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HomeMy WebLinkAbout20642-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20761 Date MAY 29~ 1991 THIS CERTIFIES that the building Location of Property 125 RACCOON ROAD House No. County Tax Map No. 1000 Section 106 Subdivision ADDITION MATTITUCK~ N.Y. Street Hamlet Block 10 Lot 12 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 18, 1992 ~ursuant to which Building Permit No. 20642-Z dated MAY 21~ 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 AN 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 W. RICHARDS & JOAN M. FRAKER Rev. 1/81 TO~N OF $OUTHOLD 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? 20641~Z Permission is hereby granted to: .~~-~....u..:~.:.....!..~.~.~.~ .... ,o .~~.....~...~...~...L...~...~,.......~....~~......~ ....... ........................ : .......... ........................... at premises located at ....~...~...~.......~ ....... .~.r~ZO.....~,. ..........~.~[~s,~ ........................ County Tox Mop No. 1000 Section ..... )....0.....~.. ....... Block ....... /....0... ........ Lot No ....../....~ ............. pursuant to application doted ........ .~..~d~....!...~. ..................... , 19~...."~..., ond approved by the ~j Building Inspector. Fee $.,~).:...~.. ......... Rev. 6/30/80 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN 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 I% lead. 5. Commercial building, industrial building, multiple residences and similar bnildings 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. 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 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 ~ew Construction Old Or Pr ........... e-existing Building ................. lIouse No. Street Hamlet nwer or Owners of Propert .~;.~.l -~ ~- : ounty Tax Map No 1000, Section ...... Block ............ Lot.. ~ ..... ~bdivision .......................... Filed .......... Map ............ Lot ................... ~rmit No ~. .Date Of Permit. .~. · .Applicant'S; ...... ~alth Dept Approval ' ' ......................... Underwriters Approw~l ............. [arming Board Approval ..................... :q~cst for: Temporary Certificate ........... Final Certicate.[~ ...... e Submitted: $ ............. c0 FOUIlDA'TION ~OUND~TIO:! '~OUGH FRAME & -PLUMBING [;~SULATION FER N. STATE E};ERGY CODE FI;;AL (2nd ADD ITIOMA'L COMMENTS INSPECTORS (516) 765-1802 VICTOR LESSARD, Principal CURTIS HORTON, Senior VINCENT R. WlECZOREK, Ordinance ROBERT FISHER, Assistant Fire Building Inspectors THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor SouthoM Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 May 21, 1992 Mr. W. Richard Fraker P.O. Box 163 Mattituck, N.Y. 11952 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 {outdated/not on file.)$25.00 No Health Department Approval on file. XX No final inspection has been made. (PLEASE CALL OFFICE & ARRANGE FOR INSPECTION) No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PEI{MIT ~ 20642-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exaulined....~..~ .~.J .... 19 .~..'~'" L\pproved ....~ 0~k~,u .~..~ .... 19r]~ Permit No~'D,~>~' q& ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: Dhte .......... ~ ......... 19... INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ats 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- ation. c. The work covered by this applicatibn may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit t~ail 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 !mil 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. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessar~tions // ~ (Signature of applicant, or name, if a corporation) .... 7:... ~.~. ~..o.~.. (~. ,,~. ?.~-.~ .:.~..~,. l::..>'.~.,. (Mailing address of applicant) * t ~ 5- ~d ;rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 4amc of owner of premises '.d~. ~...[[5.e.-~'....4 .x-.-~..- .]~..~%.6.O..'C.c.,[..g' . . .o.~. D ................... (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician s L~cense No ....................... Ot mr Trade's License No ...................... Location of land on which proposed work will be done. fo~ - -'/0 - 2 ~ .... !..& .~¥. ~ ~ .~0.o. ~. ~.. d ..... /ff.~..~.. :.~ ?...~....,5'.~'....~. ~.9 >.':..~. ................... llouse Number Street Hamlet /c~-/' - 1© County Tax Map No. I000 Section . .'. v-., ............ Block .................. Lot ................... Subdivision ('-t/I ~ ~ ~<...?-.,,,e'. ........................ FiIedMap No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ./?.~-..,.v..m ~ /-I/-~ ~ b Intended use and occupancy ~ ~ ' 3. Nature of work (check which pphcable) New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition Other Work ............... ~. ~ ~- .~r~. ~ (Description) 4. Estimated Cost ............ . ........................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwefling units on each floor ................ . If garage, number of cars ...... , .............. 6 Ifbusi iai mi dl ..................................................... · ness, commerc or xe occnpancy, specify nature and extent of each type.of use ..................... 7.Dimensions of existing structures any: Front ......... Rear ........ ' .. Depth ................ Height ............... Number of Stories .......... Dimensions of same structure with alterations or additions: Front h ~ i ................. Rear .................. Dept ..................... Height ..................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............ Rear ............... Depth .............. Height Number of Stories 9 Size of lot: Front i 'Rear ..................................... ' ' ......... Depth 10. Date of Purchase ........... i .... Name off .............. ormer Owner ............................. I I. Zone or use district in which prmhises are situated ..................................................... 12. Does proposed construction violaie any zoning law, ordinance or regulation: .,Y'~..: ............ , .............. 13. Will lot be regraded ........ d~..o. ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........... , ................ Address ................... Phone No ................ Name of Contractor .......... ! ...... Address ................ Phone No. .5. Is this property within 3 0 feet of a tidal wetland? *Yes ........ No..~. · If yes, Southold Tqwn Trustees Permit may be required. '''' ... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from :)roperty lines. Give street and block n' tmber or description according to deed, and show street names and indicate whether .nterior or corner lot. rATE or NEW~,~ORIg, /]_ ~ 7_ S S .... ................. ( me of individual signingicontract) )ore named. being duly sworn, deposes and says that he is the applicant i (Contractor, agent, corporate officer, etc.) d i . said owner or owners, and is uly authorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the manner set forth in the application filed therewith. /om to before me ..... i....t{. ..... day of. ) ........ ~.~./..., 19... 'tary Public ..... "' "~~. · ' ' .~.~~. q~o u n t y nmmry Pu~..llo, 8tete of New York ............... HO. 487950~ ~' (Signature of applicant) Qualified J. Suffolk C~ourt~/_ Comml~ion Expires De~ember