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HomeMy WebLinkAbout20391-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. et CERTIFICATE OF OCCUPANCY No Z-21019 Date SEPTEMBER 15, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 53557 MAIN ROAD SOUTHOLD NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 61 Block 4 Lot 9.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore Filed in this office dated JANUARY I5, 1992 pursuant to which Building Permit No. 20391-Z dated JANUARY 16, 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 DETACHED ACCESSORY GARAGE AS APPLIED FQR. The certificate is issued to STEPHEN M. & SHERYL LEE ALBERTSON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NfA UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A L Bu' i Inspector Rev. 1/81 ' FOBM NO. f TOWN OF SOUTHOID BUILDING DEPARTMENT TOWN HALL ' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 2 0 3 91 Z Date 19.1...8. Permission is hereby grant (y .....~3.~'~ .7........ ~-,a.... .:.........................................:.......1..~............................................................. at premises located at ....cam .7......... ..~~.-4. ?7.......lCw~ County Tox Map No. 1000 Section ........~a.,r....... Bioek .........1`......... Lot No.....,l..t...~r.......... pursuant to opplicotion dated .........~//.a~ 19..G~.e~ond approved by the Building Inspector. Fee 5...1.~.Ir - ~i'~ .l'..1.'.~..'~'.`.' uildi Inspector Rev. 6/30/80 Form No. 6 ~ ~ ~ Il(/ t2 TOWN OF SOUTHOLD D ~ L/ L5 ~ BUILDING DEPARTMENT TOWN HALL ~ Q 765-1802 - i~;; tiLL)G. DEPT. APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWYU OF SDUTHOLl7'"~_ A. This application m t 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. Firial 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 17 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. B. 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 dwell~rag--$2,5..2 g;' 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 ~lI~V.S;~. ~7K.~,`T.9~ Yew Construction....:J:..... 01d Or Pre-existing Buildin'g,.(~..:....... Location of Property:s~.~`~.~~....~C~?...~:t..,..~P4':::6~~~.~.~f.//97/ House No. Street J n `_H,amlet Onwer or Owners of Property...-~. ~?Y:./~~. ?:.~G?.4/J:.4~-~ J7/.~~[~F.~'::... q :ounty Tax Map No 1000, Section..,~~?~.......Block..~..........,.Lot~~ subdivision /.Filed Map........ .Lot...................... 'crmit No. ~V. J.-.I.~. ~ .Date Of Permit...1~.~~~:1.~.....Applicant.~C.t.K~:4 ,~'4r,~Q~yy~, , , . _ _ , , lealth Dept. Approval ..........................Underwriters Approval......................... Tanning Board Approval :e quest for: Temporary Certificate........... Final Certicate,.,7~,,.,,,, ee Submitted: $......~..~C Qo~«,~~q" APPLICANT 1EL~7 i::.°.: ~ ~~J„:., I~ ~v.`TME;Ni~ X71 i o 1. m ti~ a FOUtIDATION (1st) I ~~(~r, - I rPj, FOUNDATIOJJ (2nd) _ _ m 2. z o P.OUGH FRAME & .PLUMBING C~II V N H 3. ~ m m ` I1ISULATI011 PER N. Y. y ` STATE EflERGY II CODE f T . a b~ /a g1i,0~ m i. H y FI;lAL ADDITIOPIAL COMMENTS: m~ x t~ x !b H a v ~ H f H \",Vp O r m ~ a ~ ~ ~ - - P' - -mv ) H - ~ i .II 4 9r I ~ ~ s ,9va K? t. •i TS/y'Ey~~, "A~'}/1,.~'lyt ~ lff. .?MY~! ='t,.~' ~ ' x . ~ 1 4.'