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Home My WebLink About20615-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20999 Date SEPTEMBER 10~ 1992 THIS CERTIFIES that the building. Location of Property 145 HICKORY ROAD House No. County Tax Map No. 1000 Section 54 Subdivision ADDITION SOUTHOLD~ N.Y. Street Hamlet Block 9 Lot 6 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 4~ 1992 pursuant to which Building Permit No. 20615-Z dated F~tY 7~ 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 DECK ADDI~ION 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/A PLUMBERS CERTIFICATION DATED N/A RONALD & VERONICA BUPRKE Rev. 1/81 "-y -~ild~ng lJsp&ctor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PEP.~IT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N°-N? 20615Z :.....~F.~...~.~ _~ ...... //..~z/ ~ , ..... ...~ ./tf-~...... fi .~. ...................................... ~ ..... ./ .................. ~..~ ........................................................... ct premises loc~'/ ated at ....~./.~.......~~........./~/.~ ............................................................ .................................................. ........................................................ County Tax Mop No. 1000 Section ....... . .~.....~.. ...... Block ....... ~ .......... Lot No......~... ............... pursuant to application dated ...... ~ .................................... , 19..~....~, and approved by the 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 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, ~ certificate of Code Compliance from architect or engineer responsible for the building. ~ ~ 6. Subm%t Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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, 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 . ~.~/f~ ~. New Construction ........... Old Or Pre-existing Building.. Location of Property .... Z~..~.'. ...... Z.~.~...~.~....'~'~,'' ~ House No. Street Hamlet Onwer or Owners of Property..~.~.~.~... ~ ~.Z~/fC~ County Tax Map No 1000, Section....~.~.~. ..... Block ....... ~ ........ Lot.. Subdivision . Filed Map Lot ° . Permit No ...... ~. ..... Date Of Permit.. ~.~.. ~/~.! ~Applicant...~...~. ~....~...~.~-. ~. ...... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ..... ~.. Fee Submitted: $ ........................... ~PLIC~T INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wleczorek 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 AUGUST 24, 1992 RONALD & VERONICA BURK HICKORY ROAD SOUTHOLD, ~ 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: ww~ An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is ~___~e~/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 % 20615-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. ~OUNDA'TION (1st) ~OU~DATIO~U (2nd ~ tOUGH FRAME & .PLUMBING iNSULATION PER N i Y. STATE ENERGY CODE FILIAL ~DDITIOMR'L COMMENTS: ,% FORM NO. 1 TOWN OF SOUTHOLD UILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 1197'I BL))G. D~iP'F. i; TEL.: 765-1802 Disapproved a/c .................... t ................ APP~..ICATION FOR BUILDING PERMIT BOAED OF HEALTH '1 SETS OF Pt SURVEY ''~ SEPTIC FOR:! DCte .................... 19... · I~STRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .'ts 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- ~tion: ' c. The work covered by tiffs application may not be c~mmenced before issuance of Building Permit. d. Upon approval of tiffs application, the Building Inspector will issued a Building Permit to the applicant. Such permit tall 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 tall 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 ailding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or -~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. .ac applicant agrees to comply with all applicable laws, ordinances, building Code, housing code, and regulations, and to ~mit aut~;rized inspectors on premises and in building for necess~~~..