HomeMy WebLinkAbout20363-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20453 Date JANUARY 8~ 1992
THIS CERTIFIES that the building. ADDITION & ALTERATION
Location of Property 2~25 PINE TREE ROAD ..... CUTCHOGUE~ N.Y.
House No. Street Haralet
County Tax Map No. 1000 Section 98 Block 1 Lot 13
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 2, 1992 pursuant to which
Building Permit No. 20363-Z dated JANUARY 6, 1992
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 PATIO ENCLOSURE & BATHROOM ADDITION TO EXISTING ONE
oNE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to GERARD GALLIANO
(owner)
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
Building Inspector
~'0~'~ ~0. I
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 20363 Z
.......... ...............
Coun~ Tax Mop No. 1000 Section .... ~ .............Bilk ......... Z .......... Lot No ....../J .............
/
pu~uant to opplicotlon dot~ ................ ~ ............................. , 19..~ and approv~ by
/
8uildln9 Inspector.
Fee $....."~....~: ....~... ......
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
· Building Department
" Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A, This application must be filled in typewriter OR ink, and submitted m llm..aammm to the Building inspec-
tor with the following; for new buildings 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 of Health Dept· of water supply and sewerage disposal-(S-9 form or equal}.
3.Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5.Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of pz:operty showing ail property lines, streets, buildings and unusual natural or
topographic features·
2.Sworn statement of owner or previous owner' as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $.25~'00 -- BUSINESS $50,00
2, Certificate of occupancy on pre-existing dwelling $ .50 *, 00
3. Copy of certificate of occupanc¥ $'5.'00, over 5 'years $I0.00
4. Vacant Land C.O. $'20.00 k\~.\.%?~...~ "~
5.Updated C.O. $"50.00 Date .............
~ Old or Pre existing Building
New C°ns f'Puc t'i°n .... ' ............ Vacant Land .............
Owner or Owners of ProperW ..... . .... ~ ~,~,k'~ ,~,'~. ,~,. ,, .~.., > .........
CountyTax Map No. 000Sect on ..... ..... BIoc ........ × ..... Lot ...... .......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.~D.~.t~,~ ~. Date of Permit Applicant
Health Dept· Approval ........................ Labor Dept· Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ~,..
Fee Submitted $., ./~, ,~', .-~,~ ................
Construction on above described building an re ulations,
·
Rev. 10-~0-78
BOARD OF 11 .....
3 SETS OF PLANS .......
FORM NO. 1 SURVEY ..........
TOWN OF SOUTHOLD CHECK ..........
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
$OUTHOLD, N.Y. 11971 NOTIFY
', TEL .: 765~ 11102 CALL ................
MAIL
TO:
Examined ..... /./. ¢. ...... ,19
Approved ...../-- ~/~ ....... 19 ~.'~. Pcmlit No...~.O..~.~ .~
( Bu~l~/n g Inspectorj
APPLICA] ION FOR BUILDING PERMIT
INSTRUCTIONS
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, relationship 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-
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 issued 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 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 Zohe 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 to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, .or name, if a corporation)
.......................... "'wr"'t ~ .......... ~'k' ·
(Mailing address of applicant) '~'/\ d(~~'
State whether applicant is. owner, lessee, agent, ~chitcct, engineer, general contractor, elecirician, plumber or builder.
IS NOTED
, , ~ ~,o * ~,a (as on the tax rollror'lt
(Na~e ~ [~e of corporate ofQcer). ~ .~ ~ ~'~ ~:~'~
Builder's ~{tNo,¥~,.~ ~,;~,'; ~>:~.: ~% .4 ;'q':~ V.~i'}; .... ~ ~ ~ g: !'~ '
%[.;~,~,~,~) ~,.. :.~:~ ~ ,.¢ * ...... ~INA~ - CONSTRU~ON MUST
Plumber s 91~h~b Na..~ .. t.. ~ .................. ~L[ CONSIRUCIIOS 8HAL~ ~T
THE REQUIREMENT80[' ~E N.Y.
Electrician's License No ....................... STATE OONSTRUCTION ~ ENERGY
CODE0. NOT RESPONIiISLE FOR
Other Trade's License No ...................... DESlO~ OR CONSTRU~ION ~RROR8
House Number Street I-[aml~t
County Tax Map No. 1000 Section % ~ Block '~1 Lot 53 ...........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intendcd use and occupancy of proposed construction:
a. Existing use and occupancy .....................................................................
b. Intended use and occupancy ..~. ..~.~..~.....s~f~..... ~.... ~ ..........................
3. Nature of work (check which applicable): New Building ' . Addition ltL?aLien
Repa/r .............. Remov&l .............. De~nolitlon ........ Other Work
.X~ .~ ~X/~ ~d) (Descriplion)
4. Estimated Cost .............................. ..... Fee .....
' " (to be paid on filing this application)
5 If dwelling number of d~elliBg~iits Number of dwelhng' umts on each floor
~tgarage numhe~r~o~qa{s~ ~ · ...............
6 If business commercml or m~xed occupancy specify nature and extent of each type of ~e .... ~' ........., ......
7 Dimensions of existing structures if any: Front Rear Depth
· Height :~:?.,~ ?: .~. Num~erofStories ............................. ' · ~' .....' ....
Dimensions of same structure witl~ alterations or additions: Front Rear
Depth Height .... '. Number of Storiei..'...'..;
8 Dimensions of entire new constru6tion Front · ..... Rear Depth .........
Height ............... Number of Stories ....................... ~.. ........... ' '. ·
9 Si flor: Front R ..................
10' D~%fP h ............ :" ...... ear ..................... ,,. D~pth ...... .......
· e urc ese ............................. Name of Former Owner ................ .....
11. Zone or use district in which premises are situated ......... ~ ..........................
12 Do s p oposed con ti vi la~e any 2oni g law din gulation': i .........
· e r s~ruc on o n ~or aDc¢orre ..... ... .
13. Will lot be regraded .......... [ .................. Will excess fill be removed from premises: . 'Yes No
14 Name of Owner of premises i Address
........................................ Phone No ................
Name of Architect ' Addr
........................... ess ................... Phone No ................
Nmne of Contractor Address
............................... : .............. Phone No ................
15. Is this property located within 300 feet of a tidal wetland? ~Yes ..',.,. No ...:.
· If yes, Southold Town T£us,'tees Permit maybe requited. ,
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all Set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
' ~ t~ q' ~'~ r O~[C~P~ ~~ OR CERTIFtCArtOAt
.", USE/SUNI AWFUL OAt LEADcoAtrEAtr BEFO'J E
' ? :',WiTHO ' CERTIFICATE CERTIFICATE OF OCCUPANCY~,
~ SOLDER USED IN WATER ,
" OF'OCCUPANCY SUPPLY SYSTEM CANNOT'
,:' ~-,', EXCEED 2/10 of 1%LEAD.
STAT~ O~ N~w~¥q~,~'XT- S S
above nam cd,
He is the .~ .?q~ ~
; (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 Jn this application are true to the best of his knowledge and belief; and that the
w rk w/Il be performed zn the maj~ set forth m the apphcatmn filed therewith.
Sworn to before me this ~ / ·
~ · .,, 19.
........... .,
GARY F~NNER OLSEN
Nma~ Public~ S~am of New York,
NO, 52-2~59600 I~ ' ' ' · ............................
Commission E~r~ M~eh 30, ~9~ (Signature of applicant)