.~~~'?f,..~,(~V'• f, t.~I T~r.Y"'~ ! ww 4.M MN^~~~_.~.~~~ aRV E• ~ t . I ~ " 3 , ' ~ r' ~ ~ f'~ ' iii ~ ~'~~~X~M 1~ s { U C ~ ~I kyEl'"~ i J11l~ ~~~6rIP d e + f/~ ~Yif~ - ~F.3. r' ~ • ~ Y`T., r {I ~ ~ i ~ ° ~ z a N Q pS'd~D?~,. t7:PkftU 7.?.~' ,r"[!J'..rt ?.,1.?e~S.C/'lJErli+r$~ "DF'}' C1 .~,r ~'~s W ( ~ r ' _ G s ~ . " i ~ + ~3 ~Cl: ~ 59'~d , S"fib +x{3 7~~~ a*,z j , . , A i M.bO°:31.''30"E. - I45. 1`1 , _ ~ ~ I ~ ~ . Q ~ ~ ' ~ ~ i i` oPs`,'~~.^ E I I ::~~'~3~ ~ I ~ ' ~ ~ I I ~ ' ~ f i . ,rr S~ { ~s.~m~~_ ' YID ~ 9 leg%h°-.wcs„ I q~£tiar(i,,- n' 1{le ,r.'I A. . i~ ~~I~63if~ ~(d i~p~l~(~fl'~t{ ~I~ tr' ,"a...: ~g3`. `t^.~Z ti ~ ~ ` ~ ~ R 4 h ~L,~ ; i of z'aI y~ ~ d~" ' i t ~1' ~ I, i r r * i;„ f CEQ~ r CJ I _ -'E . ( . ~ ~~;7 ~ E~rr;T(t ~ ~ 3; 1 ~ s x:544.'„ xe 0''r ,'yY;.: »AUrnuutw w,luAlwN VA AWUro.. GU+1r;5i>fi!. E4G~ 7r> t"1I1 C.1.~n : i:'f: i+ ~'i'?.'~G/v'~~YCd e: ~ i rxES sukvEr n A nouraN a ~r ~uu}tol/tAw iNFNEwrouesr•r• GG,,; 1"C~ hL3J"+':rrt.73!' AL:t+''v.:i.:~" fr:C.a :rf7dt wEES a nro sEnvar Mu Nor EEARN. 2''o C"+~~cvrfi ~,P+ d a rrrc. G . ,V,.e{"/ fi - f LAND EURVFYOR'S tNK~ EFAE W Q' y~ 5 f/? ?e2 f'/H q NfJ 'r'. wVj ~ I J+ ~ s,r, ~ROSSW SFAE SNA4 NOT K CONSIDN[D x A vAEq uuE car. ,~'GG~: ~ , , ~:~i,^~ 7% Y1., YW f 1r Li ^ 'ARAMFES NAICATEp HEREON SNAfI RIM YY fO iN£ rEREON 104 V/NOM iN[ EaVI AC_., Y`r 4.•..r• •rY,•. + rr ~ ~ _ NIWAREO, AND ON NIS KNAIi YO iEIF 1!- _ IE COAwANr, iAVFRNMEN}AI AGENCY AV DING MSTFIUTION l15rED NEWQ/E, AN(r E: ?i,"e?'lyaS'd+'a7 L.JY',;y E;~':./i'ir.,A'~rQ J'.R }ME AERI~lEES a iNt EEND(E~ QREir ' IoEE. r+vetA~E/F rAE Nor rynfAN.,. GYiB'C." M ~1:: E']", .v' Y". ~ A ~tlOMj} Y~%77NTtE»< nr (IMUrn .I 1 °{E BO.IED OF HEALTH FORM NO. 1 0 ~ D 3 SETS O~L1:75 TOWN OFSOUTHOLD SURVEY ~i BUILDING DEPARTMENT CUCCt;.".~.'~.`~o.~,~........... TOWN HALL SE['TIC FOR:1 8 DEPG SOUTHOLD, N. Y. 11971 F TEL.:765~1B02 t:oTIF'f; Examined . . ~`el?~........., 19p~ p PfA I L TO : . • . • . ;lpproved , 19/Permit No..`~..:~//~ . . Disapproved a/c _ . (B din pector) APPLICATION F BUILDING PERMIT Date . r `.5 19~~.~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets of plans, accurate plot plan to scale. Fee according to sc}tedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :atian. 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 Itali 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 .hall have been granted by the Building Inspector. APPLICATION IS FIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uilding Zone Ordinance of the Town of Sout}told, 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. Che 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 i e tinns. (Signature 6~applicant, or name, if a c r oration)... . (lvlailing address of applicant) irate whether applicant is owner, Jesse ,'agent, hitect, engineer, general contractor, electrician, plumber or builder. \ame o! owner of premises ~il~l,1Q ?~'.i,/ /.,f,~I,~~~ . . . . . . . (as on the tax roll or latest deed) a applicant is a corporation, signature of duly authorized officer. (Name and title of corporat~~e//officer) Buildcr'sLicenseNo. :/~:~~.~,p~-,,,,,,,,,,,,,, Plumber's License No. ......r/J~.