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HomeMy WebLinkAbout20211-z rF, A FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20300 Date OCTOBER 22, 1991 THIS CERTIFIES that the building ADDITION Location of Property 145 FAWN LANE CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 4 Lot 23 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 10, 1991 pursuant to which Building Permit No. 20211-Z dated OCTOBER 18 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to CLIFFORD & JEANNETTE SCHRIEFER (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~?~G`~1. J r( LC/ I~.-,sue Buiidinq Insp ctor Rev. 1/81 108M NO. ; 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 a 2 0 21 l Z Date ..O.ld~./..~~ 19 Permission is hereby gmnted to: to ~ ..C~a:,`~ .~.........~.....~io at'remises toeated at ~.r'~. County Tox Map No. 1000 Section ......ld.,«T~..... Block ........T......... Lot No.......~„~....... pursuant to opplication dated la./.~..° 19. q~, and approved by the Building Inspector. o~ Fee S.'~©. p ding for Rev.6/30/80 I~ ,y ' a Form No. 6 TOWN OF SOUTIIOLD BUILDING DHPARTMENT TOWN HALL 765-1802 APPLICATION POR CERTIFICATE OP OCCUPANCY ~ 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 caith 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 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. 6. Submit Planning Board Approval of completed site plan requirements. :i. 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 - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, /Commercfial $15.00 Date 2G~~( ::ew Construction...~....''O//ld Or Pre-existing Building....... Location of Property.....~.7.~..... ~w?~1, , ,~.!-,r/~~... , , ~ ~~~a v~ House No. I Street aml et Onwcr or Owners of Property../[ F~r~. 7f J~',(q!?a?P,I~C/,~,~J~C~jI;/~.~~f . . . County Tax Map No 1000, Section.../K ~.......Block....t{.4.........Lot..,~~,,,,,,,,,,,,,,, Subdivision ....................................Filed Map............Lot...................... Permit No.°Z..~.:~.C~.......Date Of Permit ................Applicant............................. !ienltl~ Dept. Approval ..........................Underwriters Approval......................... Pl:~nning Board Approval.........~~......... / i:equust for: Temporary Certificate........... Final Certicate.... v,.. ;'ce Submitted: ~,.ac. y a U .J ~ ..APPLICAN . ~U~~b3o-o i 1cLJ i::S:'~~.:J:i ~~J„: j :;U.`ti•IE.NT^ I p~ 1. I mO . I a H c 0U1JDA'1`T~:It~`~ (l s t) ~...-.`~I - 1 - POU`lDATIOIJ (2nd) 2. - `o r',000H FRki~1E & .PLUMBING N J 3 ~ y 1 n ZNSULATI0;1 PER N. Y. I y STATE EiIERGY II CODE I ~ T FZ;IAL I ADDTTIOIIAL COMMEPJTS: m c~ • x • ~ H \ 77 i H ' O m f~ - - - c- v ~ ~ m H o f BO,1R0 OF HEALTH FORM NO. 1 3 SETS OF PL \:i5 , TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT Cf1EC); . TOWN HALL SEPTIC toRtt . . SOUTHOLD, N.Y. 11971 JJJ TEL:765-1802 t:oTIFY; ,iC-!~_ ''7 / CALL j . , , , , , Examinedl.~/.~~,,,,,,,,.,19~yg~ PfAIL TO: . Approved ..~~~I 19/./. Permit No.~~/~ ~ • . Disapproved a/c . _ . ~pP A ED AS. i~01'ED...... _ iEE' BY: Bull Inspector) M01'IFY B QlNG OEPAR E T AT ~ ' 765.180;L 9 AM TO ~ PM FOR TH~PPLICATION FOR BUILDING PERMIT 6=OLL()v~/tN(~ lNa'PECTIONS: C/ '7. Ft7Uh1t7ATlON -1W(:rREQUiREO Date 19.!! E(?f~ P()URE(> CONCRETE 7. R0.1C>FI - FRtaM9NC; 1?, PLUAhBfNG INSTRUCTIONS ;NSLIt.f~TION a.; ~~&^-,applica~l~~4Rg,TC11ttC4R11PJ1211y filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets,of ply'nS;CdGG~t4?~ti~l><6r~tilQla,~ to scale. Fee according to schedule. 'Qb.%~;Izlottspti~i'31td~Iti~Jla~t~h ~ABt19' and of buildings on premises, relationship to adjoining premises or public streets ~r areas,c.,an"tit:tCliifRa!d~ttti16l1Fdd~BEip(,l0it of layout of property must be drawn on the diagram which is part of this appli- :atiurt;Eh?:i «CF;iS-rRtSC't00N N: ENERGY a The"avoFlt~b~vr~3g~it1f~d~4~'pplrra~"fion may not be commenced before issuance of Building Permit. d. Upon ~a'15'p`r6'v~I-of~t&i~<~[~'p~fi~9€idr~, the Building Inspector will issued a Building Permit to the applicant. Such permit .hall be kept on the premises availabl~far`inspection throughout the work. e. ; :No building. shall p4,e Qccupjg-¢_qt used in whole or in part for any purpose whatever until a Certificate of Occupancy hall hitGe~ Beeri~'gt~dttf~d ~byt~th~'~Bifi~fiil~C~ 1~9~pector. ~t;;: !;tt,? '-1 t°,S+i~ t'("> F'M FOII T3.1[ APELI,GA.