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HomeMy WebLinkAbout20702-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21006 Date SEPTEMBER 11, 1992 THIS CERTIFIES that the building ADDITION Location of Property 150 TERRY LANE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 65 Block 1 Lot 4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 5, 1992 pursuant to which Building Permit No. 20702-Z dated JUNE 9, 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 The certificate is issued to HOWARD & GRACE POLLACK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A 01iiding 1sp ctor Rev. 1/81 FORM NO. i 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) WN! 20702Z Date l.pll............................., 19. Z Permission is hereby granted to, J f p~ to ~ . at premises located at f ~ County Tax Map No. 1000 Section . ~J~G Block ......X .......Lot No..../lLl.......... pursuant to application doted .....i... . .'r... 19.Y and approved by the Building Inspector. Fee Bui" Iding Inspector Rev. 6/30/80 E Form No. 6 TOWN OF SOUTHOLD BUILDTOWNING I jqut 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. 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's 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 .J :Iew Construction..../..... Old Or Pre-existing Building ....l.... Location of Property:.. L~........... l t5/d House No. ?7~~':~A Street Hamlet )nwer or Owners of Property ....AY x..~...~. :ounty Tax Map No 1000, Section., P.~ 5......Block.....!.........,Lot ;ubdivision.gg ................Filed Map.......... .Lot...... 'ermit No..0~Q7q?; Z,..Date Of Permit.. ....Applicant. ......'Y lealth Dept. Approval /J./A Underwriters Approval.. 'lanning Board Approval 'equest for: Temporary C/ertificate........... Final Certicate.,,., 'ee Submitted: 01 O Aw . APPLICANT D it..°..c .iJN PAT ro 1. I ~ ti *C3 FOUNDATION (1st) a FOUNDATION (2nd) za 2. ~ z ROUGH FRAME & PLUMBING y y 3 z m rri INSULATION PER N. Y. STATE ENERGY I t CODE R r 4 H FINAL k o o A DTTIOPIAL COMMENTS, s , m •v `w' H . H • } W N O r } o i cr) ro _ H BOARD OF HEALTH FORM NO.1 3 SETS OF PUNS TOWN OF SOUTHOLD SURVEY . . . BUILDING DEPARTMENT CIIECK TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:o~IFY Examined 197i' CALL Approved 19/.?! Permit No~ .D . lUJ IS I1 U Ly L TO . : . Disapproved a/c .`1 D ti BLDG.DEP7 TOWN OP SOIPPHOLD (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...5......., 19i?: INSTRUCTIONS a. This 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 shall 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins c 'ons. f . (Signature of applicant, or name if a corporation) Vk; (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. awN . Name of owner of premises ) ry,-Pc ACA 171 11C? , l "l ~iC , • . , . , . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate offi(cer) Builder's License No. . I.J.~.Q. 5.. I . , , , , , , . , Plumber's License No . Electrician's License No . Other Trade's License No . Location of land on which proposed work will be done . . House Number Street Hamlet j/ County Tax Map No. 1000 Section Block ....I 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 b. Intended use and occupancy ~4Qitia~, e 3. Nature of work (check which applicable): New Building Addition . Y........ Alteration . Repair Removal Demolition .Other Work . 