The URL can be used to link to this page

Home My WebLink About21103-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24609 Date SEPTEMBER 11, 1996 THIS CERTIFIES that the building Location of Property 750 VILLAGE LANE House No. Street County Tax Map No. 1000 Section 25 Block 1 Subdivision Filed Map No. ADDITION ORIENT, N.Y. Lot Lot No. Hamlet 14 conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEmbER 17, 1992 ~ureuant to which Building Permit No. 21103-Z dated NOVEMBER 25, 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 DORMEN ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 DUDLEY ERWIN THOMAS, JR. & SUSAN HORNE N/A PENDING - AUG. 1996 OCTOBER 9, 1996-KING PLUMBING & HEATING Building lspector lvOll~ NO. Jl 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) N~N? 2110~ Date ~., ~' co..t~ To~< ~ap No. '000 S.c.o. .......... .~ .~.... ",o~k ........ ..4... ......... Lot No ........ .'f.~ ........ pursuant to application doted ...... ./. ./. ./. /. .~. .................................. , ]9~...,~? and approved by the Building In ~spector. Fee $~ Buildi~,,t'nspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 BLDG. DEPT. APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa~ lions, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5. Submit Planning Board approva~ of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 New Cons truc ti on...~... Old or Pre-existing Building ............ $15.00 ......~-//. .~./% .% ........... Date Vacant Land ............. Location of Property .... .~.. ~.O. ............. ~../.~..~..~..c-~. ~..z_;../~..,c~.4~- ....... P. 4~/~f..,~...7~... House No. Street Hamlet Owner or Owners of Property . ,~..~. ~..'~ .~. ,~...~..oy'rz .,~M ~r County Tax Map No 1000 Section ~ 5- Block / Lot ./ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.Z././.~. 3.~. ~. Date of Permit .......... Applicant .. ~. ~ ~ ~ ./~./~..c_.~,../~..~. ............ ..... · ~./~ ............... Labor Dept. Approval ..... .~.~..'~. ............. Health Dept. Approval .... · ~_/..~. ............... Planning Board Approval . . . .~/./'¢. .............. Underwriters Approval Request for Temporary Certificate ............... Final Certificate ~ Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ,,,~..~, ~ ......... Rev. 10-10-7a Town Hall, 53095 Main Road P.O. Box1179 . Southold, New York 11971 Fax (516) 765-1823 Telephone (5 t6) 765-1802 BLDG. DEPT. TOWN OF SOUTHOLD OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION Building Permit No. ~//~-~ Owner: Plumber: (please print) print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this I_~~ day of Notary Public, State of New York No, 4879505 Qualified in Suffolk County Commission Expires December 8, 19~f/' County Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD February 22, 1996 Macdonald Woodworking Corp. Box 145 Orient, NY 11957 Re: Prem: Susan A. Horne- SCTM#1000-25-1-14 750 Village Lane, Orient To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file~"~ ~. The check is (outdated/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file.f (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21103-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDINIG INSPECTOR TOWN OF SOUTHOLD February 6, 1996 Ms. Susan A. Horne& Mr. Edwin D. Thomas Jr. 1038 Round Hill Circle Napa, CA 94458 Re: Building Permit %21103-Z Premises: 750 Village Lane, Orient Surf. Co. Tax Map ~1000-25-1-14 During a review of our files it was noted that the above building permit has expired, and a Certificate of Occupancy has never been issued. According to the Code of the Town of Southold, Article XXVIII 100-284, it is unlawful to occupy or use a structure until a Certificate of Occupancy has been issued. Please contact this office as soon as possible so that we may clear up this matter. Thank you for your cooperation in this matter. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. OUNDA~ION (1st) 'OUNDATIO~'~ (2nd) ~OUGH FRAME & .PLUMBING Z~;SULATION PER N. Y. STATE ENERGY CODE FI;~AL ADDITIONA'L COMMENTS Z~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST~.~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL ,,,,- DATE ~INSPECTO~_~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION FRAMING [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FINAL REMARKS: DATE//~~~_~ INSPECTOR~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ SOUTHOLD, N.Y. 11971 '":,-f;~'! ~,: ,~:'~,~"10~.!:;,,,--,. TEL.: 765-1802 Disapproved a/c ........................ ~ ............ (Bui~in~c~r) APPLICATION FOR aUILDING PERMIT INSTRUCTIONS CALL ........ TO: Date .././~../. 7. .......... 197.~-~ a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. t 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- c, ation. