HomeMy WebLinkAbout20337-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20411
Date DECEMBER 17, 1991
THIS CERTIFIES that the building
Location of Property 53345 MAIN ROAD
House No.
County Tax Map No. 1000 Section 61
Subdivision
ALTERATION
Street
Block 1
Filed Map No.
SOUTHOLD~ N.Y.
Hamlet
Lot 13.1
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 17, 1991 pursuant to which
Building Permit No. 20337-Z dated DECEMBER 17, 1991
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 ALTERATION TO EXISTING BUILDING #lA FOR A CANDY STORE
The certificate is issued to PUDGE CORP.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/'~
N/'~
Buil~g Inspector
Rev. 1/81
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)
N~ 20337 Z
Permission is hereby granted to:
.....
at premises located at ..~..~.~..~..~..........~...~......~. ....... ............ ...~.....~..~:....~..
County Tox AAap No., 1000 Section ..... ..~..~...~ ........ Block ...... ..~..~ ........ Lot No....~...~..~..~. .......
pursuant to application dated~?.-~:~.....~...-J ................. , 19..~..I.., and approved by the
Building Inspector.
Fee $..) ........ : ............
Building Inspector
Rev. 6/30/80
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-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 Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
Vpre-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, 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 - $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
Da~~.,~. ,'. !~.; J~ ~ ! ....................
New Construction ......... Old Or Pre-existing Building .......
House No. Street Hamlet
Onwer or Owners of Property ...... ..~.~.~---... . .....~Q..g~........ ................................ ..
County Tax Map No 1000, Section .... .~l ....... Block ....
Subdivision .................................... Filed Map ............ Lot ......................
Permit No...~.~.~ ~ ~ ...Date Of Permit. ! ~/~..~/~ ..... Applicant..~.Q.~.~...~...~.~. ..........
Health Dept. Approval .......................... Underwriters Approval .....
Planning Board Approval .... ' .................... ~~//~/~/7,,7~ ~. .' ~ '~,.
Request for: 'Temporary Certificate ........... Final Certicate. ',:. ,'.
.
-.,-,'t :".-, // ' · .' ,
?OUNDATION ( ls t)
FOUNDATION ( 2nd )
2.
ROUGH FRAME &
-PLUMBING
e
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIO~;A'L COMME~fTS:
6LOG. DEPT.
TOWN OF SOUTHOL~
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Approve~ '..~.. ,J.~., 1.c ~]t. Permit No. ~. ~..~..~
Disapproved a/c '~i~'
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTtl .........
3 SETS OF PLANS ..........
SURVEY ........ j L,' ........
ClIECK ................
SEPTIC PORH ..............
CALL ...................
HAIL TO:
Date .............. 199.1.
INSTRUCTIONS
a. Tiffs application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3
sets 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-
cation. ~,
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
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 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 apphcant 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 necessa~jnspections.
PUDGE CORP
--- (Signature of applicant, or name, if a corporation)
.. P,0,. Box. J-.4~5,. 50800..M~-tL .R0.. ,. Spp.tbp.l.d,..N'f.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........................................ DI4iqER. .......................... ' ] .......................
Name of owner of premises ................ p.U.D.G.E..C.O.R.P.. .........................................' ......
(as on the t.a~ roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
PRESIDENT
(Name and title of co,orate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ...................... x.5",..~ ,~ 5z.S~
1. Location of land on which proposed work will be done...F.e.a.t.h.e.r..H.i.l.l.,.........-......,..................Bu±ld±ng #8, Main Road, Southold, NY
House Number Street Hamlet
County Tax Map No. 1000 Section 61 Block 1 Lot .... 13.1
Subdivision ...................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed 6onstruction:
b. Intended use and occupancy . 8. ame. . ~
·
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Remoyal ............. Demolition .............. Other Work ...............
i (Dc"s~ription)
$.~ ~oq0 iO0 Fee
4. Estimated Cost .........................................................................
(to be paid on filing this application)
Ifd ' fd I1' gu ' mb hr
5. welhng, number o we in nits ............... Nu er of dwelling units on eac oor ................
If garage, number of cars ..... I
6. If business, commercial or mixedI occupancy, specify nature and extent of each type of use ....................
7. Dimensions of existing structures, if any: Front. .............. Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dim i f s 'Ih ' dditi
ens ons o amc structure wt alterations or a OhS: Front ................. Rear ..................
Depth .................... I · Height ...................... Number of Stories ......................
8. Dimensions of entire new constrflction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9 Size of lot: Front ' Rear Depth
I0 Date of Purchase . Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded .......... ~I .... ............ Wil excess fill be removed from premises: Yes No
14. Name of Owner of premises . i ..... Add Ph N
............. tess ................... one o ................
Name of Architect ........... : ................ Address ................... Phone No ................
Name of Contractor .......... ! ................ Address ................... Phone No ................
15. Is this property within 390 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold T~wn Trustees Permit may be required.
~ PLOT DIAGRAM
Locate clearly and distinctly all l?uildings, whether existing or proposed, and. indicate all set-back dimensions from
description according to deed, and show street names and indicate whether
property lines. Give street and block number or
interior or comer lot.
NOTIFY B[I~LOI~G DEPARTMENT AT
FOLL OWING INSPeCTiONS.
1, FOUNDAhON '~0 REOUI}IEO
FOR POU~ED CONCRETE
2, flOUGH ~ F~AMING & PLUMBING
3, INSUL A'fl()N~
4 FINAL ~ONSTRUCTiON MUST
BE' COMPLE]'E FOR C,O
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE
STATE CONSTRUCTION & ENERGY
CODES. NOT i RESPONSibLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW YORK, S.~
COUNTY OF .................
.................. being duly sworn, deposes and says that he is the applicant
(Name o f individual signin contract)
above named.
He is the
(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
lpplication; that all statements contmngd in this application are true to the best of his knowledge and belief; and that the
· york will be performed in the manner s6t forth in the application filed therewith.
;worn to before me this
H~EN ~ DE ~
NOTARY PUBLIC, Stat~ of~ew Yo~ ' ....................
No. 47078/fi, Suffolk ~oun~¢~ (Signature o~ applicant)
Term Expires M~ch 30, ~19 ~.