HomeMy WebLinkAbout20205-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20499 Date JANUARY 24, 1992
THIS CERTIFIES that the building ADDITION
Location of Property 195 PRIVATE ROAD #32 SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 59 Block 9 Lot 10.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for. Building Permit heretofore
filed in this office dated OCTOBER 7, 1991 pursuant to which
Building Permit No. 20265-Z dated OCTOBER 15, 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 DECK ADDITTON TO EXISTING ONE FANILY DWELLING AS APPLIED FOR
The certificate is issued to PHYLLIS ATKINSON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTT.FICATION DATED N/A
Building Inspector
Rev. 1/81
rosat xo. a
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~ 20205 Z Date , !9~/
Permission is hereby granted to•;//J~A^ ~r
.
G~~
of premises located ct ....1.~.~..~~r~~rr:•.3~*"•......... .....~s~
.
County Tax Map No. 1000 Section Block .........C1..~..... //Lot No.....laf
pursuont to application doted 19.7n./.., and approved by the
Building Inspector.
Fee S.•s.~Q
G~2 .f.. :~1+
Building nspector
Rev. 6/30/80
Form ":o. 6
y
r
~ TOWN OP SOUTI[OLD ~ ~ ~ ` ~t° , ~ ~ r ati'.
y BUILDING DEPARTMCNT
P~. ~ l~~"~ TOWN HALL ; ~q' 'f
~ 765-1802 ' ~ ~ #
APPLICATION POR CERTIPICAT); OF 000UPTNCY'r;,,-
This application must be filled in by typewriter OP. ink and submitted to the building ,
inspector with the following: for new building or new use:
1. Final survey of property cvith 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 L'oard of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 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.
G. Submit Planning Board Approval of completed site plan requirements.
j .i, For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
",rc-existing" land uses:
~ 1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. ,1 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.
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
J. 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 $15.00
Date y~.- y~;
'~ev Cunstructian..:~ Old Or Pre-existing Building..... / .
'.ocacion of Property...l9S ci .t,, / //y7/
House No. " " " '
o~rcet Flamlet
.;nwcr or Owners of Property. ~"$`-u.~-,z.i
~:uunty Ta:<Map No 1000,/Section.. :~,~........Block...G,~1',,,,,,,,,,Lot..~d~5~
;ubd ivision ; ;"Ll,,~s~~~~-"`-,r~`~. G.. File •,~lG :
5
d Map• .Lot. ~i
crmit :;0.°?0~05- Z. G ri"`q/ C..a~-~., (~e:"v°_~-a-.~.~...
....Date Of Permit./,,,,(,~,,,/,1.,,,,Applicant.....`:..
!calch Dcpt. Approval...N~'~ ...................Underwriters A r ~
PP oval. N
•'l.uviing Board Approval.. N`~ .
•~equest for: Temporary Certificate........... Final Certicate,!~,,,,,,,
uo
..oe Submitted: $~7
~~Otl~~ APPLICANT
INSPECTORS ..r
a s4_~ :
Victor Lessard tf, ~u, X01, ,
Principal Building Inspectar ~av+~.~, 2U~~.,
Curtis Horton ~ ~ SCOTT L. HARRIS, Supervisor
Senior Building Inspector ~ ~ ~ ' Southold Town Hall
Thomas Fisher u~- ~ ~ P.O. Box 1179, 53095 Main Road
Building Inspector ~i
r Southold New York 11971
Bu'Iding Irupector ~~laf:~ Fax (516) 765-1823
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspector
RoberC Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTI-IOLD
DECEMBER 16, 1991
PHYLLIS ATRINSON
P. 0. BOR Ib45
SOUTHOLD, NY 11971
To Whom This May Concern:
we are unable to complete your Certificate of Occupancy
because of the following reasons:
%x An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xR The check is /not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20205-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
-1ELJ L...._,,._li.l ~~J„;~ j ,;v.`ti4LNi^ I yy
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OUNDATION (1st)
0
FOUtlDATIOtd (2nd) _ _ a`
_ ~~$`p1\
2.
P,OUGH FRAi~fE &
PLUMBING i~'\
rn
1
H
a.
m
'INSULATION PER N. Y. I y
STATE EJJERGY II
' CODc I
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FI;JAL I
o
ADDITIOPJAL COMMENTS:
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Val 9
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9B.
fOJ~O ~o~
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a R=25.00'
39.27 ~
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'P
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P~ `h~ ~ ' ~ per" °
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69
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2 LOT 5
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' po m
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AREA 30,000 SQ.FT. 9,
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4
SURVEY OF PROPERTY
FOR
ceariFieo Tor COMMUNITY DEVELOPMENT AGENCY
SOUTHOLD SAVINGS BANK
PHYLL/S ATX/NSON
scnc 7NC. AT SOUTHOL D
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000 - 59 - 09 - P/0 IO
SCALE I"= 30'
NOV. 23, 1988
Sept 7989 (found. loa )
Feb. 19, 7980 (final)
00 lANps
~a5 MeT LqL
~ 9 O
A
S. LIC. NO. 49618
a. ,
ECO fd YORS, P. C.
(516) 7 N
P. O. BOX J909
uelN Anen
•+++aramc~ra..emw.n....,.n.....a.,.y
n
~ r r,rr' BOr1RD OF HEALTH
I ~ 1~.~ ~ L~:i ~`~~L~r FORM NO. 1 .
