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HomeMy WebLinkAbout20546-z 0. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21010 Date SEPTEMBER 11, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 1020 OLD NORTH ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 1 Lot 6.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 13, 1992 pursuant to which Building Permit No. 20546-Z dated APRIL 14, 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 ACCESSORY SHED AS APPLIED FOR. The certificate is issued to WILLIAM & CAROLYN HAMAN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~I iluildkbfi Inspector Rev. 1/81 l~ FORM No. I 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-N. Dote O 205462 Permission is hereby granted t ( ......................eA 7i y to ~/~r..... at premises located at ..la..y~ ~ County Tax Map No. 1000 Section .........X,,..... Block //l Lot No....... .7..r.l....... pursuant to application dated ....~1/~ 19A? and approved by the SD /lt-tr ' Building Inspector. Fee $..AFS? ?..4)~4... Buil g Inspector Rev. 6/30/80 ©4 o/K l(O~~ Form No. 6 j fW~~~~.! TOWN OF SOUTHOLD 11992 BUILDING DEPARTMENT 4f r--~i TOWN HALL" 765-1802 Y7v APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 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. 3. 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. 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. 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 $15.00x/, Commercial $15.00 Date .4 1...' . ~ - ew Construction... Old Or Pre-existing Building,. 111 cation of Property .....tb °Z p...... dom.... c~ 2T t .d.. t s a .o . House No, Street " " Hamlet ewer or Owners of Property.... ~.C.. n >unty Tax Map No 1000, Section.., 'I .,,,Block....... . Lot .(eeid........... bdivision.. .................P.~..\....rFiled Map............ Lot...................... rmit No.;.?L Date Of Permit.. Applicant 7-)A b.... q.'F~( Foc91J IS 1 . alth Dept. Approval...(;),, n,„ .....Underwriters A PProval..... tJ. . anning Board Approval.,(,.„(a quest for: Temporary Certificate........... Final Certicate..,n...... Submitted: $,,,,,,495 f oa . Q vc ~~i~~~4 p r p ~~61b APPLICKkdr 1cLD l:;S , .(e9LUIf o FOUNDATI'4 (1st) ~I ` c FOUNDATION (2nd) 2. G z 0 ?OUGH FRAME & PLUMBING ti H 3. \ IIISULATIO;! PER N. Y. y STATE ENERGY I CODE S. 7i Cio 4O _~m H FINAL I ADDITIONAL COMMENTS: x • m • x \ v • i-i H 1-i ~ I 5 Z cn N ^v H r{ - N9 O v, j VU r L-A. tic- , x , ~ ws fi All Em C Lill. a f 3 I I £ U j 3 i h Q o,. u j o h i i w ` (D frrAP : C3F .P€fl:7 LI'~tiGL CAROM 0 I 't. Wll.LlANt Odd _Nogg' , ?,~5= -55.71. - ? y _ IP• ti. All t ,p F (v Ai'll . l rte.. !1 Y (w'w • d 4 ...w. '~`T.`~ii~~9Ayb~ y~1~N~p~~`~, kMYSI r C l BOARD OF HEALTH FORM NO.1 3 SETS OF. PLANS........... " ~r „z `U Q~/~,~ ~ TOWN OF SOU.THOLD SURVEY BUILDING DEPARTMENT CHECK NIAK 2 4 I TOWN HALL SEPTIC FORpt Q 1992 y SOUTHOLD, N. Y. 11971 TEL.: 765-1802 t:oTIFY r~ CAL ;y.. Examinedgv.,; 19p pin I L TO Approved /1. , 191~. Peerrmit No.~J~-1~ . Disapproved a/c ~MJ.-. Y . . . ( 11 Inspector) APPLICATION FOR BUILDING PERMIT Date 19 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 ov 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 Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Taws, 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 inspection (Signature of applicant, ame, if a corporation) `l3ax4~Fotp o!-~.ll7drti!f .dtF~,. a....!z24~J rf9a0 (Mailing address of applicant) /09 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .7E"Il, 0o'F-9 Name of owner of premises , . L t, A.r4.\. ~?A '?-.e?~-..... ~ ~ M, . (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...1.5.f . .3, 4. ,1, , Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be donee O-. >.S.r~ ,OJ.c 2 i ri p , , , , , , , , , , ..............................................................t,SoJTr1 oL?~................... House Number Street Hamlet County Tax Map No. 1000 Section . 5...... Block ( Lot Subdivision e 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 lS l~ 5 a? 4- N, K n ' . Intended use and occupancy i~fYr~,o4. R' Ole "i4;C,;t"0T i 3, Nature of work (check which appillicable): New Building ..`fl.... Addition Alteration , Repair Removal Demolition Other Work I oa / (~a (Description) 4. Estimated Cost © Fee ...4 ~~,S . 5. If dwelling, number of dwelling ul (to be paid on filing this application) g, its Number of dwelling units on each floor , , , • • • If garage, number of cars . 511 .0...... • • • • 6, If business, commercial or mixed' occupancy, specify nature and extent of each type of use 7, Dimensions of existing structuresl if any: Front ! , . , , Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front ^l.•. A • • , Rear Depth Height Number of Stories . . 8. Dimensions . .of of entire ntire new . constru Numbsction: Front 12.-.~. . , Rear 1 s~ Depth Depth Height . ~ . Number of Stories . 9. Size of lot: Front , . o e , , • • • • • • Rear 59o7 ; o .S....... Depth 10. Date of Purchase 4•••"••••••• ..L Name of Former Owner . ,lkr?-r,~ far-!N0.4:$....... 11. Zone or use district in which premises are situated . , , .CIA4"-. , • • • • • • . , • , . . 12. Does proposed construction violaie any zoning law, ordinance or regulation: b) .Q 13. Will lot be regraded 0 sa.................. Will excess fill be removed from premises: Yes . . . 14. Name Name of of Owner oArchitectf premises .0 f U 0 1Cfaq~ •f;! A , , Address 4~4Nasrrn 20,, , Ar, oy~, Phone No...76fi : SS 7.1.. . • . Address Phone No.. . 15. Name of Contractor`3bb . , Address oLPMOArn+?P.,. Phone No...•).v . S.Gr.9n.., Is this property within 3 0 feet of a tidal wetland? *Yes No..~QA 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. SLL,, /h ,ac~et~ SN61s7-' Ili APPROVED SNOTED - ti ow -x,132- FE Ely: - NOTIFYFY BU DEP FT 765-7802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. n ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS I STATE OF NEW Yg! S.S COUNTY OF ?u.`.. . o~+' rf • , ~GG aN~ S , • • • , • • • • , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .......................o.N................ (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 ,vork will be performed in the manner set forth in the application filed therewith. iwom to before `me this FvF. ryyof. . • 19 q? Votary Public, County ROB G 2 . y (Signature of applicant)