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HomeMy WebLinkAbout20531-zFORM NO. 4 TOWN OF SOUTHOLD BUIIDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20893 Date JULY 28~ 1992 THIS CERTIFIES that the building. Location of Property EAST END ROAD House No. County Tax Map No. 1000 Section 1 Subdivision FENCE FISHERS ISLAND~ N.Y. Street Hamlet Block 2 Lot 4 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 7, 1992 pursuant to which Building Permit No. 20531-Z dated APRIL 9, 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 6' HIGH FENCE IN REAR YARD OF THE CARETA/~ERS HOUSE. The certificate is issued to WILLIAM L. HANLEY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspe6~or ~ 'J ' Rev. 1/81 FO~ NO. O TOWN OF SO~'13'fOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) Perrai,sion i, hereby granted to: ~ /~ ~/~~'~ ° ,, ~,~ ,~,,,, ,, ..... ~. .~...~~....: .. ........................ ................................................. ~~ ........ ~.., ................................ pursuant Building Inspector, Rev. 6130/80 Form No. 6 TOWN OF SOUTIiOLD 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. 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 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 natumal 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 I. 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 ..~q~.~%.~ ....................... ~;ew Construction...~ ....... Old Or Pre-existing Building ................. Location of Property.. ~ .~ ....... ~. ~ .~P~J ......... ~ .!~ ................. House No. Street Hamlet ),wet or Owners of Property..~.~g~P~ ................................................... 2ounty Tax Map No 1000, Section..............1 Block...........2 ..... Lot ........ ~ ............. ;ubdivision..Fo~...~%Qp~e~.~.~p, ........ Filed Map...~ ..... Lot.. i-B gobert ................. '" N. ~nt~o~ne, Rsq. ~erm£t No.~05~M .... Date Of Permit.~r~ Z,..~pplicant.as agent for Lee Hanley Dept. Approval. ~ .................. Underwriters Approval..~ ................... !ealth . .. ~!anning Board Approval.~ .................... ~eq,est for: Temporary Certificate ........... Final Certicate....~. ...... 'ce Submitted: $ ....~...0..0 ..................... ~~..~ CO ~ ~0F~ M Robert N. An~Bk~,NTEsq. , agent Lee Hanley FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ~4 '? 19 .~.? Disapproved a/c ..................................... ~,d~ ~ BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ................... MAIL TO: 71/? dz,7?,r--arX ,z~,eT'~z/ ~'~'~ h"~' ~¢~ ........ ....... APPLICATION FOR BUILDING PERMIT/ X ~, ,- INSTRUCTIONS a. Tiffs 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 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 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 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 i~sp.~ject~ias~f/~// //~ ~_ -- (Signature of applicant, or name, if a corporatf6n) 4 : . <' : '. . . z T , . ., ff .: : . / : : . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises. ~./t~v' .~.'.~..~....~..~./.~.~:e~..~f. ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. '~~'i~ ............ Plumber's License No..po %'~T~ ........... Electrician's License No. f.tO340~ ~c~,~ .......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · .,f.. ....... ................. ........... House Number Street Hamlet County Tax Map No. 1000 Section fi- Block 2- Lot .... ~ ........... Subdivision J.~'. '.J]'. ,7~...~..~.~-.~.~.P..~4..~.~.~..2~..~..'.~v ?.. .... Filed Map No ...... ,.~. ....... Lot ...~.'.~ ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which apblicable): New Building .......... Addition..........'~ Alteration ... ....... Repair .............. Removal .............. Demolition .............. Other Work ............... " (Description) 4. Estimated Cost ........................ Fee ..... i (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. If business, commercial or mixe occupancy, spec nature and extent of each type of use ................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wilth alterations or additions: Front ..... Rear ..... Depth .................... i. · Height ....................... Number of Stories ...................... 8 Di f tru ' Re pth · mensions o entirenew cons croon: Front ............... ar ............... De ............... Height ............... Numlber of Stories ........................................................ 9 Size of lot: Front ' i Rear Depth I0. Date of Purchase ........... ! ......... ~ ......... Name of Former Owner ............................. 11 Zone or use digtrict in which pre~nises situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i .......... . ......... Will excess fill be removed from premises: Yes No 14. NameofOwnerofpremises ...i .. . Address PhoneNo ' Name of Architect........ ~ Address Phone No N amc of Contractor ........ . .............. Address ................... Phone No ............. 15. Is th~s property wxthin 3.00 feet of a tidal wetland? *Yes.. ~ ..... No ......... · If yes, Southold Tiown Trustees Permit may be required. I PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. I STATE OF NEW YORK, , county OF .... ...'~..O.~..' .~ ~77... ~. :...~.~...~....~-..~..~.. .......... being duly sworn, deposes and says that he is the applicant (Name of individual sigm~g contract) above named. He is the ..................... ~ .................................................................. [ (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 this application are true to the best of his knowledge and belief; and that the work will be performed in the manner iset forth in the application filed therewith. Sworn to before me this ..................... day of 'I' ' ' ... .......... Notary Public ............. ~. (- .~:q [.~. ....... Coun MA~' El. PANKIEWlCZ i(:~) .......... · ~r~v poauO, Sr~T~ OF NEW 'a~ ; (Signature of applicant) ~(.t 52.8?67950 -- ~uFRN.8 GIuoNr't !