HomeMy WebLinkAbout20926-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22833
Date J~RqTJARY 11, 1994
THIS CERTIFIES that the building
Location of Property 1550 CENTRAL DRIVE
House No.
County Tax Map No. 1000 Section 106
ADDITION
Street
Block 2
MATTITUCK~ N.Y.
Hamlet
Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AHGUBT 28, 1992 pursuant to which
Building Permit No. 20926-Z dated AUGUST 31, 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
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ALAN R. CERNY~ JR.
Rev. 1/81
/ /ilding Inspector
rOztM NO. 0
TOWN 01: SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥,
BUILDING PERMIT
(THIS PEPJ~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N N? 20926Z
~ Building Irksl:mctor
J/!!,,1 I O 1''
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
~his 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 ~ith 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.
Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
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 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
New Construction ........... Old Or Pre-existing Building.....~. ...........
House No. Street Hamlet
Onwer Owners of Property AL~.~ ~ ~E~J~.
County Tax Map No 1000, Section...~.~. .... Block. ~.7.~ ....... Lot.
............................. Filed Map ............ Lot ......................
Subdivision ./~../.~. . .
Permit No .... Date Of Permit.. : ~ .Applicant .......... .~ '..
Health Dept. Approval .... ..... .~../.~. ............... Underwriters Approval ..... A~ ..................
Planning Board Approval ..... .~?./.~ ..............
Request for: Temporary Certificate...~/.~.~... Final Certicate.[.~., ......
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wleezorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone (516) 765-1802
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
December 29, 1993
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
Mr. Alan Cerny, Jr.
1550 Central Drive
Hattituck, NY 11952
To Whom This May,Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xxx
XXX
An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is (cut~atcd/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(Ail permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # BP# 20926Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
765.1802
BUILDING DEPT.
INSPECTION
INSPECTOR ~) ~.-~.,.,~~,~~'
'~OUNDA~ION
(1st)
~OUNDAT!ON (2n~ ~
ROUGH FRAME &
.?LUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FI~IAL
ADDITIONA'L COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
1
1971
,' T;~V'&~(; ', :;'" SOUTHOLD,
~ ........ ~ ....... - ....~ ', TEL.: 765-18011
Examined .....
'ppro,'ed
3isapproved a/c .....................................
.. ~,(B~l~lding Inspector)
APPLIDATION FOR BUILDING PERMIT
INSTRUCTIONS
BOARD OF HEALTII .........
3 SETS OF PLANS ..........
SURVEY ...................
CHECK ~ .........
CALL . . .; .....
HAlL TO:
a. Tlds application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3
',(s 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
rCareas, 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 this applidation may no~ be commenced before issuance ~)f Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
:all be'kept on the premises available for inspection throughout the wbrk.
c. No building shall be occupied or, used in whole or in pazt for any purpose whatever until a Certificate of Occupancy
:all 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
2gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described·
'lc applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and ffaegulations, and to
imit authorized inspectors on premise~ and in building for necessary~ ~.._~.%&.
-- : (Signature of applicant, or name, lq~oration)
.k).',j.
(Mailing address of applicant)
:ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..... ...... : .................................
amc ofownerofnremises ~.k~ ~--~k,~\/ T~- DATE' ~,?~_..-B.P. #~t~j~Y
i' ............................. ~Z~,.4, .......... d. ,~: .~.
(as on the tax roll or latest delOrES: ~___ 8Y:~.
' NOTIFY BUILDING DEPARTMENT AT
applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE
title of corpora, re officer)
Builders License No...(-,)..iN)g.i'.....,
Plumber's License No
Elcctrisian's Lkcnse N~ .......................
Other Tr~dc's License No ............
FOLLOWING INSPECTIONS.
1. FOUNDAiqON - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3- INSULATION
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C.O.
, ~..~ ~,_~ [ALL CONSTRUCTION SHALL MEET
~*J~ ~'qfNE REQUIREMENTS OF THE
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
Location of land on which proposed work will be'done ..................................................
.......... . .: .........................................
