HomeMy WebLinkAbout20434-zFORM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20538 Date
FEBRUARY 18~ 1992
THIS CERTIFIES that the building ALTERATION
Location of Property 1575 PINE NECK ROAD
House No. Street
County Tax Map No. 1000 Section 70 Block 5
Subdivision Filed Map No.
SOUTHOLD~ N.Y.
Hamlet
Lot 41
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 5, 1992 pursuant to which
Building Permit No. 20434-Z dated FEBRUARY 18, 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 INSTALL ELECTRIC BEAT IN EXISTING ONE FAMILY DWELLING AS
PER N.Y. BOARD OF FIRE UNDERWRITERS #N408643-NOV. Ir 1978
The certificate is issued to FRED VENTRUDO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-408643 - NOV. 1, 1978
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
Inspector
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)
N-° 204[54 Z
Permission is hereby granted to: / --
.........................
..... ~.....~~.~./..... ............................
,,. , .
,o .~. ..~..~.. .~._~'.~.. '...~:..~....~.....,~..~....~~...~.~....
_~....~../,.~.~. ...... ~ ~..;~...~j.~, , ,~,. ,_,, ~./.?...~:~.~.,.....~.._ ..,._ ....
at prem,~, located at../.~..~Z~........~"~....,~.~.........'~.r~.~.. ........................................................
County ]'ax Map No. 1000 Section .......... .~'..~.. ........ Block ..... ~ ......... Lot No ...... .~/... ............
pursuant to application dated ........... ,.~..~.~.~. ................................. , 19..~...-~..., and approved by the
Building Inspector.
Rev. 6/30/80
Form No. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN IlALL
765-1802
APPLICATION FOIl CERTIFICATE OF OCCUPANCy
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new bnilding or new nsc:
1. Final survey of property with accurate location of all buildings, property lines,
2. Final Approval from ltealtb Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plund)er certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial bnilding, 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, [957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing ali 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 build~ng $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. C6py of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $I5.00, Commercial $15.00
ate ... ..............
New Construction ...........Old Or Pre-existing Building .....
Location of Property .... ~fl f... ~.~.~. ~gA~.. ~.~f, ..... $~. ,~..~..~f.~. .....................
House No. Street Hamlet
Onwer or Owners of Property .... .~.~.~?-~...;~.-~~./~..~..0. ..................................
County Tax Map No 1000, Section. ..Block. ..Lot... ~./ ....
Subdivision Flied Map Lot
Permit Xo.~.~.t~..~. .... Date Of Permit..glJ~l~.~ ..... Applicant .............................
Health Dept. Approval ........................... Underwriters Approval .........................
Planaing Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $ -
q 3sq .......... .........
CO ~ J0,53~( APPL~C^~
FORM NO, 1
TOWN OF SOUTHOLD '
BUILDING DEPARTMENT
f:'~:'B ~ 5 ~ TOWN HALL
'. SOUTHOLD, N.Y. 11971
TEL.: 765-1802
.~pproved ................ 19~Pe~it No..~.
Disapproved a/c .... .... ~ ............... ~ ............
.........
BOARD OF HEALTH .........
SETS OF PLANS ..........
SURV£Y ...................
CIIECK ................. ;..
SEpIIC FORH ..............
CALL ...................
}tAIL TO:
Date ...~.~.~..~. ........... 19 .~ .~7~-~
I INSTRUCTIONS
a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
~ts 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 application may not be c~mmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
.roll 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 necessaryJ'!~Pections.
-- ../(Signature of appr[cant, or name, if a corporation)
(Mailing address of applicant)
;fate whether~5)~ tS~ ~Jq-g-~applicant is owner, lessee, agent, architect, engineer, general coytractor, electrician, plumber or builder.
~ame of owner o~~~ premises....~..~:~....~/.~..~ ~..~... ~... ~/~.~. ~... ~..Z-~. ~. ~. ~. ...............
' ' (as on the t~ roll or latest deed)
applicant is a corp,otatiqq~ signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Locatio of la do whi hp d k illb d '
n n n c ropose wor w e one ..................................................
tlouse Number 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. X S nguse an occu ncy .......................................
b. Intended use and occupancy ~
property lines. Give street and block m
interior or corner lot.
3. Nature ofwor heck which apt~licable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal ............. Demolition .............. Other Work ...............
4. Estimated Cost. ~r~ -- ~ ~ ..~tJ ~' .(D,e~nption)
....... ' ............................. Fee... ~...~. ,. ....... ,:. ...............
(to be paid on filing this application)
5. If dwelling, number of dwelling u!nits ............... Number of dweIling units on each floor.
· If garage, number of cars ..... ; ...............
If business, commercial or mixed! fly
7 'Di occupancy, spec nature and extent of each type of use .....................
· mensions of existing structures if any: Front .............. Rear Depth
Height ............... Number of Stories .................... ' ....................
Dimensions of same structure wit~ alterations or additions: Front ................. Rear .................
Depth ..................... ~. Height ...................... Nmnber of Stories .....................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ........
Height ............... Numbler of Stories ................. ' ......
9. Size of lot: Front ............ i. Rear
Date of Purchase t ............................... Depth ......................
............ ~ ............ Name of Former Owner
Zone or use district in which ~reL~i~ee .,,.,, ,;*,,$ot{ .........
Does proposed construction wolal;e any zoning law, ordinance or regulation:
Will lot be regraded ................................
.......... i ........ Will excess fill be removed from premises: Yes . .N.
Name of Owner of premises .... i .......... o
· , .............. Address ................... Phone No.
Name of Architect ........... i... ' ............
........... Address ........... Phone No ..............
Name of Contractor .......... i ............... Address ................... Phone No ................
Ia this property within 300 feet of a tidal wetland? *Yes ........ No .........
*If yes, Southold To~n Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all b~ildings, whether existing or proposed, and. indicate all set-back dimensions from
tuber or descriptioh according to deed, and show street names and indicate whether
FATE OF NEW YORK, S.S'
(Name of individual signing ~ontract)
UNDERWRITERS CERTIFICAT~
R£~UIRED
DAT~: ~ B.P. # ~
FEE: , .
.... ,o DEPART~
765-1802 9 A~ ~ 4 PM FOR THE
FOLLoWiNG JNSPE~oNs:
PUIJRED CONCRETE D
2, ROUGH. FRAMING & PLUMBING
3, INSu~TION
4. F~AL . co~sr~ucr~o~ MUST
SE COMPLETE FOR'c.o.
ALL CONomU~/ON SHALL
THE REQUIREMEN~ OF THE N.~
STATE CONS~ON &
~NERGy
v. ~$TRU~ON ERRORS
being duly sworn, deposes and says that~he is the applicant
~' is the ........
') ............................
said owner or owners, and is duly aulthorized 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 setl forth in the application filed tlierewith. '
'om to before me this
...................... day of...