HomeMy WebLinkAbout20593-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of %he Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23562 Date MARCH 21, 1995
THIS CERTIFIES that the buildin~ ADDITION
Location of Propert~ 1590 MILL ROAD ~A%TTITUCK NY
House NO. Street Hamlet
County Tax Map No. 1000 Section 106 Block 10 Lot 2.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated ~RIL 27, 1992 pursuant to which
Building Permit No. 20593-Z dated APRIL 29, 1993
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 A DECK ADDITION TO AN EXISTING OWE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to
HOWARD & PATRICA WOLBERT
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
(owner's)
Building Ins/tor
I~ORM NO. B
TOWN OF $OUTHOLD
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? 80§9~Z
Permission is hereby granted to: ~ ~ ,
~...~.~~~..~ ....................
~.~./.~......~~......~....~~..~.~,. .............................. ~ ............
/at premises~ocated at ..~....~.~...~.~'/~.....~..."~....~..~.K~ .........................................................
pursuont to opplicotion doted ...... .~.../.~..~... ................................. , 19..~T...., ond opproved by the
Building Inspector.
Fee $...~....O..¢..~
Rev. 6/30/80
Form No. 6
TOWN OF SOUTtlOLD
BUILDING DEPARTMENT
TOWN HALL
765-I802
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 contairs
less than 2/10 of 1% lead.
5. Co~ercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architmct or engineer
responsible for the building.
6.Submit Planning Board Approval of completed site plan requirements.
B'. F~r 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.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swirmming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5, Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.00
.//
B ~
~_~/~ z,~ ate ..... ~./,. ~../. ~. ~. ......................
New Construction.~..~..~..~... Old 0r Pre-existing Building .................. ~ ,
. House No~~ ~:Street ~Z/~/~amlet ~~W
County Tax Map No i000, Section...Z~~.........Block. ~ ...... Lot. ~ /
Permit N~~.J ~.Date Of Permit ..... ~~Applicant/~ ~~..~.~,.~~
~lealth Dept. Approval .......................... Underwriters Approw~l ..................... .. ..
Planning Board Approval ...................... ..
Request for: Temporary Certificate ........... Final Certicate..~. ....
..
· ..'. . ...........
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, NewYork 11971
Fax (516) 765-1823
Telephene {516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 3, 1995
Mr. Howard Wolbert
P.O. Box 280
Mattituck, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 20593-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
:OU?_jDATION ~ .. (
,!
~OUNDATION ( 2nd )
~OUGH FRAME &
-FLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
".., ~ ~//~ ~~ ~~'
FI~;AL
ADDITIONA'L COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROU~PLBG.
FOUNDATION 2ND [ ] ~ISULATION
FRAMING [~J/FINAL
!!il!'/~PR 2 81992 'row~ o~ Sou'rHoL9
........................ )/ ~ ~ ~ TEL: 765 1802
' '~TZ ..... "~'"
Disapproved ~/c
....
to
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .....
CALL
;g~ ~'v ........
MAIL ''
....... .<z~......~..
INSTRUCTIONS
Date .. '
a. Tiffs application must be Completely filled in by typewriter or in ink find submitted to t ' ' ' " '
acts of pIan~, -~ccurate plot plan to scale, l~e~ aCconging to schedule, he Building Ln-xpe~tor,
b. Plot pl~ showing location of lot and of build~gs on premises, relationship to adjoining premises or pubic
or areas, and giv~g a det~led description of layout of property must be drawn on thc dmgram whirls pa~ of t~s
~aQon. . / ' '
" c. The work covered by t~s application may not be Commenced before issuance of Bugd~g Pe~it
, ~. Upon approval of this application, the Building Inspector w~l issued a Building Pemit to the app~c~t. Such
shall be kept on the premises available for ~spection throu~out the Work.
c. No bulldog shall be occupied or used ia whole or in part for any purpose whatever until a Ce~ificate of Occupmm
~hall have been granted by ~e Bulldog Inspector.
