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HomeMy WebLinkAbout20561-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20966 Date AUGUST 24t 1992 THIS CERTIFIES that the building Location of Property 2850 PECONIC LANE House No. County Tax Map No. 1000 Section 74 Block 3 Lot 17 Subdivision Filed Map No. Lot No. ADDITION PECONIC~ N.Y. Street Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 16t 1992 pursuant to which Building Permit No. 20561-Z dated APRIL 17~ 1992 was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is CEMENT BLOCK FOUNDATION UNDER PANT OF EXISTING D~Lr,ING AS APPLIED FOR. The certificate is issued to of the aforesaid building. OLIVE H. MURRAY (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 lrOB~ NO. · 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.° 20561Z Permission is hereby granted to: ...... ............................... /at premises located at ....'.~.....~....-~...~..........~...~.../'..q~ ..................................................... County Tox Mop No. 1000 Section ...... .~.....~.... ...... Block ...~. ............. Lot No ..... ../...Z. ........... pursuant to application dated .... .~././..'~.. ........................................ 19..~.....~, and approved by the Building Inspector. Fee $......~...~..~ Rev. 6/30/80 Form No. 6 TO~qN OF SOUTUOLD 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 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. 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 - $i00.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date · · Construction ........... Old Or Pre-existing Building ................. ~cation of Property,.~.~.~ House No. Street Hamlet Owners of Property .......... unty Tax Map No i000, Section....~...~. ...... Block .... ~ ......... Lot .... I.7 ................ bdivision .................................... Filed Map ............ Lot ...................... ............... rmit No ......~ ~' .Date Of Permit pp .... -~- .... \ alth Dept. Approval .......................... Underwriters Approval ......................... ~nnieg Board Approval . · ~uest for: Tcmporary Certificate ........... Final Ccrticate ........... FOUNDATIO:~ ?OU~DATIO:~ _~. (lst) ~0UGH FRAME & -PLUMBING (2nd) rNSULATIO,~; PER N. Y. STATE EZ:ERGY CODE FI;;AL 765-1~02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE~INSPEC~~~ ~ 76S-1802 ./~~BUILDING DEPT. /~ INSPE(:TION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 BOARD OF HEALTH ......... 3 SETS OF PLANe; ......... SURVEY SEPTIC FORH o. . . · L ........ / TEL.: 765-1802 Examiued · Approved .... ~.'~. ..... , 19 .~...2.-.Permit No..,~...,.~..,~. Disapproved a/c ..................................... CALL HAlL TO: APPLICATION FOR BUILDING PERMIT Date ........... 19 .C. INSTRUCTIONS a. This application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 lets 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 this application may not be commenced before issuance of Bui/ding 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa~sp, ections. · [ .'~-~* ............. ]'.~OL.,t~f,-ca.oOrPOr tion'~"---a-'--) .... ~ (Signature of applican't, or name, if a .... (Mailing address of applicar/t) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .... -F. ............................................................................. 4amc of owner of premises ...~,./..I;C ..... ./~..d/./7..r'~.qy .................................................. '(as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No..../.~..O. ~. ~....~..~.. ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade s License No ...................... Location of land on which proposed work will be' done.. ?.~<.;>:q,?-. .... -.~...,,//... z. ! vX .................... i1 ,, ........................................... ..................... ¢ 1_~¢.~..,~:~.,.~ .... House Number Street Hamlet County Tax Map No. 1000 Section .... ~..~. .......... Block ....~.~. ............ Lot../. ~. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: ~. Existing use and occupancy .... xu5 C.C...;A ....................................................... ,. Intended use and occupancy . "5. ~ ........................................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratio., · Repair .............. Removal .............. Demolition .............. Other Work 4. Estimated Cost .... "~ ,' '~" .... ............................... Fee ......................... / (to be paid on filing this applicJti 'U 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 qf use .~./. ~...}.. :-:: ....... 7. Dimensions of existing structures, if any: Front...~../. f. ...... Rear .... .,q-. 1 ...... Depth . . . Height . . . ./.7~, .'~ ......Number of Stories . . . a~.. ,': ................................... 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 .. 2P ................ 10. Date of eurchase .... /..~.~' .... N~meofFvrr.'-:'©v,'r,': .~4.~t.~..~.~..,~..~..(.~ .'5.~-f?.'. 1 I. Zone or use district in which premises are situated...~.'~..~../.~..~..A~: .?'5: ............... 12. Does proposed construction violate any zoning law, ordinance or regulation: . ./~,'{ y? .................. 13. Will lot be regraded .../~. -0 ...... , .............. Will ex, tess fill-be removed.from premises: Ye. No X' 14. Name of Owner of premises '~ t , I '- , Address ' ' ' ' Phone No. Name of Architect .......................... nAddress ..:.... ....... i ...... Phone No ........... :~, Name of Contractor ~.-A°/q~,/~.. ~.~'.//./.~./..~?..~..~Address ~.'~x?..6',..?. ........ Phone No. ~:''- '~£- ;)' ~''-'" I5. ls this property within 300 feet of a tidal wetlaud? *Yes ........ No...~ ..... · If yes, Southold Town Trustees Permit may be required. PLOT DIAG P~d~{ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK .... .. ,, ... ~2, c' ~ ~"*',, "Y ............... being (Name of individual signing contract) above named. ':~ ;" ::;~['~ 'i'~i.~, r~HA[!. MEET duly sworn, deposes m~d says that he is the applicant 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 set forth in the application filed therewith. Sworn to before me this ' ~ ublic ....... ~'' ' ''~' /' C' "'~' ' '~' '~'?' ' ' County ,,,*~:o. ~,,~..'-- (S'igl/ature of applicant