HomeMy WebLinkAbout20710-zFORM NO. 4
TOWN OF SOU~HOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-21055
Date SEPTEMBER 29~ 1992
THIS CERTIFIES that the building
Location of Property 95 DEAN DRIVE
House No.
County Tax Map No. 1000 Section 116
Subdivision
ADDITION
CUTCHOGUE, NEW YORK
Street Hamlet
Elock 5 Lot 4
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 9~ 1992 pursuant to which
Building Permit No. 20710-Z dated JUNE 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 AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to JAMES & IMELDA CORCOB~%N
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
/~uilc~ing Inspector
~,~WM' NO. ~
TOWN 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)
No-No. ~O?lOZ
Permission is hereby granted to>~
................................
..... * . ..// ~..//..'Z.¥~
............ ~...,~..****~. ..... ~.~ .........................................................................
at pre'* ~s~l~ated at ............. ~~...~..: ....................................................................
County Tax Mop No. 1000 Section ..................... Block ~;~'~ Lot No.
,,/./~ ..............................................
pursuant to application dated .......... ...~....~.. ................. , 19..~......,~'.., and approved by the
Building Inspector.
Fee $...~.:,,,~,., ......
//~uil'ding Inspector
Rev. 6/30/80
SEP 2 2
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN ~ALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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
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.
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.007
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 - $i0.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ........... y..... .................. . .
New Construction ........ Old Or Pre-existing BuiLding .......
Location of Prope~yl ..... ~.$."~.. ................ ,...'./~..~...~..;. i..".~.'/*.' i°i i.~..~..~..
House No. Street
Onwer or Owners of Pro ertv ~~ ~ ~~
County Tax Map No 1000, Section.. JJ.~ ........ Block ....... k ........ Lot ....... ~ ..............
Subdivision ......... Filed Map Lot ....................
Permit No.~.72~ .... Date Of Permit ................ Applicant .............................
Health Dept. Approval ...................... ... . Underwriters Approval ................... . .. .. .
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate.....~.....
" 'C;;:'-'." .D AS NOTED
:-: ~B.P. ~
' " ~ :. . BY:
· , ',, '~' ~,-, ,.L , ~-~ ~i:PART?,AENT
~ ~ ~t. ' '~ A-'-iON - TV/O REQUIRE
~ ~ SIGN OR
~ ~ ~ ~ LO~ ~ APPROVED AS NOTED
~ ~ o ~ BUILDING DEPARTMENT
¢~.~ 9 AM TO 4 PM FOR THE
" ' ,. ~NS~ECTIONS:
· '~.' ' ~MO REQUIRED
"'' ~ 'FOR POURTD C h ¢ ~ '
O ~R=TE
.... ..- ; '. 2. ROUGH' FR,A~ING & PLU,MSING
' '.' '~' ',/': , "' "- "' lOT ~. ~lk'~t. ¢~": .....
';.' "' ' - .... ! N MUST
A~ dlslances fo w~lls and cess~fs am ~LL COr"c'r~' .¢- ~
..--,. LL MEET
.,,~. by Iocafio~ from ~ous, owner~ and field '¢ '~- ~ ~ '- - ~ N. Y
. obse~alions, since moe/wells and cess- ~ THE R~. , ':,' 'h~ I S ~F T '"
. pooh are not visible these dimensions .... ' ~ATE CONSTRUCTION
ca~nat ~ certified, . ; COD~S. NOT RESPONSIBLE FOF
' ':" ' '"~ '~ DESIGN OR CONSTRUCTION ERRORS.
~URVEY FOR~ , '" ':" :*' .'" m~F[~NC~. -
TOWN OF sOUT~ ~ ...... ~D ~, /¢~ ~" "' ~'~ ~
OU ' '~"~" ' '
~¢..~.~(~ ,,..y ,~-(~ ,-.:..,., . . ..,:,,. ., ',~,.~ ~ , ¢ ,
!1 I~,b.~Lb..[~LZ'~Q-,~ ';4 ~'-~!t ~
Examined
Approved .... ~.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Disapproved a/c .....................................
¢~OBuildin~, Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
BOARD OF HEALTH
3 SETS OF PLANS.~._ ...."'~L2''''"''''
SuRvEY .....
SEPTIC FORH ..............
Date .... ......... 19
a. Ttfis 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-
qation.
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 inspections.
(Sig~at_,u.r_%of appli?~ant, or name, ifa corporation)
(Mailing address of appLiffant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of of premises . i~/ .......... ~7 ..... (~ ~' t'h'e' ;a'x' ~o'l[ ;~-ilt;~t' ~id')' ' Jl~'P'l~lJl~flJ ~'l~6~fi ......
