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HomeMy WebLinkAbout21147-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22435 Date JULY 1~ 1993 THIS CERTIFIES that the building Location of Property 31900 MAIN ROAD House No. County Tax Map No. 1000 Section 19 Subdivision ACCESSORY Street Block 1 Filed Map No. ORIENT~ N.Y. Hamlet Lot 7.5 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 8, 1992 pursuant to which Building Permit No. 21147-Z dated DECEMBER 15~ 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 ACCESSORY TWO CAR GARAGE AS APPTJ~D FOR. The certificate is issued to EDWARD W. LA~A~ (owner) of the aforesaid building. SUFFOLK. COUNTY DEPARTMENT OF HEALTH APPROVAL UNDER~fRtTERM CERTIFICATE NO. PLUM,S!RS CERTIFICATION DATED N/A N/A N/~ /~1 din'g Inspector Rev., ln'O~''n~ ~0, ~ TWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°N? 211{TZ County Tax Map No. 1000 Section ....... ./..~.. ......... Block .............. ./.. .... Lot No ....... . .~..K~... pursuant to application dated .... ../..~'..../ .~.. ................................. , 19...,~e?,end approved by the Building Inspector. Fee Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 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-&isposal(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 "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 applicantJ 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. BusineMses $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. ! [ ?.~Q ............ .~. ~.t.~...~...~. ff ............... ~. J.~ 1 ..~. [~.~ ......... House No. Street Hamlet Onwer or Owners of Property..~..~.C.~...~J~ L~.~...~...~.~ ..................... . ¥ B1 ' ' County Tax Map No 1000, Section ............ ock ................ Lot, ..................... Subdivision .................................... Filed Map ............ Lot ...................... Permit No..~.~/.~. ~.'~ .... Date Of Permit{.~./.'./.~.~. ~..~..Applicant~'~.~/~.~.~. Health Dept. Approval ~.~A~.~. , 2Y~.~ ........ Underwriters Approval. f .~.~. ~.e~...7.~.q~.. ~ .... Planning Board Approval.~....~.~.~.~.~ .... Request for: Temporary Certificate ........... Final Certicate... Fee Submitted: $ .... ~...~.--.~. APPLICANT INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gar'/Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD 16, 1993 31900 MAIN ROAD ORIglff, 1~ 11957 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 ~~not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. {All permits involving plumbing being . issued after April 1, 1984). BUILDING PERMIT ~ 21167-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 1ELD · 'OUND~TIOU :OUGH FRAME & .PLUMBING [IlSULATION PER N. Y. STATE ENERGY CODE Fi;IAL ADDITIOMAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION [//J~OUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL FORM NO~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ./..%¢.3~ ........ , 19 ~ /ct 3// Approved ... ~ .......... 1977/. Permit No ............ Disapproved a/c ..................................... ....... ~J~uildi~/Inspector) APPLIOATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLA~S .......... SURVEY ................... CIIECK ............ CALL ..... . . HA I a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 set,.~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatio~hip 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- cation. ¢. 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 w6rk. 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 ldmit authorized inspectors on premises and in building for necessa~s~ ~ ...~...~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) t" ~ e/.q- ? State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... '.D. ......................................................................... Name of owner of premises ...~..~...b~..i~.,..~.~....~. ?... ~..]~..W'..~/. /.~. ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auttlorized officer. (Name and title of corporate officer) , B{filder's License No .......................... Plumber's License No ......................... : Electrician's: License No. ................'.7- .... Other Trade's License No ...................... Location of land on which proposed work will be' done. ~.~ ~t~.~. ..... .................... ............... ..... House Number Street Hamlet County Tax Map No. 1000 Section ...~..2~ .... Block' Subdivision ..................................... Filcd Mdp No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a- Existing use and occupancy ... ~ ...~/~ff ~ff~.~.~. ' ' ~;' f:-' ,,' ~"' ...... ~ * .'%- -i ..... b Intended use and occupancy 2 C ~ ~ ~ ~ ~ ~j ........ ~' : 3. Nature of work (check which applicable): New Building ...'7~... Addition .......... Alteration .......... Repair .............. Remcval ............ Demolition .............. · · Other Work 4. Estimated Cost ...... ' .' ............. Fee · .: ·..: ...... c~. ~,~, .,.-~:w.. ............... (to be paid on filing this application) 5 If dwelling number of dwelling hnits · ' ............... Number of dwelling units on each floor If garage number of cars ! ~ ................ 6 ' If busine'ss ........................................... commercial or mixed occupancy specify ....... · ' nature and extent of each type of use ............ 7 Dimensions of existing structure~ if any: FrOnt Rear Height Num "her ............................. Depth ............... ........ of Stories Dimensions ' ' '~ .... ' ........................................................ of same structure with alterations or additions: Front ................. Rear ................ Depth .................... i.. Height ..... 8 Dlmensionsofentirenewconstrgction:Front ............... .~----Ter' ~. . '~ep't~ .~:~' Number of Stories .2~:1 · ....... ";' · Height .~' Number of Stories '~ ..... ~ ....... Rear . 9 Size ............. ' ...................................................... of lot: Front ~ 10' Date of Purchase ........... ~ .......... Rear ..................... Depth ...................... 11' ' .......... i ........ · ......... Name of Former Owner ............................. Zone or use district in which premises are situated 12 Does proposed construction violate any zoning law ........... '' i ............................... · ordinance or regu/ai/on': 13 ' ............................. Will lot be regraded ...~j~.. J. : ............. /~ ....Will excess fill be removed from premises: Yes 14. Name of Owner of prem'~gs'~.~.q .~.~..,[,..~,/~ j'.. ~'A~Idress ~../.~.~.e..~.a/.% .~.d. :.. Phone No. r.~.2..4.: .~' Name of Architect ...... ~ ............... ^uaress .................. Phone No ............ Name of Contractor C/~d,~./.e,~...! ~.*.'.'~,4,.-C.,, .%:..Address ..~¥a.~Xz~.Z/~. i ...PhoneNo .... I5. Is this property withnln 30~3 £ee"t' of 'a' t±dal wetland* *¥o~' ' ' No.2~ ...... ' ...... · If yes, Soul:hold Tbwn Trustees Perm±t: may be requ±red. .... 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 nhmber or description according to deed, and show street names and indicate whether interior or coruer lot. !TATE OF NEh¥'~OR~, t/ S.Si . . (Name of individual signi;i~co~t;ac't5 ' "" bore named. ; is the . ' (Contractor, agent, .............. ~ .......................... , corporate officer, etc. said owner or owners, ~d is duly aCthorized to perfom or have perfo~ed the said work and to m~e and file this ~plication; that all statements container N this annlicati ork will be perfomed in the manner se{forth in t[~ appl~;t~ true to the best of liis knowledge and belief; and that the filed therewith. Qualified In Surfak Cou~ ~ -t 0 m-ri 1