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Home My WebLink About20536-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20635 Date APRIL 10, 1992 THIS CERTIFIES that the build%ns Location of Property 1020 VANSTON ROAD House No. County Tax Map No. 1000 Section 104 subdivision ALTERATION CUTCHOGUE~ N.Y. Street Hamlet Block 12 Lot 11 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 4, 1992 pursuant to which Building Permit No. 20536-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 ALTERATION TO ENCLOSE EXISTING PORCH QN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JEAN PLET a/k/a JEAN WENZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PENDING - APRIL 3~ 1992 N/A Rev. 1/81 · // Building Inspector FOI~M NO. O 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) N°No. 2053$Z Permission ls hereby granted to: · .-./~ ._..~~/~.. ............................... ~ ........... County Tax Map No. 1000 Section '"/fi" '~'"'"'L'"' Block ....,~'..~.. .......... Lot No ..... ./../. .............. pursuant to application dated ............ '~ ' ~.......~.... .............. , 19....~...,J', and'~-- approved by the Building Inspector. Fee $.....~.:...e~... .... Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN t~LL 765-1802 A~PLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in hy 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 ali 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 bui%dings and installations, a certificate of Code Complianca 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: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A ~roperly 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, Swi,uning 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 New Construction ........... Old Or Pre-existing Buildiug ..... z./. ......... .............. o House No. Street Hamlet ..... · ~.. ~ ....... BK~. Te~ co~,:y ~ ~p ~o ~000, s~:~o. ..... /j~ .... ~o~ ...... (~ ...... ~o~...A~ ................ Subdivision ....................................Filed Mup ............ Lot ...................... Health Dept. Approval .......................... Underwriters Approval ......................... Flanning Board Approval ........................ Request fo~: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ..... ~ " ~, ...... .[;...~... ~.,~ .... .... /.~ .............. THE NEW YORK BOARD OF FIRE IJNDERWRJTERS WE ARE IN THE PROCESS OF iSSUING CERTIFICATE OF COMPLIANCE FOR THE ~LECTRICAL INSTALLATION AS ~'~ AN APPLiCATrON~D BELOW, . LOCATION ~ ~ ~ FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... C/q../.~. ...... , 19 ~../? .\pproved .. · ...... , 19 ~?CPennit No. Disapproved a/c ..................................... ./ (Building Inspector) APP,L. ICATION FOR BUILDING PERMIT ~URv£Y CIIECK SEPTIC PORN .............. CALL ................... HAIL TO: Date ...... 7 .......... 19..~'.'L- INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ts 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 : areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :tion. ¢. The work covered by th/s application may not be C[mmenced 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 all 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 ~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or :gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~e appI/cant agrees to comply with all applicable law~, ordinances, building code, housing code, and regulations, and to mit author/zed inspectors on premises and in building for necessa/uMnspectio~2.~ '~"''~ . · ...... ;. · .... ~ .............. ($'~ '"1 7~re'; fapp leant, or name, If a COrpOration) /.!.e ? ._ ........ ( Ia,ing addres {ppLic C ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder2 tree of owner of premises ...... (as on the tax roll or latest deed) ~pplicant is a corporation, signature o£duly authorized officer. N tit e of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electr/cian'~ License No ....... Other Trade's License No ....................... Location of land on which proposed work will be d~'~'e .................................................. iouse Number / O Street 2onnty Tax }.lap No. 1000 Section ..... /..d...~. ....... Block .../..'~... // ;ubdiv/sion ............ Filed Map No. (Name) .............. Lot ............... ;tare existing use and occupancy of premises and intended Use and occupancy of proposed construction: · Existing use and occupancy · Intended use and occupancy ..... ;.7-{ ...... . .o~.~....--~...,.~p ...... 3. of~ (c h~ .. Addition '"'" Alteratmn ....... uval .............. Demolition .......... ' ......... I .............. Other Work ............... 4. Estimated Cost .. / ........ [ .... .'.'.~,~: ~ (Description) (to be paid on filim: this application) 5. If dwelling, number of dwelling ~nits I . ' . If garage, number of cars 4[ ............... Number of dwelling units on each floor .... /... 6. Ir business, commercial or ~;:. ,i ..................................... . .... . ' ' ' · , - .,..^e~ occupancy, spec fy aature and ex ' · ' 7. Dm~ensmns et e.,x~Stmg structUrck, :e~ ,-. o2~/ tent et each type of usc ..... . . ........ ' ............ Depth.. ;2,..~ .......... He ght . . ., , .... . ' ......... l'~umberorStories , [ ldlmenslons O~' sa~ne strtcture w; ..... ' ' ' ', .............. :. ........... ........ Depth. '.~': ,~- .a-erauonsor add,frans: Front . ~g' 1~.~ ~ 0 ;' ......... ~ q ht ..................... Nnmber o'S or es i ~ ....... 8. Dimensions of entire new constniction: Front . _H. toht ............. Number of Stnrle~ · · Rear ............... Depth ............... 9. S~ze of lot: Front ff..O ' ~ .................. , ....... ............... Rear / ~'~ ....... t .............. 10, Date of Purchase ;q/~ ' ' ......... . Depth ,~ 11. Zone or use district in which -r- . '":.' ........ Name of~Eonner Owner ...~.m..',..C,...c.~..W.b.}r. .......... 12. Does re os · . i . . .tO ..... . - - ~, .... , uromance or regulatmn: ...~'.~9 .......................... 13. Willlot beret-reded . . 14. Name of Owner of premises W..~.~z. ~gt~ ~o/-e 'r- ',' dl exces~s fill be removed from premises: Yes No · .... '? .....'""--'-~ ~-.'.. · address 'cz-tST.c"A°. ~.5.e- . Phone No .7 ~. ~ .~o'-/(~ . NameofArchitect ~. i .,, " ~ .. . Name of Co , ~ ................ ~aaress . . ntractor . .(4L,Vc. ecJ...O, t~,.:- O toCC/g' ! ,, ~ · ',;.._:._ ............ Phone No ................ 5. Is this property within 30'~1' 'f'e'o'v' ~'{:'-~' ~5',' ~uoress . . .~;~q..C-..Ko.~? ~ .,~_. .... Phone No · If yes, Southold To~n Trustees Permit may be required. ' ' ".' i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether nterior or comer lot. FOR THE FOLLOWING INSPECTIONS: gUN ATION . TWO 'eQUIREO POR POURED CONCRETE ,2, ROUGH. FRAMING & PI UMBING 3. INSULATION 4. FINAL CONSTRUCT 8E COMPLETE FOR C.O. ION MUST ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY . CODEs. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS '\TE OF NEW YORK, (Name of individual signing contract) named. being duly sworn, deposes a'nd says that Itc is the applicant o '"" the ............... ' (Contractor agent corp(;rai~ ~fficer 'e't~ ............................ ~id owner or owners, and is duly a tlmnzed t'o perform or have perfonned the said work and to make and file this ~cation; that all statements couiaincd In this application arc true to the best of his know/edge and belief; and that the will in the manner set fprth in thc application filed therewith. be perfo~cd ' m to before ~ne this [ , " ..... ......... ........ n 8u,o k ebun~ ~ r (Signature of applicant ' ~mmis~ion ~im, M,~ 22, 1 ~