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HomeMy WebLinkAbout20171-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20345 Date NOVEMBER 14, 1991 THIS CERTIFIES that the buildin~ Location of Property 265 FREEM~tN ROAD House No. Street County Tax Map No. 1000 Section 139 Block 3 Subdivision Filed Map No. MATTITUCK~ N.Y. Hamlet ACCESSORY Lot Lot No. 37 conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 23~ 1991 pursuant to which Building Permit No. 20171-Z dated SEPTEMBER 26~ 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 ACCESSORY WOODEN ~HED IN REAR YARD AS APPLIED FOR. The certificate is issued to KEITH HARRIS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ~uilding Inspector FORM NO. 4 TO%TN OF BOUTHOLD BUILDING DEPAR~4ENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20346 Date NOVEMBER 14, 1991 THIS CERTIFIES that the buildin~ Location of Property 265 FREF24AN ROAD House No. County T~x Map No. 1000 Section 139 Subdivision ACCESSORY Street Block 3 Filed Map No. MATTITUCK, N.Y. Hamlet Lot 37 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTE~55ER 23, 1991 pursuant to which Building Permit No. 20171-Z dated SEP~ER 26, 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 ACCESSORY METAL STORAGE SHED IN REAR YD=RD AS APPLIED FOR. The certificate is issued to F~ITH HARRIS (owner) of the aforesaid building. SUFFOLK COUN~f DEPARTMENT OF HEALTH APPROV~J~ UNDER~RITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED / Building Inspector Rev. 1/81 IPOB, M NO. f~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT Cf'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.e 20171 Z Date . ./..~.~... ....... Permission is hereby granted to: County Tox Map No. 1000 Section .... ./.~.. ........... Block ....... ..~...~.. ........ Lot No .....,~..~.. ........... pursuant to application dated ........... ..~/....~....~. ................................ , 19...~./.., and approved by the Building Inspector. Fee ~ ........................ Rev. 6/30/80 ! ii SEP 2 3199'! BI.DG, DEPT. TOWN OF ~00THOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 "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, Swinging 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 ...... .................. . .. . . . Location of Property .... ~ ................... ~ ~.g..f~.,"'.~... .~, ........... ' . .~. ,~.~ /.~.~...~ .. House No. Street Hamlet Onwer or Owners of Property ........ l.~. ..... County Tax Map No 1000, Section ......... Block ............. Lot ................... Subdivision Filed Map Lot Permit No ................ Date Of Permit ................ Applicant ............................ . Health Dept. Approval ....................... .. . Underwriters Approval ........................ . .'laoning Board Approval ....................... . 7, equcst for: Temporary Certificate ........... Final Certicate ........... ?ce Submitted: $....~:p.~ .................... ................. ~ 0 ~ o~ 03 ~5 APPLICANT Form No. 6 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTI1OLD BUILDING DEPARTMENT TOWN HALL 765-1802 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. 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, 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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ...... f.~.~.~ ~ / ........................ ~;ew Construction ........... Old Or Pre-existing Building ..... i~ ........ Location of Property....~.. .................. .~.~..~..~...~.4 .......... . .~..r~.~.;?...~M.~..' House No. Street Hamlet Jnwe,r or Owners of Property....~..~.~.f-.i..~. ......................................... ;ounty Tax Map No' 1000, Section ..... ~.~.~ .... Block ........ ~. .... Lot ..... 5.Z ............ ;ubdivision .................................... Filed Map ............ Lot ...................... )ermlt No ................ Date Of Permit ................ Applicant ............................. {ealtb Dept. Approval .......................... Underwriters Approval ......................... 'l,mning Board Approval ........................ lequest for: Temporary Certificate ........... Final Certicate ........... ~OUNDATION~ ( 'OU~DATION { 2nd ) :OUGH FRAME .FLUMBING I~SULATION PER N. Y. STATE ENERGY CODE FI/JAL ~.. ADDITIONAL COMMENTS INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD October 10, 1991 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 Keith & Kathleen Harris 265 Freeman Road P.O. Box 513 Mattituck, N.Y. 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) XX No Underwriters Certificate on file. XX The check is (not on file.)$50.00~ CO'S REQUIRED 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). Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 765-1802 BUILDING DEPT', INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ,r~ REMARKS i,? DATE INSPECTOR · ~' 0 7, .