4. Estimated Cost d O.,! (Description) 1 Fee (to be paid on filing this application) S. If dwelling, number of dwelling units Number of dwelling units on each floor , . b. business, sio s of ( r or m mixed d occupancy, specify nature and extent of each type of use g > number of 7. Dimenncommercial strixe • if any: Front , 6,5...... , , Rear .6S Depth . Z .4, • , • , , , , , 8 existing ...,Nu~berofStories..1.Y,,,,•,,,, / Dimensions of same structure with altesrafions,or4i4ditions: Front • p U.5 Rear .6S Depth , q.~4! Haight V, I......... . Number of Stories . r.k II 8. Dimensions of entire new construction: Front .3!.`4 . Rear 3)!~ N Depth .f b! 2y Height . I,0• ! • , , , , , , , , Number of Stories I . 9. Size of lot: Front J.4.t..,........... Rear LQ2.:a? 10, Date of Purchase -Depth c? SSA . I• . . . Name of Former Owner -1o . 11, Zone or use district in which pre 'miles are situated . • ~ • • • ~ ' ' ' ' ' ' ' 12. Does proposed constructio~~iolate any zoning law, ordinance or regulation: E~ , . , 13, Will lot be regraded IV ed " " " " " " ' be removed from premises: Yes 14. Name of Owner of premises2a a ,aQy,~ Will Address excess fill b Name of Architect cJ {f • • Phone No. 26,5, ; !fill , , , , . • . Address . Phone No. . Name of Contractor . Z1% Ep71S , Address (So. S40 µmao0I(,D • ne No. 15. Is this property within T300 feet of a tidal wetland? *Ye " " ' *If s...... o. Town Trustees Permit may be required. PLOT DIAGRAM' Locate clearly and distinctly all jbuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I l TATE OF NEW YO TA OUNTY TS O OF ; \ S1S me of individual lignin> ' ' . ' ' ' • being duly sworn, deposes and says that fie is the applicant (Na . . ~ act) )ove named, i e is the C.-A. civ toV............................................................. (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly 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 irk will be performed in the manner set forth in the application filed therewith. /om to before me this S....... .day 199, 1 1. ! +tary Public, Count ROBERT lR ' NOYARt P l ui'N•t. (Signature of applicant) Eel Mr9 81,19 tJ ~ rti rl :C ro ~Iti?.Y ~S+Q to _ (r. A ~ i1~ CA ~j~ 1 ~ i r+~ M l~ ~ ~ 11 { 7~ i Cl tti a a•;''~ ' C~ t, ~ ~ t~' v q 3' iV 6 y s GrJ E i G, Gl- (00.0 N U n U U "h z i A v a 'n -p ^ ~ J {tl r? S a_ b~ Ito! eam a { Je~~{ {JS ` R' .t i t.}7 +SI S 1 4 :+1 ~V (tl .,1 T ` -~"^'t'v N; R'rva F, ~ t*.. r b: ILL ~•1 t ~ - •.Inr JG - 2 tS An~- VY .n J M t_ ry rp 3 _ I uo ^ * OY 1 VI - U I ILI aW _ re - - I R; tLE - li co 4., I - Sze _a ° ` I µ -ice ~_~v ~J,.. i c5'rJ u , ~ YGtQMP .-_--c - - i I g~~V r i ~n 2~_ 2A5 CCR 7- 51011 PIP i Ala„ JNff) AS NOPA - nniE 6Y_3.Pa J~oz.~~©yy~ LL~~ f EE ~ BV ART OCCUPANCY OR 765-11 ROB BYLAW TO =4 PPM FOR DEPARTMENT THE _ TF kg ~ LA;1___ USE IS UNLAWFUL 1. FUOUNDDA AIN INSPECTIONS: 1. FTION - "TWOREQUIRID FOR POURED CONCRETE WITHOUT CERTIFICATE 3.- N UGATION AMING & PLUMBING OF OCCUPANCY S FINAL - FOR CONSTRUCTION MUST BE COMPLETE ALL CONSTRUCTION RUCTION SHALL MEN! THE REQUIREMENTS OF THE N.V. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR 1 OUI DESIGN OR CONSTRUCTION ERRORS JIAV - 51992 BLDG. DEPT. i l TOWN OF OUT 1) I rA,F i'.~r ryr , r^ i I 11II I it I IL `i),144 ,fV I DAR _ 7 yL z~.a (NRL42 I I i _ _ fl 64 H I' I II I I~ I' Y u I ---i! E cf-- Z7 LU Gxf (i Pf r:. Imo- i I iI II I~ I JUN - 5 IM D I it i Oro i + - I ~ BLDG. DEPT. TOWN OF SOUTHOLD 411- i r N+y II ~~i 1 4~ C~ ewn rE~e I 3y6 ~ a6E ~ Robb r~,~y 3oC(~ /l I I ~CF6 I 3CE6 b~- t( ' 1 i i ;obH I ipfF I i i it I rti6 ~r i I' 3066-~q--'3ob6 _ 3 bb _ I` c ° Y D66 ~ 1. W4 Ies, I o„ t I f BLOG.DEPG TOWN OF SODUiOLD JJ ~'.:LC