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HomeMy WebLinkAbout20619-zFORM NO. 4 TO~FN OF SOUTHOLD BUILDING DEPAR%~MENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z~20727 Date MAY 14, 1992 THIS CERTIFIES that the building ADDITION Location of Property 5875 PECONIC BAY BL~D. House No. Street County Tax Map No. 1000 Section i28 Block 1 Subdivision Filed Map No. LAUREL, N.Y. Hamlet Lot 3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 6, 1992 pursuant to which Building Permit No. 20619-Z dated MAY 11~ 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 DECK 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 UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JOHN J. & AMELIA M. MARTIN Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*-No. 206]gZ Permission is hereby granted to:/2 ,~) / , , ..... .... ro ......... ...~-/////'-'~("//' ' at premises located at ..~..~....Z.~..........~'~~:...,...~........~......~..,~ ........... County Tax Mop No. I000 Section ...... /.~....~... .... B~ock ........ ../.. .......... Lot No....~. ............... pursuant to application dated ..... ~/.~.. ................................... , 19.?....'f~., and approved by the Building Inspector, Fee $.....~...0.,....~ Rev. 6/30/80 _=,~ ......... · ...... Form No. 6 1992 ": ~PLICATION FOR CERTIFICATE OF OCCUPANCY TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 Ppre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic featares. 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 - $i00.00 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 ate New Construction ........... Old Or Pre-existing Building ................. ~' Location of Property..~. ~...~ .~--...~..~ ~ $.6~... ~....~./.. ~.~.~.~... ~ ~.~.~.~./... (.~ .~..~.~'~ Streel House No. Hamlet Onwer or Owners of Property ..... County Tax Map No 1000, S~ction..ff.~. ..... Block ..... ./. ......... Lot.....~. ................ Subdivision .................................. . . Filed Map .......... . . Lot .................... . . ................ Date Of Permit ................ Applicant.~.~...~..~.~¥~.~y'.~ Permit No Health Dept. Approval ...................... .... Underwriters Approval ........................ . Planning Board Approval ....................... . Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ........................... ~ ~p~ '' ~~.-//~Z~ ......... ?OUNDA~ION :OUNDATION ROUGH FRAME & (lst) f2nd) -PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: NOTE: · = MONUMENT REWS~O~S YOUNG & YOUNG JUNE~Ig?Y 400 0STRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG "SURVEY FOR: '" dOH~ d. MARTIN ~ AMELIA M. MARTIN .... 6 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD Of' HEALTII .... SURVEY ~" ............ CHECK .................... SEPTIC F 0 F,.H .............. Exami ~ed ~./~// ...... 19 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT CALL ................... MAIL TO; Date ................... 19... INSTRUCTIONS a. Tlils 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. 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 sh~all 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 all applicable laws, ordinances, building code, housing 6ode, and regulations, and to admit authorized inspectors on premises and in building for necessary~pecAions. ,-, --. ~natu~licant, c/r name, if a corporation) .............. ~ - .(Mailing addre_s~ of alSplicant].,~ r_.,.x ,-'._ -~.~../ ,,,'22, State whether applicant is owner, lessee, agent, architect, engineer, general contractor,%lectrician, plumber or builder. Name of owner o f premises...~. ~ .~.. F~f~.. ~.~.. ~~: . . .~Fff..~. f_/ (as on the tax roll ?r latest deed) If applicant is a corporation, signature of duly autt?rized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be'done... ~ >'~ .... · ...... ...... House Nmuber Street 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 .... /~-_-_-~..O...'79/. ~ ..................... ,.: ............................. b. Intended use and occupancy ... ~....~--: .~./.~ ..... .d?..O.....~..d~.4 c_~.jk..7~..J,:~.~J~.'; * .~. ,~ &~ ~ ..... ~ ~ .:".,';' ~., .............. 3. Nature of work (check which appii'cable): New Building Addition A~teration Repair .............. Removal Demolition Other Work ' 4. Estimated Cost .... : ......................... Fee , ,,._~..~..~. .............................. i (to be paid on filing this application) 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 olccupancy, specify nature and extent of each type of use ..................... 7 Dimensions ' ' ' if any: Front Rear Depth · of existing structures, ............................................ Height ............... Numbelr of Stories ......................................................... Dimensions of same structure withl'alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ...............Depth ............... Height ............... Numbelr of Stories ........................................................ 9 Size of lot: Front ' Rear · ' ............ ~ ............................... Depth ...................... 10 Date of Purchase i ............................... Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viotat~ any zoning law, ordinance or regulation: ............ 13. Will lot be regraded ........... i ................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..... I ............... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 15, Is this property within 30~ feet of a tidal wetland? *Yes ........ No *If yes, Southold ToWn 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 nu tuber or description according to deed, and show street names and indicate whether interior or corner lot. NOTIFY B UiLDI'i~G"- OEP~ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I, FOUNDATION . 'BA/O REQUIRED FOR POURED CONCRETE 2,ROUGH. FRAMING & PLUMBING 3.INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. S'J~'fE CONSTRUCTION & ENERGY C©DES, NOT RESPONSII~LE FOR DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEW.XO~K, :OUNTY OF... 2tt ¼[ ...... ......... , .... .... .... (Name of individual signingj contract) bove named. . ........ being duly sworn, deposes and says that he is the applicant · 1 e is the ..., ..................... l ....¢u.~ ~ j (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this >plicatlon; that ail statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner sqt forth in the application filed therewith. ~orn to before me this //~ 1' ............ otary Public, ~:'~ff~'" ' '~\~; ~ '~'~' :: ~/_~._~..7~ County ~ /9 / / Z