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