APPLICATION IS HEREBY MADE to -
~uilding Zone Ordinance of *h~ ~ ~ _ the Budding Dep~ment for th~ ;~
~eeulations for ,h .... -,~ ~uwn oI ~outhotd, Suffolk Cra,. - ...... u~ce oI a B~Iding Pe~it
T~.i __ ,. ...... ons~mctlon of buildings .~a',- ~.ty, New York, ~d otb ..... ,- ,. . pu~antto t~
-,,~ -~p~cant agrees to cornel,, wit~ -,I - ~., ~dons or,alterations, or fo ¢ ~--~'~,~?zc ~ws, Ord~ces
admit autho~zed ~ ......... ~ z ~t a~- appucaole laws, ordinances . . ~r -emoval o[ demohtmn, as here~ d '
. -~,~,~ on premises and m bmldmg for necess ~ode, housm~ code, and regulation~S~e~
(Signature of amml~c;~t' [ ..... : ...........
· ~ - ....... or~me, ffacorporanon) '
.' ' ' ~- ~~.. ~ ~z~ ~
(~,~,~g ~dd~ or ~.~;) ...... ~"'
State whether applicant is owner, lessee, agent, ~chirect, engineer, general contractor, electrician '
.............
~o.,,~,~ ~o,, o~,~,~,'~;~> ........... :~~
lfapplicant j~ a corporatio~nature of duly authorized officer.
.................
Plum bet's License No ........ ~ ...........
Electrician's License No ......
Other Tradc5 Lic..*~ " '~ ~'
Location of land on which proposed work will be done:
...... .......
llouse Number ' · ...... ~ ....... t.~.5.
Street, . · ' .....
Hamlet' '
~o..,~,~,,,~,o~,,o. ..... z~: ..... :~,o., ...... /~.... ..... ~o, .... ~,.Z ...... :.
°'''''°' .......... ................ ..;;. . .
o~ nexis -. ......... Lot ........
' "no usc and occupancy of premises and intended usc and OCCUn~--~' '
,'-,~cy ol proposed construction:
~ e~..~~~, ..........
B. Intended use and ocaupanay.: ......~...~6
,~tccessory Buildlng ......... Fen ..... 0the
! · . · r Work.
(tn b~n filing this application}
o = · numocr of cars ..... l ......... ; ..................... f ...........
6. Ifbu~meg~,com ' · · ' . .......... · .........
.... mcrcml qr m~xcO occupancy, specify natur~and cxro.t ~--~ ....... c ,,~ ~
t. ~cnsmnsofexmtm~mcture~,ffany:Front ~/~/ ~ x/, /Y~2~ ~, .. ~
· ~ = uiatrlCt in XV[llCll p~cmlscs arc aituated... ~.;; , "
I2. DOeSnrOnoe~ .... + .... · · ,m . . .............................................
13 Wnl I~ b~ ;~ ~,,-~on v~ma~ay zoning law, ordmanKe or regulation: ....... fro ..................
., mtcct ........ ~ ........... Address ~ vh~.~ ~'
~ of Contractor .....~ ............. a~,~ .... ~
l~ ~ .~_ . , . , · ............................ Phone No ...... ~.
-~% ~aa ~roD~rty locaged wzthln PO0 feet of a tidal ~e~land? '*YgS...IUO.%~
ar ye~, Southold To.nj Trustees Permit may be required.
[ PLOT DIAG ~M
Locate cle~ly ~d dist~ctly ri ~buHd~gs, whether existing or proposed, ~d, indicate ri set-back
prope~y Hnes. Giw Street ~d block humber or description accord~g to deed, ~d show street n~es and ~dicate .......
interior or corner lot.
STATE OF NE~%YOR~, x . , /
. (Name a[mdividual sl~nn~g c~ntracO
' (COntractor officer ~tc ) .............
~ , agent, corporate , .
of said owner or owners. ~d ~s duly~autiorized to pcTform or have perfo~ed the sa~d work and to m~c and
application: that ~]1 smlcmcnts con,air,ed in Hfis application arc Iruc to Hm bcs~ of his kno~v[edg~ and bclicfiand
work will be pcrl'o~cd in tl~c m~ncr set forlh in tlic application fil~d H~crcwith.
Sworn ~o before me Hfis
No~a~. Public. · · ounW '
N~ Publi% State of N~ Ye~ .... . ,,.
No, 4951~64 (Signature of applic~:
Qualified In Su~olk Coun~ ~
Commission Expires May 22, 19 ......