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HomeMy WebLinkAbout20442-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20831 Date JUNE 29, 1992 THIS CERTIFIES that the building ADDITION Location of Property 1980 NEW SIDFFOLK ROAD House No. Street County Tax Map No. 1000 Section 109 Block 5 Subdivision Filed Map No. CI~Ct{OGUE, N.Y. Hamlet Lot 18 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 13, 1992 pursuant to which Building Permit No. 20442-Z dated FEBRUARY 21~ 1992 was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is SOLID FUEL BURNING APPLIANCE IN A NON-~L~BITABLE ACCESSORY BUII~ING The certificate is issued to JOHN J. MILLER~ JR. ~ MICII~EL P. PO~q~LL (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NE 20442 Z Permission is hereby grante~d t~.~ ~ ........... ~.....~..~..,...~..~ ........ at premises located at ..../.....~..C~........~.~.~....~...~ .............. Building Inspector. Fee $.....~..~ Rev. 6130/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN IIALL 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 ali 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 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 pm-existing" land uses: l. 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 - $100.00 3.. Copy of Certificate of Occupaucy - $5.00 over 5 years - $10.00 4. Updated Certificate Of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.~0, Commercial $15.00 ~:ew Construction ........... Old Or pre-existing Building ...... .~.. House No, Street Hamlet er owners :ounty Tax Map No 00, Section /~7~ .............. oloc~ ....... kiz ....... Lot... /.~. ubdivision .................. .................. Filed Map ............ Lot ...................... ermit No.l~.~.~.~ ..... Date Of Permit.O~..~]f.~2..Applicant ............... ealth Dept. Approval ...................... · Underwriters Approval lanuing Board Approval ........................ ~quest for: Temporary Certificate ........... Final Certicate ........... ~e Submitted: $ .................... . ....... ' ..... ;.. · . FOUNDATION (1st) FOUNDATIOn4 (2nd) 2. ROUGH FRAME & .PLUMBING ZNSULATION PER N. STATE ENERGY CODE FI;;AL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~,/~../. ....... , 19 ..~ atpproved .... .~.~. ~. ...... 19~. Permit No,...~.. ~ .~..-~ ~ Disapproved a/c ..................................... . (l~ildi ~/Insp~ector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS ........... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ................... flAIL TO: INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 cbmmenced before issuance of Building Permit. id. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 ball 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 luilding 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..~m~ng c, gde,~d regulations, and to dmit authorized inspectors on premises and in building for necessary~_-"Nx -- (S~g.~ture~fl appliZ'~t~4a~fi am i~,jf_~corpo ration ) (Mailing address of applicant) ]tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ....................................................... - ........................ qame of owJer of premises..~..~..~...~..~....~.. ! .c..~c~ .&...t...~..'~..C.-.. ~..o~....~.~ ........ (as on the t.ax 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 License No ....................... Other Trade's License No ...................... ~,~.~,:., · Location of land on which proposed work will be done ........... :. .......... .~, ......................... ................. \ .q...x9 ......... .............. ..................... tZ6 (._0o ?.? ........... . House Number Street Hamlet County Tax Map No. 1000 Section ..... /..t?.2 ........ Block .... .k .~.. ......... Lot.../~.. ............. Subdivision ..................................... Filed Map No .............. . Lot ............... (Name) State existing use and occupancy of prergises and intended 4~se and occupancy of proposed construction: a. Ex~stzng use and occupancy~/~,,/ . ,.. ,. · ...... b. Intended use and occupancy .,/'~2~. i ~zJ/~'/~-~ ~....~..d~. ........ 3. Nature of work. ( heck which applicable): New Building .......... Addition Alteration ........ Repair .... ............ Remoyal ............. ., Dejnolifion .~,, ........ .~.. Other Work .... ~ .... 4. Estimated Cost ... ~.,~. ,~. ,~..~;t ...... (to be/paid on filing this application) 5. If dwelling, number of dwelling qmts ............... Number of dwelling units on each floor ................ · If garage, number of cars ..... ~ .................................................................. 6. If business, commercial or mixedloccupancy, specify nature and extent of each type of use ..................... 7. Dimensions ot exmtmg structures> if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ............................ ~ ........................... Dimensions of same structure wlt.h alterations or additions: Front Rear Depth ..................... Height ...................... Number of Stories ...................... 8 Dim ion of ti traction: F · ens s en re new cons ront ............... Rear ............... Depth ............... Height Number of Stories 9. Size oflot: Front ............ 'i .......... Rear ...................... Depth ...... ................ 10. Date of Purchase ..................... . ......... Name of Former Owner ............................ 11. Zone or use district in which premises are situated .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... I .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... i ................ Address ................... Phone No ................ Name of Architect ........... I ............... · Address ................... Phone No ................ Name of Contractor .......... ! ................ Address ................... Phone No ................ 15. Is 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 ' ' ' lcmldmgs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block namber or descriptioh according to deed, and show street names and indicate whether interior or corher lot. APpiiO, ED AS NOTED . NDYIFY BlJlL~rN~i D~pARTM~T AT '765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION TWO REQUIRED FOR POURED CONCRETE :2, ROUGH - FRAMING & PLUMBING 3. INSULATION FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET ~HE REQUIREMENTS OF THE N.Y. STATE CoNSTRuCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS '3TATE OF NEW Y, ORK.o 20UNTY OF .~~'~ ............................... i ................. being duly sworn, deposes and says that he'is the applicant (Name of individual signinglcontract) ~bove named. te is the ~ ' i' (Contractor, agent , corporate officer, etc . ) ~f said owner or owners, and is duly ahthorized to perform or have performed the said work and to make and file this pplication; that all statements containeld in this application are true to the best of his knowledge and belief; and that the ?ork will be performed in the manner se! forth in the application filed therewith. ;worn to before me this ' ";.'"p · /..