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tbis 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 agy 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 appIieable Laws, Ordinances or Reo, ulations, for the construction of buildings, ad, ditions or alterations, or for ~emoval or demolition, as herein described. Th~ applicant agrees to comply with all applicabie taws, ordinances, building code, housing code, and regulations, and to admit authorized insp, ectors on premises and in building for necessary inspections. '- (Signature of applicant, or name, if a coStCo'ratteen') ' ' ' ...,ht.~.o..r;'z~,x .4.~.?T ~/,~,,~v- ~...r./47~.Z (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ~'.~ .,f . .z~. ~...,~-. ......................................................................... Name of owner of premises (as on the tax roll or latest deed) If applicant is a corpqration, signature of~duly authorized officer. (Nam~ and title or. bo/pbf£t6 offiker) Builder's License No ..... ./?...~..~...~.. 4(../ ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done. ' ...... ' .......... I louse Number Street, Hain let County Tax Map No. 1000 Section ...~ ........ Block . / Lot ./.,~. ' Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~...7 ./ ..... .,.,.,~..z'.~./..~..~'...~.,,?. ~ ~Zw, A'7, ~M,'W'/~---- 2" ......... ~fj~,~, .~.y~,,,;,~ · · . .& ........... '~ c'"b=tntended Use and occupancy ........................................ ,)~.,}):..~. x,,] ~::~i, .. ~;~,~I.~ }~' :', '"; e ........... ' / 3. Nature of work (check whic applicable): New Building ..... ' .... Addition .......... ~dtcraa~,.,,... ;.: Repair .............. R~moval .............. Demolition ............. Other Work. ~ .o.~..z~.4~_.. 4. Estimate'd Cost· .. ~,~ .o..~. ~ ~,~,~ x, { V~escr/ption) ............................. Fee ..... ... - 5. If dwelling, number of dwelling units / (to be paid on filing this application) Ifs .............. Number of dwelling units on e ,~¢'. ....... arage, number of cars .. 1 .............. , · .... 6. If business, Commercial or mixed occupancy, spec nature and extent of each type of use ................ 7. Dimensions of existing tructures, if any: Front .......... Rear ' Depth Height ..... Num~.e ...... ........................... D mens OhS of same structure w~th a terations or additions: Front Dc th ' }ieig t ................. Rear... ................. ~ .......................... Number of Stories ............. 8. Dimensions of entire new construction Front .... · · · · Height Number of Stories ............... Rear Depth 9 Size ofl~: ............. ' i ....................................................... · Front ......... , ............ Rear 10 Date of Purchase · Depth · ' ............................ Name of Former Owner 11. Zone or use district in which ~remises are situated ....... .~..% ./. eS,..,r/.a'¢..~..,.,.,~./,:~i/.' .~.' .~.' .................. 12. Does proposed construction viiolate a~ny zoning law, ordinance or reanlation' /v' o ........ 13. Will lot be regraded ..... !....42z~..,~. . .............................. ............ Will excess fill be removed from premises: 'Y~'s ' ' · ' '/'" ' ' 'o ............ P.,~ne No ............... 14. Name of Owner of premises ~..~t.e,.~.T./V...,~,v..&--... Address ..z~? ~.~.~..~c--~z..~,v~ ~,,, ' N( Name of Architect . - ' .... i ................... Address ................... P~_hp. jle No. . . Name of Contractor ,4't~t ¢~,. ,,y.~.~. q../~..oe..~,,~..e,.~.~< .,~ddress .. iq, .%.~'..o? e..,?.?..o.~..~'p'h'o'ne No. 15.Is this property located withln~O0 feet of a tidal wetland? ~YES .... NO..t~. ' · I.f yes, S°uth°ld Town Trustees Permit may be required. '"i PLOT DIAGRAM Locate clearly and distinctly 0ll buildings, whether existing or proposed, and. indicate al~ set-back dimensions frorr property lines. Give street and block number or description according to deed, and show street names and indicate whethe: interior or comer lot. STATE OF NEW_~3RK.D/2 /,].~ ! (Name of individual sign ng contract) above named· r'ULLOWING INSPECT~otqs I. FOUNDATfoN tWO ~EO! FOR POURED CONCRET~ 3. INSULATION 4. FINAL . CONSTRUCTION 8E COMPLETE FOR C.O. MUST ALL CONSTRUcTIoN SHALL MEET THE REQUIREMENTs OF THE N.~ STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIBLE 'FOR DESIGN ~R ~NS~UC~ON ERRORs . · being duly sworn, deposes and says that he is the applicant: lie is the ................. . ~~ ' ' gent, corp;rate of~ic;[ e'tc.; ............................ of said Owner or owners, and ss duh authorize'Ffl-lu i,~orm or have performed the said work and to make and file this application; that all state:nents cunt: ned in this application are true to the best of his knowledge and belief; and that the Work will be performed in the manneriset forth in the application filed therewith. Swum to before me tl_li~ x2 i A / ... . ........ dayo,': .... / ',.' (Signal}Ire of applicant)