~ ...... (Signature of applicant, or name, if a corporation) '/5 / (Mailing address of applican£) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber'or builder. ~me of owner of premises /f~..O..~'..~ c-Z:' ~ /~r/-o ,~'l C ~ /3 6Me.'l< (as on the tqx roll or latest deed) applicant is a corporation, signature of duly authorized officer. ...... a title of corporate officer) Builder's License No Plumber's License No ......................... lectnoan s L~eense No. Other Trade's License No ...................... '"" l-Z,: Location of land on which proposed work will be done. / tV'~'"' ./.?~.,g'. ,..'F/CoW '/~..~. //7? / .......... .:..? .......... .~ ~.~':y .... louse Number Street Hamlet Co,nty'ra., mp 1000 Sec,ion 0.>7/. Block .... ?. Lot .. .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) gtate existing use and occupancy of premises and in tended use and occupancy of p reposed construe iion: I. Existing use and occupancy ..... .~<./..q~.~-e..~. /~'"'l 6 ,/ .~..,~..o.7. oc/~~ ~. Intended use and occupancy ....... Nature of work (check which a-i-)· . · ,-. . -,),denote): New Building .......... Add t on .......... ,\Iteration .......... i~epmr .............. RemovaI .............. Demolition ..... Other Work .. 4. Estimated Cost ............. ' (Description) 5 Ifd Iii numb f I Ill g ~nits N (to be paid on ~tin~ this application) lfg mb of ............. umber ofdwelling units on each floor... I[busin · · j ~ss. cofimercml or m~xed occupancy specify nature nd extent o feat 7. Dnnens~ons o~ exis ' . . h ty~e of use .. · , . ~ ~ingstmcture~ fiat y. Front ~ D ~ ....... : ='= ....... ~clgnt ..... ~ xt- ., ................ ,,ear ... ~.-- De-th ~ ' ..... anunlooro Stories ~ ........ " ' .............. ~. ,~,~ w~t l mteratlons or additions. Front ~ .... Depth ...... ~'~ · · H ', ' ~ ~' '. .... Z ..... Rear , . · .,. e~l, ~t ....... ~ , · ......... 8. D nenstons ofentirenew ..... ~ ~ _ · ........... Nt tuber of Stones . Height ............... Numl~erofStnhe~ .. Rear ............... Depth ............... 9. Size of lot: Front /o o .......................... , . ...... ""%'~'*~"1 ......... . Rear . . /~o ..... &' ~.' ..... ;'~'2 ............ 10. ~ateo~rurcnase . . /! ~ /~/ ' ~ ................. Deprn ..... l.~ ~ 11. Zone or use district in which .................. t~ame of Fenner Owner .~.q~ .~~ · prennses are situated... 12. Does proposed c ................................................... 13. onstruct on v~o ate any zoning law, ordinance or regulation: .... ~.q ........................ Will lot be regraded ...... ~ . . 14. Nme of Owner of nremis~s~a~' ~'~b;,'2'aL~I1 excess ~1 b9 removed from premises: Yes Nme of Architect ~ ..... ~a~ess .~. A .~tq~qy (~.~i~ ~/~ . ........... '~; ............... Address . ' .............. N~e of Contractor ........ ~/~ ................. Phone No ............... ~5. Is this property within 30:0' ~' ~' ~' ~55' ~ddres~ . .,., ................ Phone No ................ .... a~ wet~anag ~Yes ........ No..~.~... ~If yes, Southold To~n Trustees Permit may be required. ....' [ PLOT DIAG~ Locate clgnrly and distinctly ~1 ~' ' buildings, whether existing or proposed, and. indicate ~1 set-back d~ensions from ~ropeNy ~nes. Giv~ street ~d block n~mber or descNptio~ according to deed, and show street n~es and ~dicate wh~ther nteNor or comer lot. · TE OF NEW YORK, S.S !5'1' I°°° ...... (~/ ............... ,;" .............. being duly sworn, deposes ahd says that he is the appli t ~ named, amc of individual signing c )ntract) can (5~ u,'~,. ~. ~C ', 3 the , (Contractor, agent, Corporate officer, etc.) :aid owner or owners, and is du y autO,or zed t~ perform or bare lication; U~at all statements contained in this appl cation are t performed the said Work and to make and file fids - . rte to the best of his knowledge and belief; and that tt~e kwdlbcpcrfo~cdmt/e ~anncrsetforth , ........ .m to before me this [ ..... therewifln .... ................. ~ ....~AT~t-~g ~9 .... ', ...... County ~ ~eg, No. 4906784' l Be~ified in Nassauz9~u~D ' · M~ gommission ~pims~ (Signature of applicant)