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Home My WebLink About20480-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF occUPANCf No Z-20610 Date MARCH 25~ 1992 THIS CERTIFIES that the buildinq Location of Property 1145 GILLETTE DRIVE House No. County Tax Map No. 10OD Section 3B Subdivision ADDITION Block 5 Filed Map No. EAST MARION~ N.Y. Street Hamlet Lot 4 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 3, 1992 pursuant to which Building Permit No. 20480-Z dated MARCH 16, 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 AS APPLIED FOR The certificate is issued to GARY BLOECKER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A " /y Buil~ding InsPector Rev. 1/81 I~O~M HO. J 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) 204.80 Permission is hereby granted to: ~...~ ../..~ ........................... ..~.,...,~.~......~ ..~./.. ................................ . ~ .~-~~~;.~.~.~.....~ ...... . . ~o ~~~../~_...~~;~..~.~....~~....~ .................................. at premises I~ated at ./~..~;~~..;.~~ ...................................................... Coun~ Tax Map No. 1000 Section ...... .~.~ ........ Bilk .... ~ ............ Lot No ....... ~ ............ pu~uant to application dat~ ..... ~/~ ..................................... , 19..~ and approv~ by the Building Inspector, Rev. 6/30/80 TOWN OF ~,OU. ~0,/~ .. A~PLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL 765-1802 Ae 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 Plauning 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, Swinging 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 .................. New Construction ........ ... Old Or Pre-existing Building ................ ~ . Location of Property..~l.~ ............. . House No.' Street Hamle Onwer Owners of Property County Tax Map No 1000, Section .... ~.~.: ..... Block...J7 ........... Lot..~. ........... Subdivision .................................. Filed Map Lot . . No . .~ ~.~P~ ~ ~ermit~/~ ~ Permit .. ~ ........ Date Of ~ ............... ~' Health Dept. Approval .................... Uuderwriters Approval ...................... Planning Board Approval .................... . . . . Request for: Temporary Certificate ........... Final Certicate ........... ............................. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. I N~J.~TION I~NAL DATE fIELD FOUNDATION FOUNDATIO~U 2. ROUGH FRAME & INSULATION {1st) (2nd) .PLUMBING PER N. STATE ENERGY CODE FI~IAL ADDITIOMA'L COMMENTS: ,, ivlAR 8 1992 Examinel . . ;r~ ,-..: ........ , 19~..~. Approved ................. 19~..~. Permit No~.' Disapproved a/c .............................. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NAR I 3 1992 ............................................. TOWN BOARD OF HEALTII ......... 3 SETS OF PLA~S .......... SURVEY ................... CIIECK ................ ,,,, SEPTIC PORH .............. ,~PPL CATION FOR BU!LDI,~G ~-~R~¥,,, iNSTRUCTIONS Date . .~.....~ffA~.. ~...~. a. This 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- attn. 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 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 hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessa~ons.~/ ~ -- / (Signa~u~6 of applicant, or name, if a corporation) · q'. P.?.4 ¥ !...g. O .... (Mailing address of applicant) irate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,lame of owner of premises ~g¢~t gCe~Cs:6R, ' (as on the t~ 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 ................................. tlouse Number Street Hamlet Cot,nty Tax Map No. 1000 Section .O./~g:.o.o. ....... Block O$~oo Lot OO¢, Oo~' Subdivision ............... (Name) Filed Map No ............. i. Lot ................ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. / .F?.~c~ t~wecC/,v6~ b. Intended use and occupancy g'~q Mt=5 R ' , ........ teration .......... epmr .............. RemOval ............. Demolition .............. Other Work ............... 4. Estimated Cost ..... o*, o o (Description) .... , ............................. Fee .. ~ (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor Ifg I ................ · arage, number of cars ..... i ............. .. 6. If business, commercial or mixe4 occupancy, specify nhture and extent of each type of use ................... '' 7. Dimensions of existing structure , if any: Front ............... Rear .............. Depth .............. Height ............... Numb. er of Stories ....................................................... Dimensions of same structure with alterations or additions: Front Depth i Height ................. Rear ................. Number of Stories · Dimensions of entire new constr~mtion: Front Rear Height Number of Stories .............................. Depth .............. 9 Size of l~i: ............. ' ...................................................... Front 10' Date of Purchase ........... : ........... Rear ...................... Depth ...................... · Name of Former Owner 1 1 Zone or use district in which ' ' situated ............................. · Dre~mses are 12. Does proposed construction violate any zonin, law or~: ....... , , ;' Will lot be regraded ......... I ,, , ,~-,~-~ ur re,,marion: ................................ 13. . ................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .G.~e-,/ .t3.CoeC~, ·Address ~q..~.o~ .~?/~.~g/q.~.o~..PhoneNo ................ Name of Architect ......... ! ' ' ' · Address ......... Phone No. Name of Contractor ........ J .............. Address ................... Phone No ................ 15. Is this property within ~O'0' feet of a tidal wetland? *Yes ........ No..~.. .... · If yes, Southold TOwn Trustees Permit may be required. PLOT DIAGRA/vl Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dhuensions from property lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether interior or coruer lot. PLEASE SEE ATTACHED DIAGRAM AND SURVEY COPY IN 3 SETS. ;TATE OF NEW YORK, ...... ...... '' '('I~a'~?g~i'v"~ "'/'~' '; .................. being duly sworn, deposes and says that he is tile applicant maz m mmv)'uual signing contract bove named. 'e is th I (Contractor, agent, corporate officer, etc.) [' said owner or owners, and is duly aluthorized to perform or have performed the said work and to make and file this )plication; that all statements contained itl this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner sot forth in the application flied therewith. ~vom to before me this ~ . , ................... . ....... , 19 .~...2~ otary Public ...... '..~p'fl~.~JEfi¢...'.. ~.~..?*~. .........' Notary Pub~T~?dt~~ ' '~ . . . County. · No. 41-4520800 ~lualified in Queens County '! Certificate Filed in New York Coun~t ........... '~.~"~.. ........... Commission Expires April 30, 19~2 / / ( ignature of applicant) - £o"OOt' ~ -'..a~O~', ?£'. P~