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Home My WebLink About20118-zFORM NO. 4 , TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20193 Date SEPTEMBER 9~ ,$991 THIS CERTIFIES that the building Location of Property 535MAJORS PATH House No. County Tax Map No. 1000 Section 54 Subdivision ALTERATION SOUTHOLD ~ N.Y. Street Hamlet Block 1 Lot 24 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 30, 1991 pursuant to which Building Permit No. 20118-Z dated SEPTEMBER 4~ 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 ENCLOSE EXISTING PORCH ADDITION WITH FIREPLACE AS BUILT. 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 FLORENCE & JACK GOLDSHOT.T.R Rev. // ~uildi~ Inspector IPOR,M NO. 0 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) 2011 8 Z Oate ....~ ........................................ , ,,..?.,Z/. / County Tox Map No. 1000 Section ..... ~...~.... ..... Block .......... ./... ....... Lot No ...... ~.~... pursuant to application dated ..... ~../..~..~.. ................................... , 19.?../..., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD ~'"-'~,J~PLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 proper'ty 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 "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 applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinuning 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 ·: . . ....... Date .....~...~.¥ ................ New Construction .......... Old Or Pre-existing Building ............ Lo a,on of Property..i.. .. Z ...... ..... i .......... House No. Street Hamlet 0nwer or Owners of Property...~.~.~.~-/d~ County Tax Map No 1000, Section ..... ~.~.~......Block .... .........? ...Lot...~..~.~ ............ .. . Subdivision .................................... Filed Map ............ Lot ......... Permit No ................ Date Of Permit ............... AppIicRnt ......... Health Dept. Approval ......................... . Underwriters Approval ..................... . . . . Planning Board Approval ....................... . Request for: Tempor~ Certifi,9~te ..... ..... Final Certicate Fee Submitted: $ ........... .... ................. ~ 0 %~01 q 3 A~PLIC~ 76S-1802 BUILDING DEPT. INSPECTION ',[ ]'FOUNDATION 1ST [ ]' ROUGH PLBG. [' ]''FOUNDATION 2ND [ ]~INSULATION ,[ ] FRAMING [~]~i~AL.. !REMARKS: '/~.~9 ® THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY I~' ad 85 JOHN STREET, NEW YORK. NEW YORk 10038 THIS CERTIFIES THAT Mr. Jack Goldscho~,l N/S Majors Path 450'e/o Horton Lane Southold, L.I .... ....... i,,,~d o. May 11, 19 7 2 ..,t /o.,,,t to I,e itt ¢.otttpllat,c., with the requlrernents of this Board. FIXTURE OUTLETS 23 ~ECEPTACLESI SWITCHES 24 20 FIXTURES I RANGES OVENS EXHAUST FANS NCANDE$CENT FLUORESCENT 23 DRY£RS TIME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET *Furnaces: 1-1/Shp., 1-1/12hp., 1-10 Amp Food EYender E R V I C OF CC COND, 2/0 NO. OF NEUTRALS 1 AWG OF NEU]RAL 2/0 ^U6 3 0 1991 · i~LOG. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ., 19 .~../ Approved ............ 19 .~./eermit No...~. ? ./'..~./ Disapproved a/c ..................................... . (Build/ffiS InspeCtor) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTII ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK ............. .~ ...... SEPTIC FORH ...... /. ...... CALL .... ............... HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;eti's 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 ~r, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- zation. c. The work covered by this application may not be c~mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ;hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in wlmle 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 3uilding 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. I'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary insj~fftions..a_~ ~ ~/7 ,.j~.~,-~aff_~/2 -- (Signature of applicant, or name, if a corporation) Date .~."fl..~ ....... 19 f / (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , .. · ~ .................~...~ ................................................. of owne ofp emises i ......................................... , - . (as on the t~ roll or latest deed) If applicant is a corporation,!s gnature~.of duly authorized officer. (Name and.tif.l,e= of corporate officer) Builder's Licenie No. ......................... Plumber's License No ......................... Electrician's License No. Other Trade s hcense No ...................... OCCUPANCY OR USE; UNLAWFUL WITHOUT CERTJHCATE OF OCCUPANCY Ilouse Number Street Hamlet County Tax Map No. 1000 Section ...... .~...~. ........ Block / Lot .~.~2 .~. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / /.~].W~ ~ ~.~.~.~.......~L. ~ /.~/~ b. Intended use and occupancy ' .; 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val .... .. ~, ~ ! .......... Demolition ...... Other Worl~ ...... ~ .~ ' ' ~' ' (Description) 4. Estim,atedCost .~.6/db~ . · ....... Fee .) L~ tCC~ . . , (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 business commercial ......................................................................... or mixe~ occupancy specify nature and extent of each type of nsc 7' Dimension's of existing structure~ ' ' .................... · if any: Front Rear Depth Height ............... Numlber of Stories .............................................. Dimensions of same structure with alterations or additions: Front Depth i ................ Rear .............. 8 ...................... Height ...................... Number of Stories ...................... . Dimensions of entire new construction: Front Rear Height Number of Stories .............................. Depth ............... 9. Size of lot: Front ! ... Rear ....... D pth .......... 10. Date of Purchase ....... , .......... Name of Former Owner ........... · ............... I I. Zone or use district in which premises are situated .... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ................ , ~1 13. Will lot be regraded ......... ~ .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ........... Address ................... Phone No ................ Name of Architect .......... i ................ Address ................... Phone No ...... , .......... Name of Contractor ......... i ................ Address .................. Phone No .......... , 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No. · If yes, SouthOld ' ........ ~ Tpwn Trustees Permit may be required. ... PLOT DIAG RA/VI Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block ~urfiber or descriptioh according to deed, and show street names and indicate whether interior or comer lot. ; FEE. , ~_ ~ , DEPART 7654802 9 AM ~ 4 PM 1, FOUNDAT[O~ ~ ~OREoUIRED FOR POURED CONCR~E 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4, FINAL CO~STRUC~oN MUST BE COMPL~E FOR C.O. ~ ~u~U .- CODEs. ~ON DESIGN OR CON~Ru~oN ERRORS ;TATE OF NEW YORK, . · ' .:,,,, .. : .: S~ :OUNrTy OF .... ,'......,- .......... .................... ~.U.. ~-~.i'~..~..[.".~.~.~(~. {[.~.. being duly sworn, deposes and says that he is the applicant (Name of individtial signin~ contract) bore named. ~ ~ (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly ~uthorized to perform or have performed the said work and io make and file this ~ phcatmn; that all statements contained m this apphcatmn are true to the best of his knowledge and belief; and that the 'ork wil! be performed in the manner s~t forth in the application filed therewith· worn to before me this .......... ........ 'Otary Public,~ .~.., . .'. County ~ · HELENE D. HORNE i //] //~ ' -- ............. i Qualified in Suffolk Count (Signature of applicant) Commission Expires May 22, 1 i