Ilouse Nmnber Street Halnlet
County Tax blap No. 1000 Section , IO.~. ~..t~. Block O Z., O.Q Lot f2tj./: 0..~>.. ....
Subdivision ' Filed Map No Lot
·" (Name) ...........................................
State existing use and occupancy of premises and intcuded use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and 6ccupancy ~.~. ~.4..'.'~.
3. Nature of work (check which applicab e)' New Building Addition .....
R ~ ..................... Alteration
Repair .............. emoval .............. Demolition ....... Other Work ...............
4 Estimated Cost --
' Fee
· . · ! (to be paid on filing this application)
5. If dwelhng, number of dwelling units ............... Number of dwcSlling units on each floor ........
~ If garage, number of cars ! .......
6. If business, commercial or mix!d occupancy specify nature_and extent of each type of use ..................
7. Dimensionsot'existingstructu(es, ifany: Front... .~..'~.~... Rear lll~.-, . Depth '.., .....
Height ............... Number of Stm4o~ '' r ...... ~,~]~. · ·
Dimensions of same structure with altar-*; ...... 4,m: .... n ' ' ' ' ' 29'~'~; .............. Oe:& ..............
Denth I.~.'~.: . ' u~:_,., i~_ ~.is~aer~1. .'1.1r1': ....... Rear,.-i;,'~.~ .............
~.'- . ' . ' ...... i' · · ,,cx~t .. ~,..'an;., ~,-~l~.--Z. Numh~r,~fStorio~ ~u/'~.
8. Ia~mens~o~:~of~enhrenewconstlmction:Front . .OJ.~ .... ~o,, i~2¢. ~'~T,~."'i~'~a.t .......
,.~g,~ . .,o..~n- .......... cqumoer of Stories .. · .~q. lT~'.' ..... '. ' ....
9. Szeoflot Front .... I ,, '' .................... ' ..........................
· · : ............ t~ear ...................... Depth .....................
10. Date of Purchase .......... ! .....: ..... ......... Name of Former Owner ............................
I 1. Zone or use district in which pr~mises are situated ..............
12. Does proposed construction violate ~iny zonim, law o-q---~-.f,,; ~-~,.'. ~+~,-' ' ' '~']-~ .......................
13.. Wdllotbe'regraded . . OI · , . · ·
..... . j~O.~ r;.' ~ '~'.:-:.' ~..:,z'"'"~,'__ ..... Will qxg~s fill be removed from nrem~ses' Yes
14. ,~ame ot uwner ot premises r'~ .~154 ..~m~... AddresJ..~...~--~.~.:.. Pblone No.~r..a~.r~ll..
Name of Architect . ,
........ · ................. Address ................... Phone No ................
Name of Contractor ....... 4 · · · .... Address ................... Phone Mo ...............
15. I~ this property within' ~00 'f'e'e't' ;'f' ~' tidal wetland? *Yes ........ No..~. .....
· If yes, Southold ~own Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly alll buildings, whether existing or proposed, a~d, indicate all set-back dknensions from
property lines. Give street and blocklnumber or de ' ' -'
interior or comer lot. . scnption accordm~ tu deed, and show street names and indicate wh~ther
STATE OF N£.~ORI~
cou rv (.g..
.........
(Name of individual signing co~tract)
~bove named. '
'lc is the .......................
....... being duly sworn, deposes and says that he is the applicant
said owner or owners, and is duly
Pplication; that all statements contair
~'ork will be performed, in the manner
;worn to before me this
............ ,K.Z~..9 ..... day,,of i -,...~. a.,~,~..~/~? ~ ot ~
· , ' ' ( i O -. , / %
~bl~,Sl~eofN~Y~ . ~ ~ ~ ~ ~ ~1 . { ~
NO, 4879505 ~ . ' ~ '~' '~ ......... ~. ~~
lc ~]gn cant)
~mtsslon E~lres O~m~ 8, le~ ~~
· (Confractor, agent, ................................................. corpora.te officer, etc.)
mthorlzed to perform or have performed the said work hnd to make and file this
ed in this application are true to the best of IHs knowledge and belief; and that the
;t forth in the ~/pplication filed therewith.