~ . . E-Iectrician's License No. ~~f~' , , , , , , , , , , , , , , , Other Trade's License No. . 1.~/~, , , , , , , , , , , , , , Location of land on which proposed work wilt be done . . 5355 "7 'llJc.v`~r~ . {louse Number Street Hamlet County Tax ivfap No. ] 000 Section (eft......... Block Lot q~.~, . . q f ~ y ~y~ . Subdivision /'a/ Filed Map No. ..11....... Lot ..,~y. Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..1~~-~~ ~~Y~ i`'~ -f ~tp~°y t0 7fN+~'~.`W~k:: t:'.CtVr;+. a~::~ii5P:~6is~........ . `e N+°A b. lntendcd use and occupancy ..i~, , , , , ~t+ ,Iy ' rrtr~,,;a~e•„r.3+sra•r{rmrp;x~ • ( 3• Retain of work checl,~.whicRe applicable): New Buildin Demolit (t p ~ . ' ! : • •'Alteratiori . m oval ion • , . ddition • • • • Other 1Vorky.~..".......... • . 4. Estimated Cost~~~.s?,,~~ ~ . 1~ M a~tt.lDerscription) Fee 1 S. If dwelling, number of dwelling units 'r~ (to be paid on filiri~,}his~~pp icatio'p) ~V Number ofdwcllim~ s~~`'"~ If garage, number of cars ,(t/{,~,, d unit`s on cacti Moor :,/}~~„~7 ,i. 6. If business, commercial or mixed occupancy, specify na e and extent of ea h ype of use . Dimensions pf xtsdng structures, if any: Front • Height ~~e////~/e~~ . Nwnber of Stories . ' ' • • • Rear . , Depth Dimensions bt a • ~struc[ur with alterations or ad • ~ • ~ • ' ' ' ' • . • ~ . . Depth ~ Iicight . 8. Dimensions of en new cons[ ins' Front . , , • Rear nrction: Front ' arty nber of Stories Height NumbcrofStories. Rcar...... .Deph 9. Size of lot: Front ~ 10. Date of Purchase ~ • ' • " " " • • Rcar . , ,?C~~, d'j " " " " " . Depth , . ' . . • • • • • • • • • ...Name of Former Owner ~„~~p~. 1 Zone or use district in which premises are situated . N;~, . . ' p p ate any zoning law, ordinance or regutafion: . 13. Wili lot be regraded A•t • • . • 14. Name of Owner of sremrses vtol . • . • . • . P .Will excess EII be removed from premises: Yes Name of Architect ddress .wry, . , ,Phone No.. Nante of Contractor Address ~11.T' . Address ~ Phone No. a,~`,-:, , , , 15. Is this property within 300 feet of a tidal wetland? "'Phone No.. .';~d~~ . *If yes, Southold Town Trustees Permit may be required. " No...... PLOT DIAGI2AIvI Locata clearly and distinctly ail '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. • TATEOFN• O ~ . 4~.. (Name of individual signing ~ • • ~ ~ ' ' ' ' ' • • being duly sworn, deposes and says fhaY he is the applicant rove named. ;contract) is the . ~ • (Contras r, agent, rporate officer, etc.) said owner or owners, and is duly authorized to pcrfo~ vc performed the said work sn . plication; that all statements contained in this application arc true tpp the best of his knowled, • d to make and Etc this irk will be performed in the manncrsct fort}[ in the application Elc~"tlterewitlt. 6~ and belief; and that the ~om to before me this ..l. ay of '19~.~ tary Public, ~ ~ ~ ~~''i-'~ County • CI,A1R81.• ©4EW NobryPublto. Stab otNta?vYark Nota ypz,~~ (S' ature of applicant) i Co•• „ V a_ ~ ~1 ,70 I ~ S- I ~ I 4.e~'k~ ~,e _ ~ ';i' 1 @~L I I . ~ ~ i t i i ~ I. d i ' R I it ( ~ ~ ~ I i i fi, `C ~ _ ~ 0 a . ~ ~ i ~ ~ ~ ~ ,~%ti ~ = ,t~ , '~rG•; . Jl _ ~ I i h~ ' i h ^r . .1 g...~,5 b j o. x I' a O ~ 7A0 A~~ ~ aF~~z z m ~ ~ ~ t~ 3.-> D i~v p: ~ z m +R ?a9h.~ t