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HomeMy WebLinkAbout20156-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z- 20375 Date NOVEMBER 25, 1991 THIS CERTIFIES that the building. Location of Property AVENUE B House No. County Tax Map No. 1000 Section 6 Subdivision REPAIR & ALTERATION FISHERS ISLAND~ N.Y. Street Block 2 Lot 22.3 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 16, 1991 pursuant to which Building Permit No. 20156-Z dated SEPTEMBER 23~ 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 REPAIR & ALTERATION TO EXISTING HOUSE ASAPPLIED FOR. The certificate is issued to MARJORIE PEDLEY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A .... ~' Building ~nsp~ctor' ~ 3 Rev. 1/81 FO~,M NO, ~ TO~VN OF SOUTHOLD BUILDING De:I'AkTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 20156Z Permission is hereby granted to: ~ , ?~,~,~ ~ · ..~>.-...: - -~ ........ .,. ...... ~..~,,:....~--.-~ ............. ....... "~'"'~'"""~' .......................... '1'[ ........ YF .............................................................. at~' ~ ~premis~ located at ~.i.i ........ ~ .................................................. .............................. .'~..,. ........ ...d...~.3... ~ ........................ County Tax Map No. 1000 Section] .......... ~ ....... Block ........ ~.. ...... Lot No .....~..~.!..~... pursuant to application dated ~....~ ........... ~..~. ............... , 19..~.L and approved by the Building Inspector. Rev. 6/30/80 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION Location County Tax Hap . ./....OLD OR PRE-EXISTING BUILDING---~---VACANT LAND....-~.... of Property.. ~ ....... HOUSE NO. STREET HAMLET Owners of Property ....... ' .. No. 1000 Section ...~.. Block ..~... Lot'-.~2/3. Subdivision ....................... Filed Map ........ Lot .......... Permit No Date of Permit . . -Applicant .. % ....... Health Dept. Approval .... N. ld. ........ Underwriters-Approval .... ~/~. ..... Request for Temporary Certificate ./.... Final Certificate . . Fee Submitted: ~ ~. ~oo ... APPLICANT ................. ~. ........... rev. I0/14/88 -er. FORM NO. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765 - 1802 "~. APPLICATION FOR CfRTIFICATK OF OCCUPANCY INSTRUCTIONS 'This application must be ifiled in typewriter OR ink and submitted to the Building Inspector with the follo~img; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual n'atural or topographic features. 2. Final approval of ~ealltb Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrmcal! installation from Board of Fire Underwriters. 4. Sworn statement from p!lumber certifying that solder used in system contains less than 2/10 of IZ lead. i. 5. Commercial buildings, industrial buildings, multiple residences and similar · buildings and installations, a certificate of code compliance from the Architect or Engineer responsibl~ for the building. 6. Submit Planning Board ~pproval of completed site plan requirements. For existing buildings (P~ior to April 9, 1957~ non-conforming uses, or buildings and "pre-existing" land u~es: 1. Aceurate survey of property showing all property lines, Streets, buildings aud unusual natural or topographic features. 2. A properly completed a~plicatlon, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, . If a Certificate of Occupancy ms denied, the Building Inspector shall state the reasons therefor in wrSting to the applicant. 3. Date of any housing co~e or safety inspection of buildings or premises, or other pertinent information ~equired to prepare a certificate. For Vacant Land Certmf~ca~e of Occupancy: I. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing Single and separate ownership of ~he entire 10t prior to April 9, 1957 shall also accompany the application. If a!Certificate of Occupancy ms denied, the Building Inspector shall state the reason~ therefor in ~rriting to the applicant. FEES: ]. CERTIFICATE OF OCC~_ANcY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwell!in~ $25.D0, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessoiry buildings, $25.00 - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certifieate~~ of Occupancy - $5.00 - over 5 years - $10.00 4. Vacant Land Certifihate of Occupancy - $20.00 5. Updated CertificateI of Occupancy - $50.00 6. Temporary Certificalte of Occupancy - $25.00 Residential $50.0~ Commercial 'OUNDATION 'OU~DAT!O~ ~OUGH FRAME & (lst) .PLUMBING ¢2nd) ]~SULATION PER N. Y. STATE ENERGY CODE FI~;AL I ' ....