~'°"'@°"°'°"'"°"""r~G~G I+ 3 SETS 0F/PL.1NS
1 TOWN OF SOUTHOLD SURVEY? .
~ B OCf I991 ~k ~ BUILDING DEPARTMENT CEIGC); Fem .
( a
i~! ~ u ~ G.~h,~o TOWN HALL SEPTIC roRa . .
` ~ SOUTHOLD, N. Y. 11971
y0~ry,.. t7it+;?t7C1CCS ~ TEL.: 765-1802 t:OT I FY
~y/.
/'/~+99 19 /J. CAL L
Examined .~K NAIL T _ • .
Approved ~C?~~~, , , , , 19/~~ Permit No..~~ ~.S
, ~ ' ' ' '
Disapproved a/c
~ / (B mg Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19~~
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Tnspector, 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
x areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
:ation.
c. Tlie 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
,hall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in pazt 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
tegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
Clte 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.
_ ~~.-.r.~~!........
(Signature of applicant, or name, if a corporation)
PO Z3.y' /6 YS
(Mailing address of app cant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
\ame of owner of premises ~6i,~~
~ ~ TKiNS ~
(as on the tax roll or latest deed)
:f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ~ :~!~:-?u!`t~ .
Plumber's License No . .
Electrician's License No .
Otlicr Trade's License No . .
Location of land on which proposed work will be done. ~ ~,/~;?~Cj,
,~.ax;~ . 9/e2~.`~'z-,~~
. ! 9..5...8<i..b'. c~ . 3~... /
Itousc Number Street Hamlet
County Tax Map No. 1000 Section 3 ~ Block , , , , , , , , , , , Lot ~ U. .
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 ~ . ~ ~I`'
. ~ ~~~x..~z
b. Intended use and occupancy
.~-..~.~~-~:PJ..~,.. s
3. A'ature of work (check which a~'pplicable): New Building .
Re air • • . Addition ...x.... Alteration .
p Re oval Demolition
Other SVork .
(Description)
d`-~`'tl ~ . . Fee .
st~matcd Cast r I (to be paid on filing this application)
5, If dwelling, number of dwelling] units , , , , , , , , , , , , , , , Number of dwelling units on each floor .
If garage, number of cars , ,
6. If business, commercial or mixc;d occupancy, specify nature and extent of each type of use . .
7. Dimensions of existing structures, if any: Front , , ~ ~ • • ~ ~ ~ • ~ ~ • • ' ' ' ' ' ' '
Hei ht ....Rear Depth...............
g ••••••.......NumberofStories
Dimensions of same structure with alterations or additions: Front ~ • • ~ ~ ~ • • ~ ~ ~ • ' '
Rear....,.............
e
g ..Height Number of Stories .
8. Dimensions of entire new constriction: Front Rear De th
Hei ht Nurrjber of Stories p ' ' ' ' ' ' ' • ' • •
9. Stze of lot: Front . . Rear Depth , ~
10. Date of Purchase PG,,,,,,,,,,,,,,,,,,NameofFormerOwner
P P g miser are situated . . . . . . .
11. Zone or usa district in which r ,,ate any zoning law, ordinance or regulation: , , , , , ~ ~ ~ •
12. Does ro osed construction viol'
13. Will lot be re raded ~ . ,Will excess till be removed from premises: Yes No
14. Name of Owner of premises - ~Address~ C3. Q.1( /G.VS~ , , ,Phone No. ~ 6~- 0 05'7
Name of Architect , • • ~ ~ ~ ~ ~ ~ • ~ • .
Name of Contractor . ~ • ~ ~ ~ ~ • ~ ~ ' • ' ' ' ' ' • • • Address ...................Phone No............... .
15. Is this
IEryesrtSouthold T "Address Phone No.
P Y 300 feet of a tidal wetland? ~
~ ,own Trustees Permit may be required. " " No„?~.....
PLOT DIAGRAM
Locate clearly and distinctly all ',buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether '
interior or corner lot. I
S
~ ~p~ Q) ~S NU'B'~~!
tAA~r~: wh5'9~ a~,~as,
I~ FFE'. Sp
t~1C3'tit•M ~
u~i[~i,~ t~r,~ARTM Ar
i ?tSt+~tg0? ;3 AiG7 'I{y ~t PM FOR 7HE
4"Ot.t.C)WINt; INSsu`fiCT@ONS:
' t. Fr)iihEC)A7ki')tti . "I"WO RECIUIRED
I FOR POURED CONCRETE
'i 2. ROUGH - FRAMING, gC PLUMBING
3. iNSUt.ATION
«5. FINAL CONSTRUCTION MUST
RE COMPLETE FOR C.O.
j diL& CONSTRUCTION SHALL MEET
'I TWE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
~ CCxDES. NOT RESPONSIBLE FOR
j DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW YORK
~'OUNTYOF S.~FGO, S:Sc
~ ll~.... f~-
' (Nam~of ind~s ua~ nin ~ ~ • ' ' ' ' • being duly sworn, deposes and says that he is the applicant'
g g contract)
cove named.
(Contractor, agent, corporate officer, etc.) ~ • ~ ~ ~ ~ • • ' ' ' ' '
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that •the
irk will be performed in the manner se',t forth in the application filed therewith.
vom to before me this I
.f.7. ~ .day of . ~ .Q . 19~~
>tary Public, ~i.~.~.1(~(/, , , , , County
' CLAIRE L.OLE'W
Notary Publlo, State of N G~
Qualified in Suffolk Coe
8 19S1C (Signature of applicant)
Commission Expires De emb~Y~