If applicant is a corporation, signature of duly auth?rized officer. DATE: ~////¢/L~B.R # ~ ~/O ~-
(Name and title of corporate officer)
Builder's License No. I ~ O-c ~- ~ ~4T~ OCCUPANCY OR
................. "" '~' .... U$~ i$ IJ~LAWFUL
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIQNS:
1. FOUNDATION, - TWO REQUIRED
FOR POURED CONCRETE
Plumber's License No ....................... ~l~'[{O~}' CERTIFICATE z ROUGH- FRAMING'& PLUMBING
3. INSULATION
m~,trican's License No ....................... OF OCCUPANCY 4..IN~t CONSTRUCTION MUS'r
BE COMPLETE FOR C,O,
Other Trade's License No ...................... ALL CONSTRUCTION SHALL tv'fEET
~ ~'3 THE,,J~QUIREMENTS OF THE
I. Location of land on which proposed work will be'done ..... .~..~.. ~./¢...~-¢f<(,-,S~S. TRU. C.T..O.N..&...~.N.~B.G.Y.
/n ~,/) / /7 _~ ~' CODES. NOT, ~¢S[ION, SIBJcJE, FOR
..... ......... ...... .
House Number Street
County Tax Map No. 1000 Section .... ./~..'(.~. ......... Block ....~ ......... Lot..'..~....~. · .......
Subdivision...~.~.2/25..7~ ............... Filed Map No..~ .~..¢./~.. ..... Lot.....x~.. ........
(Name)
2. State existing use and occupancy of premises and intended use an~l occupancy of proposed construction:
a. Existing use and occupancy .4g/~-~-~.CdlC,,a,.C~.e:~.. 'i,~. ¢7~.¢,¢./_...'--. '~'t:*~' ' 'L'ZC'~E'">' '.~'-,/'~'; ~.', ~ .............
b. Intended use and occuvancv ~' .z~.~.~.la....t.~- ...... .~..,~?.~'-) ................. ~ .~ff... ~t.~/e_ ,:,~/-z~ ~i ...............
' d..
3. Nature of work (check which applicable): New Building ........... Addition ....... Alteration ..........
Repair RemoYal Demolition Other Work
' ' ' · ~ ipti )
· ~a I.(~O.1~ I .(~..,~ ~ (De cr on
4. Estimated Cost .' F
] (to be paid on filing tl~is application)
5. If dwelling, number of dwelling finits ............... Number of dwelling units on each floor ................
If garage, number of cars"
6. If business, commercial or mixed~ occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structureq, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure wiih alterations or additions: Front ................. Rear ..................
Depth ~ Height Number of Stohes
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ..
Height ............... Number of Stories ...........................................
9 Size of lot: Front ~ Rear Depth ...........
10. Date of Purchase ........... i · · ' ........ Name of Former Owner ................
11 Zo disti i hih emi situ ted ...........
· ne or use rct nw c pr sesare a .......................
12. Does proposed construction violdte any zoning law ordinance or regulation: ...........
13. Will lot beregraded.........,.................I . Will excess fill be removed from premises: Yes No
14. Nmne of Owner of premises .
.............. Address ................... Phone No ................
Natme of Architect
.......... ; ................ Address ................... Phone No ................
Name of Contractor ........ .....i ............ · Address ................... Phone No ................
15. 14 this property within 300 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold T~wn 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 n'umber or description,'according to deed, and show street names and indicate whether
interior or corner lot.
COUNTY OF..~.-1.°.['.~.: is.? '
..... [.~ ..... J~ ....... , .................. being duly sworn, deposes and says that he is the applicant
(Name of individual signin contract)
above named.
He is the ........................ ~~
gent, corporate officer, etc.)
of said owner or owners, ~d is duly ~uthorize~rform or have perfo~ed the said work and to m~e and file this
pphcahon; that all statements contemned m thru application are true to the best of his knowledge and belief; and that the
work will be perfomed in the m~ner sgt forth in th~application filed therewith.
Sworn to before m~is ~ ~
.......... ~ ..... daY~k .... ,19.~~
Nora* Publi~.~..~~ County ~ ' ~
. . ., . ,
Oual~lod tn S~ffolk CgU~ .~f r i . (Signature of applicant)
Commission E~ires ue~m~or ~, m~ ·
765-~.802
BUILDING DEPT.
INSPECTION
[]FOUNDATION IST [ } ROUGH PLBG.
[JFOUNDATION 2ND [ ] INSULATION
[]FRAMING [~INAL
REMARKS=
'OUIIDAT][ON (1st)
~0UNDATION
(2nd)
~OUGH FRAME &
-PLUMBING
II~SULATION PER N. Y.
STATE ENERGY
CODE
FILIAL
ADDITIONA'L COMMENTS: