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Home My WebLink About20614-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20909 Date AUGUST 3{ 1992 THIS CERTIFIES that the buildin~ ADDITION Location of Property 3570 MINNIEHAHA BLVD. House No. Street County Tax Map No. 1000 Section 87 Block 3 Subdivision Filed Map No. SOUTHOLD~ N.Y. Hamlet Lot 7 Lot No. conforms substantialiy to the Application for Building Permit heretofore filed in this office dated MAY 4, 1992 pursuant to which Building Permit No. 20614-Z dated MAY 6~ i992 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 OUTSIDE DRESSING ROOM ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. LUCY MICHAELS (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A JULY 29~/ 1992 - THOMAS A. TAGGART Rev. 1/81 FO~lt~ NO. ft 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? 3051~Z Permission is hereby granted to: .~?.~.~ ........ ~..../,~... . ~~).~..~....~..~..~z/ . . ....... ...... ............... ................................. .......................................... ~_.~Zz_~.z..z. .................. ~.~ ~ ~ ,o. ,00o ~.~,,o~ ..~..~ ........ ~,~ ........ ~ .......... ~o,,o ...... ~ .......... ~.~.~, ,o ~,,~,,~ ~,~ ....~....~ ....... ~ ............ .,,.~ ~,o.~ ~, Bulldlng Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ~I~LL 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 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. Subm%t Planning Board Approval of completed site plan requirements. B. 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. 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. 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 $15.00 Date ..7l~.{/2.~. ............................. New Construction ........... Old Or Pre-existing Building... f Location of pro ert,, . .Tzo . House No. Street Hamlet Onwer or Owners of Property ............................................ County Tax Map No 1000, Section....~,,L ...... Block .... ~. ........... Lot.. Z. ................. Subdivision ' Filed Map Permit No.~.¢.4~.].~...Date Of Permit ~-- .Applicant. Health Dept. Approval ......................... · Underwriters Approval ........................ . ~ Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ............ Fee Submitted: . ......................... ................... CO .o2 APPLiCAnT TOWBt OF SOUTtIOLD ' OFFICE OF BUILDING INSPECTOR P.O, BOX 728 TOWN IIALL SOUTI-tOLD, N.Y. 11971 TEL. 76%1802 C-C E___R T ~ F I C A T i 0 N Date I certify that the solder used in the Water Supply system Contains less' than 2/10 of 1% lead. Sworn to before me this 193 . ';otars, Vubii¢, <J~"C'Qb\k ~County INSPECTORS Victor Lessard P~incipal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD a-OLY 20, 1992 ALBERT T. FICligI$SEN 575 a-ENNINGS ROAD, BOX i451 SOUTHOLD, NY 11971 RE: LUCY HICHARLS 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 0e~.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 ~ 20614-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 'OU?_~DATION ( 1 st) ~OUNDATION (2nd) tOUGH FRAME & .PLUMBING £NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: Examiued ....... · .... '..'.: '.,' ]9... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF ItEALTIt , s Ts oF PL., ,s .<."'"'. SURVEY ..... SEPTIC F 0 RI'I I';OT I PY ~ . .'?AS.x ........ HAIL TO: INSTRUCTIONS a. Tlfis application must be co~npletely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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 >r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- zation. 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 ;hall 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 ;hall 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 ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ?,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, ans~ regulations, and to :dmit authorized inspectors on premises and in building for necessary inspectioj~s) /l // ~ --' (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ...................................................... Name of owner of premises .... f.~.?..c.~....~..f.~.~.~.~.tt.,q. ................................................. (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 .... /..~.~.".~.~..f/'.~. .......... Plumber's License No ......................... Electric, Jan's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. }louse Number Street Hamlet Z 7. 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 .... . ,~$.t.~.o-I ,~,?¢ ................................................... b. Intended use and occupancy .... ~'-~ ~ ~ ~ ~ ~ ':': ' ' Nature Of work (check applicable): New Building .......... Addition .....Pf~..... Alteration which Repair Rem?al .............. Demolition ... Other Work ......... 4. Estimated Cost ........... ~. ..................... Fee ..................... ! (to be paint on filing this appli~a~tion) 5. If dwelling, number of dwelling Units .... ~ ......... Number of dwelling units on each floor../o'./.~. .......... · If garage, number of cars ..... , . 6. If business, commercial or mixed occupancy, specify_ na ure and extent of ..... , · ~ , eac t peofuse ............. · ......... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth I Height Number of Stories 8. Dimensions of entire new construction: Front,.. J' / Rear ,.:.,.. Depth Hight Nub ~'St ries~ '' ~; ' 9 Size oflot: Front I.'-. ' R~ar · ' ....................................... Depth ...................... Date of Purchase . 10. · · ·: ................. Name of Former Owner .......... 11. Zone or use district in which premises are situated ................... 12. Does proposed construction viol4te any zoning law, ordinance or regulation: 13. Will lot be regraded I ................................ 14. Name of Owner of pr;~i}~s' ~.' ~i+i ..... ' .......... Will excess fill be~removed from premises: Yes No · ~T}.t¢~O¢(~. ....Address ....~.o.q .'~..~. .......... Phone No. 7~.~.¥ ~.~-/~.. Name of Architect ..... ~-; ............... Address . ~,~ ............... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Tpwn 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 nlumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE'C~YO,4RI~,. S S 2OUNTy OF .,Q..o.-t'(-..o.tl.~. (Name of individual signin~ contract) ...... being duly sworn, deposes and says that he is the applicant ~.uh~-~ named. ~ ' leis the ' ff~{ ~ (Contractor, agent , corporate officer , etc. ) ,f said owner or owners, ~d is duly ~uthofized to perfom or have perfo~ed the said work and to m~e and file this pplication; that all statements contain,ed ~ this application are true to the best of his knowledge and belief; and that the fork will be perfo~ed in the manner s~t forth in the application filed therewith. .worn to before me this ........ ~.~ ....... day of. 'I" '~ .........., 19~ .......... ................ ~o. 52-8125~.~1~ (Signature of applicant) etm GENERAL CONDITIONS Inspections 1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determ'ine whether the permittee is complying with this permit and the ECL. Such representative may ordler the work suspended pursuant to ECL 71-0301 and SAPA 401(3). A copy of this permit, including All referenced maps, drawings and special conditions, must be available for inspection by the Depalrtment at all times at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and ReneWals 2. The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the ~permitted activity is exceeded or a violation of any condition of the permit or provisions of t~e ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material mfqrmabon is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since thle permit was issued. 3. The permittee must submit a separate written apptication to the Department for renewal, modifica. tion or transfer of this permit. Such application must Include any forms, fees or supplemental infor. mation the Departmeni requires. Any renewal, modification or transfer granted by the Department must be in writing, i 4. The perm ttee must submit a renewa applicat on at least a) 180 days before exp ration of perm ts for State Pollutant Dmcharge Elimination System (SPDES), Hazardous Wastel Management Facilities (HWMF), major Air Pollution Controt (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order orldetermination previously issued by the Department or any of the terms, con- ditions or requ~rement~s contained in such order or determination. Other Legal Obligations of iPermittee 6. The permittee has accbpted expressly, by the execution of the application, the full legal responsibili- ty for all damages, dir~ct or indirect, of whatever nature and by whomever suffered, arising out of the project described i~ this permit and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from this project. 7. This permit does not cbnvey to the permittee any right to trespass upon the lands or interfere with the r par an rights of others ~n order to perform the permitted work nor does it authorize the impair. ment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee ~s respods'ble for obtaining any other permits, approvals, lands, easements and rights- of-way that may be required for this project. Page 2 of ~/' ~PPROVED AS NOTED NOTIFY BUILDING OEPARTMENT AT 766-'t802 9 AM TO 4 PM FOR THE FOL~WING IHSPECTIONS: ~, ~OUNDATION - TWO ~EOUIB~D F~ ~RED COnCrETE ~ ROUGH - FRAMING & PLUMBING ~ I~U~TION FINAL - CONSTRUCTION MUST BE COMP~E FO~ C.O. ALL CONSTRUCTION SHALL MEET THE ~EGUI~EMENTS OF THE N.Y. ~TATE CONSTRUCTION & ENERGY CODE~. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS OCCUPANCy OR WITHOUT CERTiFiCATE OF OCCUPANcy OCCUPANCY O'R USE IS UNLAWFUL WITHOUT CERTIF(CATE OF OCCUPANCY