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HomeMy WebLinkAbout20828-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20950 Date AUGUST 19~ 1992 THIS CERTIFIES that the buildin~ Location of Property 1100 GIN LANE House No. County Tax Map No. 1000 Section 88 Subdivision ADDITION SOU'i~OLD, NEW YORK Street Hamlet Block 3 Lot 13 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 7, 1992 pursuant to which Building Permit No. 20828-Z dated JULY 14~ 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 AN EXISTIN ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A JOHN & MARILYN JENNEY Rev. 1/81 TOWN OF SO~'THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: , / ,, -- ............. ..... at premises I~ated at ...1~.~......~..~-~ .............................................. Co~nt~ Tax Mop No. ~000 Section .... ~.~.~ ......... B~o~k ...... ~..~ ....... Lot ~a ..... L% ............. pursuant to application dated ...... ...~...~...~ ......................... ,19.~..~., and approved by the Building Inspector. 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 unnsual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation f~om 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 ann ~ 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 - $i00.00 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 ..... . · ....................... ~ew Construction .... .~. ..... Old Or Pre-existing Building ................. Location of Property~ .... /.~.~...~. ................... '~'/''~" ................ r- -- '.. House No. Street Hamlet )n Owners of Property ;ounty Tax Map No I000, Section ...... .~...~....Block ..... ~.~ ....... Lot..Z~ ................. ;ubdivision ' Filed Map Lot 'ermit No .... ~v..q...Date Of Permit ....... Applicant ................... Iealth Dept. Approval ...... ~..~. ................ Underwriters Approval ...... ..~..~.. ............ 'lanning Board Approval...~...~. .... :equest for: Temporary Certificate ........... Final Certicate ........... ~OUNDA~!ON ( 1 st) ~OU~{DATION (2nd) tOUGH FRAME & .PLUMBING FINAL ~ ADDITIONA'L COMMENTS 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST r ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL DATE INSPECTOR, 76S-1802 ~'~ BUILDING DEPT. INSPECTION FOUNDATION 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' ~2,/..~...,199..L- Approved .t. ~ .... 19t~ .~ Permit No, .~, .~..'~..~,~ ..~ Disapproved a/c .............................. ~ ~ ~OV~[.::~. : ~ . ~ INSTRUCTIONS APPLICATION FOR B!JH~D k.G PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CI[~CK ................ ..o, SEPTIC FORH .............. HAIL TO:~ ~-~ ~ o~-~9,a,~ L .. ..... G ....... (/~ ~ 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 3aflon. c. 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 ~hail 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 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. rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ -- ,(Signature of~pplicant, or~ame, if a~6rporation) ..:..'4.&eT.w?..,¢.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractorv.electrician, plumber or builder. .. t~ ~.~2..~Z ........................................................................... , ......... Name of owner of premises .... ~..O. zi/M....x,,.~..~. O.~_~.c~ ................................................. Cas on the tax roll or latest deed) if applicant is a corporation, signature of duly auth~orized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electri~ian's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. x ................................................ ... I.t.O.O. ........... '~. .~. ./(zg~J.~. ............... w. .~ ................................... House Number Street Hamlet County Tax Map No. 1000 Section ..... .~.~ ......... Block . Subdivision...~..~qeO .................. Filed MapNo....~.[.~... Lot ..... ~ ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... /~ ....... ~.~ ........ ,,, .................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition..........~ Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ?.*-~.O .~..' . ' (D ipti ) escr on 4 Estimated Cost ~ .~..~.D~..O. (to be paid on filing this application) 5. If dwelling, number of dwelling finits ............... Number of dwelling units on each floor ..... } .......... If garage number of cars ' ~ 6. If business, co.mmercial or mixedi occupancy, specify nature and extent of each type of use '.. ~' . 7. Dimensions of existing structures if any: Front ~. ' Rear ~,~ ~ ~ 'l~,~'h ':_~L ~ ~ ....... Height ............... Number of Stories.. Dimensions of same structure with alterations or additions: Front ... k~5'~. .......... Rear . .~,b.'~... Depth.. ~ql~.t ................ Height ...................... Number of Stories.. J ......... 8. Dimensions of entire new constn~ction: Front .... .~..~. · .x ..... Rear ...6,.-~.. ......... Depth .~.. ¢: .......... Height Number of Stories ' ' 9. Sizeoflot: Front /oot . ' ....... , .... . .......... Rear . gtO.o.': .............. - · ·. Depth ./~ .O. ................ 10. Date of Purchase ..... ~.l.~.l......................NameofFormerOwner ./~..'F~. ..................... 11. Zone or use district in which prmnlses are s~tuated ....... : .r ............................................ 12. Does proposed construction viola!te any zoning law, ordinance or regulation: ..~tO. ........................... 13. Will lot be regraded . .~.~ ..... :'. ................. Will excess fill be remove~d from premises: Yes No 14. Name ofOwnerofpremises .,~..~.,9.~.e4~ ..... Address ~ ~.og.~.~pgr/.,~.~. ., PhoneNo .g.TJ:.~'.~.tl .... Name of Architect ; . . ^.~a .... ' ~Z-v~J ,~t,~'~.' ,,, .. ' Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No..~ ..... · If yes, Southold TCwn Trustees Permit may be required. · -. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate all set-back dimensions from . property lines. Give street and block ngmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, , COUNTY OF ................. s'S (Name of individual signing contract) tbove named ...... being duly sworn, deposes and says that he is the applicant le is the .....~. tgi. tt).~. ........ i ................................................................. I (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner s6t forth in the application filed therewith. ;worn to before me this ...................... day of .......... , iotary Public, . 'x ...... Coun y ... · .... ~~11~3 . ~gnature of a~licant) il' SURVEY FOR FDWARD G. & DOROTHY $. KOTHE ATSOUTHOLD TOWN OFSOUTHOLD SUFFOLK COUNTYt N.Y'. SCALE ~ I"= 4.0' 'MARCH Igt 1970 REFERENCE ~ MAP OF BAY HAVEN. ' FILEDJAN. 22m1959 FILENO. 2910 6UARANTEED TO~ iNTER.COUNTYTITLEGUARANTY&MORTGA~EG~ EDWARDG.~ DOROTHY$.KOTHE. LAND SURVEYOR N.Y.g. LtL, NO. ~87 RiVERHEADI N.Y. NOIIFY 8U!L.D~N6 DEPARtmeNT 765-~802 9 AM TO 4 P~ FOR THE FOI, LOWING ~NSP~CDO~fS: ~ - t, REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAnkiNG & PLUMBING 4, FINAL CONSTRUCTION ~UST BE COMPLETE FOR C.O. ALL CONSTRUCT{ON ¢HALL MEET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY OESIG~ OR CONSTRUCTION ERRORS OCCUPANCY Ol~ USE IS IINL.~I;~,~FUL ~ITNOUI' CER'!'i FJCATE OF OCCUPANCY JUl fl '"