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HomeMy WebLinkAbout21041-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21113 Date OCTOBER 28~ 1992 THIS CERTIFIES that the building WOOD STOVE Location of Property 1285 FLEETWOOD ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section i37 Block 4, Lot 29.1 S~division Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 17~ 1992 ,, pursuant to which Building Permit No, 21041-Z dated OCTOBER 22~ 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 WOOD BURNING STOVE TO CODE AS APPLIED FOR, The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROV/kL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ETHEL HELGANS & ANO. /Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21041Z pursuant to application dated . .~,..., .... , and Building Inspector, approved by the Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT T0~N HALL 765-1802 ': APPLICATION FOR.CERTIFICATE OF OCCUPANCY A. Thio application muot be filled in by typewriter OR ink and oubmitted to the building inopector with the following: for new building or new uae: 1, Final survey of property ~ith 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 f~om Board of Fire Underwriters. · 4. Sworn statement from plumber certifying that the solder ~sed in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial b~ilding, multiple residences an~ similar buildings and installations, a certificate of Code Compliance from architect or engineer ' responsible for the building. 6. Submit Planning Board Approval of completed sit~ plan requirements.' For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and · pre-ex~stmng land ~ses: 1. .Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application an~'~ 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. 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. Cer.tificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate ,of Occupancy - $5.00 over 5 years - $10.00 · ~. ,Updated Certificate of Occupancy - $50.00 5. T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.OO X ° :w Con truction.., ......... Old Or Pre-existing Building ................. ~c~t~on of Property:..~.%~.~. .... .~.[%V~.W~-...~.~ c~c~ .... House No. Street ' ' .... Hamlet .s~y T= ~p,o ~o0o, Section.~.~2,.~oc~ ...... ff ........ ~ot .... ~7~.~ ............ bdiviaion ' " ' Filed Map Lot rmtt No.~,/,O.~/·[.~ .... Dat~ Of Permit ................ Applicant ............................. ]lth Dept. Approval .......................... Underwriters Approval ........................ mning Board Approval ........................ luest for: Temporary Certificate ........... Final Certicate.·...~...,, Submitted: $ .....% ....... . .......... ' ,930 .. ..... .. t ~l t,.3 ~£i~'' '. ..................... o-ZO ..... -. ~ AP %.- :OUNDATIO:~ %OUGH FRAME & .PLUMBING (1st) iIISULATIO:! PER N. STATE E}IERGY CODE FI:IAL .I ADDITIONA'L COMME~;TS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ~]~AL REMARKS: DATE INSPECTOR 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ....... - ....... Removal .............. Demolition .............. Other Work ..... .,~ ....... $.~OO (Description) 4. Estimated Cost -©0 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 ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ............... [ ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ................................ . ............. : .......... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase .................... '. · · ~ ..... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 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. Is 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS NOT£D . NOTIFY I~U(L~J~G O~'P~~ 765-1802 9 AM TO 4. PM FOR FOLLOWING INSPECTIO!h~S FOR POURED 2. ROUGH - FRAMING & O!_L,'~, 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.¥. STATE CONSTRUCTION & ErilERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW..~Y;O~ RK.!~>~>_{ {/ ~ ~ COUNTY OF. ~.T~IZ).L..~x.,_ ~'~ ....... .......... eing (Name of individual signing bdntract) above named. duly sworn, deposes and says that he is the applicant He is the ..................................... .~. ............................................. (Contracto ,r~gent,~Corporate officer, etc.) ~f said owner or owners, and is duly authorized to perfor-Tff~r have performed the said work and to make and file this ~pplication; that all statements contained Jn this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. ;wom to before me this .......... ..,,-~.~-~..day of ....... ~..~..':,., 19..~-. ,o,, .... ......... ¢?.: ..... ~ ~bllo, 8tato of New Yo~ ~ ~Signaturc .................. No. 4879505 of applicant) Quelified n Surfak Coun~~ Commiss on E~iree De~mb~ 8, 19 ~ Disapproved a/c ................. ~ ................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Building Inspector) ~,PPLICATION FOR BUILDING PERMIT a. This application must be compl s~ts of plans, accurate plot plan to scale BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC F 0 II.H CALL · . MAlL TO: Oate .... /o..]./.? ........ 19 ~?. INSTRUCTIONS ~tely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 Fee according to schedule. b. Plot plan showing location of 1. )t 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 applidation may not be commenced before issuance of Building Permit. d. Upon approval of this applicati6n, 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 Zone Ordinance of the Town iof Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bbildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ~11 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premise~ and inbuilding for necessary insp~rtions. --' (Signature of applicafft, or name, if a corporation) :. . .l&85.. 0oo . C.4cho ~ ..~..;/ (Mailing address of applicant) State whether applicant is owner, les: ce, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .... : .................................................................. '-, Name of owner of premises ...~-,.~..L.I ...................................................... i · , (as on the tax roll or latest deed) If applicant is a corporation, signature ~f duly auth~ofized officer. (Name and title of 6orporat~ officer) Builder's License No .......................... Plumber's License No Electric. ian's License No. .......... Other Trade's License No 1. Location of land on which proposed work will be'done ................................................ ............. f .~.-c W.e.,,.p. : ............ ~..~. ................... ttouse Number : Street Hamlet County Tax Map No. 1000 Section~ .1:~.~.,. ' ~ "o . ./_/ ....... · ,,, .,-.,.-. Ix.. Block ........ Lot..~.c~:. l .......... /5-7 ' Subdivision .................. i ................... Filed Map No ............... Lot ............... iN,me) 2. State existing use and occupancy o? premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... ., . ..;, .>.~.; .................. b Intended use and occupancy c ~ ~aV~*~'~'"~' "i"-~: ..... :' ~