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Home My WebLink About20603-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21028 Date SEPTEMBER 18, 1992 THIS CERTIFIES that the building Location of Property 300 MARION PLACE House No. County Tax Map No. 1000 Section 31 Subdivision ADDITION EAST MARION~ NEW YORK Street Block 8 Filed Map No. Hamlet Lot 12.10 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 30, 1992 ~ursuant to which Building Permit No. 20603-Z dated MAY 4~ 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-247426 ~ AUGUST 20, 1992 PLUMBERS CERTIFICATION DATED N/A HENRY & DOROTHY ST. GEORGE Rev. 1/81 l~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne_N?` 2050~Z Permission is hereby granted to: .................. ~..~..:...~~....~..:..~ ...... /./..~..~.~ ....... emises Iocate~ ~.U.~.~, ~.~._~ .~ ' at pr at ... ' ~ ........ .~..g'~a...T~.. .... .~ ........ County Tox Map No. 1000 Section .....~,.]~:a~.~ ........ Block ...... .~...~ ........ Lot No .....].~.:./....D. ...... pursuant to opplteation dat~:l ........ ~. ........................ , 19..~...~..~ and opprove~ by the Building Inspector. Fee $...~.~).:..~.. Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 : 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 f~om 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 an~'~ 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..Cer.tificate 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.T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ate ..... ..... t/' ' few Construction. .......... Old Or Pre-existing Building ................. .ocatton of Property,.. ~p~..'.. ~Y~t0.kT...~Lr. ~.R · .~. · x.. q ". House No. Street Hamlet 'nwer or Owners of Property ounty Tax Map No 1000, Seetion...~A:~.] ..... Block ..... [~.~ ...Lot. ubdiviaion .. .................................... Filed Map ............ Lot ...................... ermit No,~.~.~ ...... Dat~ Of Permit..~.!~..~..~.Applicant.~~ .~.~?~ ealth Dept, Approval .......................... Underwriters Approval~f .~..~..~.~...~.~.~..~... [arming Board Approval ........................ -~quest for: Submitted: $ . .- co ' 3. ,- Temporary Certificate ........... Final Certicate ........... · ~PLICANT ' '" ~ ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY BS JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT Lot FIXTURE OUTLETS ~ECEPTACLES SWITCHES FIXTURES RANGES ~OOKING DECKS OVENS DISH WASHERS DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIFARCLOCKS SERVICE DISCONNECT S E g OTHER APPARATUS: c .o. o~.E.cc=co"t~.,~ / ^. w o rio oF HI.LEG. A, W G, NO, OF NEUTRALS A. W O OF CC, COND OF HI-LEG OF NEUYRAL GENERAL MANAGER 11 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ?OUNDA~ION (1st) ?OUNDATION (2nd ] IOUGH FRAME & INSULATION .PLUMBING FERN. STATE ENERGY CODE FINAL ADDITIO~A'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ~ ~ 76S.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING f ] FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL, SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ''~D ~ , 19 ee=it No : -301992 Disapproved a/c .............................. ~ ~.'~ . . . (Building Inspector) APPUCAIION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEAL]tH ......... ~---'0 SETS OF PLANS .......... '.~--SUR VEY ................... .~CllECK .................... SEPTIC FORH .............. 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. e. 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. b. No building shall be occupied or used in whole or in part for any purpose whatever untiia 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 necessarx ~nspections. ~% -- , (Sigm~nt, or name, if a cd, ration) · .o. ............ (Mailing address of applicar)t) ,., / ! ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~.~..~, .~."/..]Y).,..~.~)O../~.. ~. }( .-5,'.~,. ~.~..~..'~, .~.~f-'. .......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth.,orized officer· (Name and title of corporate officer) Builder's License No. ~.D.. [ .~...p~?J. ~ FF_., L.~...6Q ~ 'i-¢1 ~eL? Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be'done... ~..~.~....~..~.~. !0..~/.. ¢('7 ........................ House Number * /¥1¢1~,6}o pC, Street ~/96 ~ ,q~, o w Hamlet County Tax Map No. 1000 Section .... ~.~..[ ........... Block .... .~. ........... Lot..~.... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.....~..-{.0M~.~.. ..... ................. :,.. ~:.,.?~,..%. ................ b Intended use and occupancy ............................... , ..... , ,. ?. ,., , .............. Estimated Cost .... ~ ~-O O, . ........ If dwelling, number of dwelling bolts ........ Nature of work (check which appiicable): New Building .......... Addition ...~...J... Alteration ........ '.. Repair .............. Remov~l .............. Demolition ............. '. Other Work ............... (Description) (to be paid on filing this application) ...... Number of dwelling units on each floor ................ · If garage, number of cars ...... ~ ........... 6.. f business, commercial or mixed ~ccupancy, specify na.t,ure and extent ............... of each type of use ' ............ · . 7. Dimensions of existing structures,,'ifany: Front ..... -~, ./ ..... Rear . .Z..~... ...... 'I~;t'h' i~ '.~'.' i ....... Height ............... Number of Stories ................... Dimensions of same structure with alterations or additions Front i/~i~.' '" ..... l~r' ' ' }~)' :' ........... Depth ..................... ~ Height ...................... Number of Stories ........... ~ . 8. Dimensions of entire new construction: Front ..... /'.,~. .......Rear .. ~... IL.. ...... Depth . ./.0 .......... Height ............... Numb!r of Stories.. ,/ ............. , ......................................... 9. Sizeoflot: Front ...... ~0.~,~ ........ Rear .... ~.' .~5'~.. ....... Depth .~.~ ...... 10. Date of Purchase ....... .~f.:..~i.Z'. ..... ' ......... Nam~ of Former O~vn~'../~..~.~../f. ~..~i~'~L) ........ 1 I. Zone or use district in which premises are situated ....................................... 12. Does proposed construction violat~ any zoning law, ordinance or regulation: . . .eiJ ~l ......................... 13. Will lot be regraded ..... , .....i · · · gO.fl .......... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises -~-~:~.~.~+~6'.0:t~,.~.Address Name of Architect '~' Name of Contractor .......... i ............... Address ................... Phone No ................ 15. Is this property within 3010 feet of a tidal wetland? *Yes...' ..... No.. J~.D... · If yes, Southold To~n Trustees Permit may be required. · . PLOT DIAGRAM Locate clearly and distinctly all bhildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block n~ mber or description according to deed, and show street names and indicate whethir interior or corner lot. STATE OF NEW YORK, COUNTy OF S.S 1 (Name of individual signing contract above named. being duly sworn, deposes and says that he is the applicant He is the ........................ ~ ....... i (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly 6uthorized to perform or have performed the said work and to make and file this ~pplication; 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 s~t forth in the application filed therewith. ~wom to before me this , ............ ........ day ........ Notary Public, , .~'~',..'~~ · County ~ \ ~ ix x~ · ' ~ JOYCEM. WILYqNS \ \ \~.. x[3[_ ~ . . _~ . of ......... No. ~6gi~, 8u k~u · . ' ~Ju~l~ ' ' ~ (Signat~e ofapphcant) 0