[-- Examined ... Approved ... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.' 765-1802 ...... ,19 · ~.. ...... , 19 ~./. Permit No. ~./~./. '.~... Disapproved a/c ..................................... BOARD OF HEALTH nl SETS OF PLANS SURVEY ................... GIIECK .................... SEPTIC FOR~I .............. (/~ing'Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 pubtic streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- -'ation. c. The work covered by tkis application may not be ebmmenced 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 whole or in part for any purpose whatever until a Certificate of Occupancy ,hail 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or legulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Ehe 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 ,Jnsp, ectio/)s. -' (Sighature of applicant, or name, if a corporation) (Mailing address of applicant) ~*~;~Ud~-~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ~rf~o~der. .... ......................................................... : ........................ Name of owner of premises .................................................... (as on the t~a¢ roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician s L~cense No ....................... Other Trade's License No ...................... I, Location of land on which proposed work will be done· .' ....................................... ' ......... ......' .... . IIouse Number Street Hamlet County Tax Map No. 1000 Section .... f..~.~ ......... Block ..... ?..~. ......... Lot ...... ,,-~. ~. ...... .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) '.. State existing use and occupancy ofpr~emises and intendcd_~e and occupancy of proposed cor~struction,: / a. Existing use and o'ccupancy .GL. ............ ~ ....... b Intended use and occupancy , ork (check which app'licable): ' New Building .......... Addition .......... Alteration ....... Repair Removal Demolition .............. , ............................ Other Work 4. Estimated Cost .......... Fee ........... (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ............... Number of dwelling units on each floor · If garage, number of cars ..... I ............. If business, co.mmercial or mixed ~ccupancy, specify nature and extent of each t e of use ............... 7. Dimensions oir existing structures~ if any: Front ...... .~. ....... Rear ...... Y.~ ...... Depth /.~.' Height ...... Num bet of Stones .................... Dimensions of same structure wit alterations or additions: Front pth ................. Rear ............. De .... I Height ... 8 Dim ......................................... Number of Stories .................. ensions of entire n w constmctmn: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ...................................................... 9. Size of lot: Front /©0 J ....... Rear ........ ./49 O. ...... Depth . 10. Date of Purchase /~-~..O ...... .......... ................. Name of Former Owner I 1. Zone or use d2st mt ~n wluch premises are situated ............. ' ' Does proposed constructmn wolaie any law, ordinance or regulation: 12. , zoning 13. Will lot be regraded ~.O ~ ................. ' ......... ....... : .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises ...-~&rO~. .......... Address ................... Phone No .............. Name of Architect ........... ! ................ Address ................... Phone No .............. Name of Contractor .......... ~ · · · ·. Address .... 15. Is this property with±n 3010 .......... ' ............. Phone No .............. feet of a tidal wetland? *Yes....~.... ~o ......... · If yes, Southold To~n Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all bluildings, whether existing or proposed, and, indicate all set-back dimensions property lines. Give street and block mimber or descriptioh accord~g to deed, and show street names and interior or comer lot. iTATE OF NEW~OP~'e'> :ou ¥ OF.. , (Name of individual signingj contract) bore named. {e is the ................. (~ .~.~.~ .(. ......................................................... ~ (Contractor, agent, corporate officer, etc.) £ said owner or owners, and is duly ai~thorized to perform or have performed the said work and to make and file '~plication; that all statements contain6d in this application are true to the best of his knowledge and belief; and that ork will be performed in the manner selt forth in the application filed therewith. worn to before me this NOtlIW Public, Stat~ o~ N~ ~ ' ' ' / '2' '"~"}~ "~ .b' ................ ... No, 4879505 l Qualified in Suffolk COU.?~/ C~2_ (Signature of applicant) Commission ~.npires December,8,