~,~.z,.,'f ;4, ~ . · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 amined ................. 19... ;approved a/c ..................................... BOARD 3 SETS SURVEY CHECK SEPTIC OF HEALTH ............ OF PLANS ............ PORH ................ NOTIFY CALL ..................... MAIL TO: (Building Inspector)" APPLICATION FOR BUILDING PERMIT ' Date ....~. ; ........ 1 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ; 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 areas, and giving a deta/ied description of layout of property must be drawn on the diagram which is part of this appli- ion. 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 11 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 11 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 lding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ;ulations, for the construction of buildings, additions or alterations, or for ~'emoval or demolition, as herein described. : applicant agrees to comply with all applicable laws, ordinances, bu'ilding code, housing code, and regulations, and to. alt authorized inspectors on premises and in building for necessary inspections. · '(~ign~ture.'o'~a~lic~t~ ~)~ ~r~e', ~f~'c'o~o'r~t~c~n')' ' ' .. ~ s ~/~e.~ . . .~. ~. .c,O ~.~ .... t,l, .'M. O. (,. ~.9.O ..... (Mailing address of applicant) te whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ne of ow.er of premises ....... 88e.~og:~ i~£/~ .~.¢.y. ' .' (as on the tax roll or latest deed) pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Tradc's License No ...................... · .do Location of land on which proposed work ,.viii be done ...... . .t:...~'..~.... .0.$ .~'... ..... ~...C--.~.q~.....~... flouse Number Street. Hamlet :ounty Tax Map No. 1000 Section .~...-7. ~..'72.~. :.~... mock ...... ............ Lot ........... Subdivision ...................................... Riled Map No ............... Lot ............... (Name) irate e ' x st ng use and occupancy of premises and intended use and occupancy of proposed construction: ~. Existing use and occupancy /'dO.~.~. . ,. Inten~ed ~,e a,d o=c,pa,~y ....... ~ ........g...Oe... ...................... 3. Nature et wor.~(check whic pplicable): New Building ..... ' ..... Addition .......... ,~dtcration ....... Repa/r .. ~ ......... Removal ...... Demolition Other Work .......... . ~ . ~ . (to be paid on filing this application) "~[ ~2;~[he'?~,~g:nber.o f dwell,n~ u~}ts . M 'f& ';2 '~ .... Number of dwelling units o. each "eot. 7. gi~;s~,.55~mer~ml or m,x~d ~Scupan~y. ~pecify natt,~ and extgnt or each type o/asa Dimensions of same structure ~ith alterations or additions: Front ~ ~ ~T · . ~ ........... . ... NumberofStohes ....... · Dimensions of entire new construction: Front ............... Rear ............... Depth ............... He ~ it . ~. = .. ' ..... h;; .... Nu~ber of Stones ........... 1. DateofPurchase ~ ~ .............. Depth .. ~.~ . . , ~. O~..og~..~... t~.gO ........ Nam . ' ............ 1. Zone or use d~stnct m which p~emises are situated e of Foyer Owner . .C~gl.~l.~ .... ~E.~g~ ...... .. oes proposed construction vidlote a ...... : .... ~ wm ~ot oe regraaea ' '. .... ~'~" ................. Wall exees fiJ~ ~,e emoved from premises: Yes No . Name of Owner of premmes ~0~t~...~g~.ZAddres . ~ . Nme of Arch~tect ...... ~ ~ .., s ~ ~.~.~.~'~Vhone~o. Tgg.~77.q~ ..... · If *e~ e ...... ~ - ~=~ -~c-~n~uu .feet of a tidal wetland~ *YES .... NO ~''' ~ -, .... .u~u ~Ow¢ Trustees ~.~ may be required. '~'' : r~[ DIAG~M Locate cle~ly ~d dist~etly ~1] bu~dNgs, whether existing or proposed, ~d, indicate ~I set-back d~ensions from ope~y ~nes. Give street ~d block]number or deschption Recorder to deed, ~d show street nines and Ndicate whether :eliot or corner lot. 4,,t ."l'"E TE OF NEW YORK, JNTY OF (Name of individual signin~ contract) named. ......... being duly s~vorn, deposes and says that~he is the applicant the ~ ! ' I (Contractor · ' agent corporate officer etc ) .................... .,Id..owne.r or ,o, wners, and ~s duly ~utbor zed to pexrform or have performed the said work and to make and file this cauon; that au statements contain{2d in this application are true to the best of his knowledge and belief; and that the will be performed in the manner set forth i" '", " ' · . , n ute application , , . n to before me this , ,,, \ ,i OIcd therewith. ......... ........ ,C. ......... 7./ ~ --' O~ .' tatgnature of apphc~t)