... Block'. ..... / ........ Lot...;X ...........
Subdivision Filed Mhp No Lot '
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use and occupancy ..................... : ~
3. Nature of work (check which ~pplicable): New Building .......... Addition .......... Alteration . ./.. .....
Repair .............. Removl1 ............ Demolition
~ ................... Other Work ...............
: ' ~' t"~ ~ ' (D r/pti )
4. Estimated Cost ........... ' "";' .................... Fee ..... '
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........ / ...... Number of dwelling units on each floor../..
If garage, number of cars
:d ify ...................................
6. If business, commercial or mixe occupancy, spec nature and extent of each typ~ of use .........
7. Dimensions of existing structur s, if any: Front . ........... Rear .............. Depth ...............
Height ............... Number of Stories ............
Dimensions of same structure With alterations or additions: Front
Depth I Height ................. Rear .................
8 ............................................ Number of Stories .............. ~. ~ ......
· Dimensions of entire new construction: Front
' Rear Depth
9 Height ............... Number of Stories .......... ..... ............................ , .
Size of lot: Front ! ...............
· · ..... Rear ~ Depth '
10 Date of Purchase ......................................................
· "' · · ' Name of Former Owner
1 I. Zone or use district in which pr{mises are situated ....... ~ . .
12. Does proposed construction violate any zonin, law --~'-"--' ..... .' '. ....... [) ;4 ........................
13. ses: .......
14. r .' ' ' ' ',~4-',4;, ;~: ~' · Will excess fill be removed from premi s No
p ~ses ~./-j(~/.~,,)....~.Z.ZT..P'/'/.,a:-} Address ~.~ ),,~
i ' ' - · ................. Ph,~.~ ,~u ................
Name of Architect ............................ Address ................... Phone No ................
Name of Contractor ......... :. · Address ........... ' · Phone No ................
15. Is this property within 3'00 feet of a tidal wetland? *Yes.' ....... No...k~. ....
· If yes, Southold Tiown Trustees Permit may he required·
.... PLOT DIAGRAM
Locate clearly and distinctly all
property lines. Give street and block
interior or coruer lot.
buildings, whether existing or proposed, and, indicate all set-back dimensions from
umber or description according to deed, and show street names and indicate whether
(Name of individual signing ~ontract~ .......... being duly sworn, deposes and says that he is the applicant
bore named.
is the ' '
j (Contractor, agent, corporate officer, etc.)
said owner or owners, xd is duly a~thofized to perfo~ or hare perfomed the said work and to ~e and file this
~plication; that all statemeats contained ~ this application are true to the b~st of his knowledge and ~elieL and that th~
'ork w~l be perfom*d in the m~r setj forth in the applicatioa filed therewith.
worn to before me thi~. '