~;j~j~IISS~)rI,Et~tl' MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uildirlg Zo{l~,psQ,tltyr~~pce o~'~~gR~p,p6Southold, Suffolk County, New Xork, and other applicable Laws, Ordinances or tegulatio~65i;fjgra~}Ip(rQ,~gt~gtil@p of buildings, additions or alterations, or for removal or demolition, as herein described. Che ap~pl~~aggregR,~pl~jy~r{iP~}P~j1J~pplicable laws, ordinances, building code, housing code, and regulations, and to admit ~ut;~,a~~e~}Ogpectors on premises and in building for necessary mspe tions. FI~lAL - CONF:TRUCTiON MUST _ . BE CO(V~PLETE FOR C.O. (Si~• ure of applicant, or name, i corporation) ,ALL CONSTRUCTION SHALL MEET TkE RE(2UIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CC~LiES. NOT RESPONSIBLE FOR (Mailing address of applicant) State ~~e~liN OR C10NS'~RUCTION EF~RORS pp Ican Is owner, essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............l~lL1.~ . \ame of owner of premises L. ~ 1 :i~~o!~ d...`6 ..J.4' G1 ?t\ YI C 7~7~ J s-i P /e (as on the tax roll or latest deed) if applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. QGf/. 17 ~.Y-:...... . Plumber's License No . . Electrician's License No . Otllcr Trade's License No . . Location of land on which proposed work will be done. . ]louse Number Street , ` Hamlet County Tax Map No. 1000 Section ~~Q ~ Block Lot . Subdivision Filed Map No. 3.a..~.Q.... Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~'h~.•.I , iGPS. (.C~,~,, , b. Intended use and occupancy ~f'S'K, ~.(1/.f. P-..........~, "r,~„£„ .r, i~ 3. Aature of work check which a Repair , , , . PPlicable); New Building Addition Re Y • • • • • • • • Alteration . r • • rr~oval Demolition . Other Work . (Description) 4. Estimated Cost......a74r:2p.aQ~,,,•..•.•..•...• Fee (to be paid on filing this application) s 5. If dwelling, number of dwellin units Number of dwelling units on each floor ; . • If garage, number of cars • • • • • • • • . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures, if any: Front Rear , , , . , , , Height . Number of Stories . Depth , . • , , , unensions of same structure p kith alterations or additions: Front , , , , , , , , , , , , , , Rear . De th 8 He',tensrons of entire new const • 'Height . Number of Stories , , , . 1'uction: Front Rear De th ioht Number of Stories , p ' ' ' ' ' ' ' ' ' 9. Siza of lot: Front : Rear Depth , 10. Date of Purchase • , , , • • ' ' ' ' ' ' ' • • • • Name of Former Owner 1 I. Zone or use district in which premises are situated . _ oes proposed construction viol, o ate any zoning law, ordinance or regulation: 13. Will lot bere~raded Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~ • Name of Architect ' ...Address ...................Phone No............... . .................Address............... ....Phone No Name of C pntorPetoty within 3• • ~ ~ • • ~ • ' ' ' ' ' ' • • • Address Phone No. 15. Is thas 00 feet of a tidal wetland? * ~ " " " " " " *If yes, Southold Town Trustees Permit may be required. No.,t/.:,.., 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 riumber or description according to deed, and show street names and indicate whether interior or corner lot. - j ~(1' ~yua~inY YKYpos s i.2c~nehY ~ ~ / ~ ~~~9., ~ ~ , ,L a f ~/5 ~qwh ~~a~ TATS OF NEW YOIZI~ 'OUNTY OF ~ SV. S.S , , , , , , J ,eovuve , 2, • . • BC • . , , , being duly sworn, deposes and says that he is the applicant' (Name of individual si nin contract) ~ovc named. c is the Q"'u.fe,? (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 t}te irk will be performed in the manner set forth in the application filed therewith. +om to before me this I.l~c` _n~ ay ex-EEe~~.e~ . .eft-u-d • • 79`~l. >tary Public, SvF~\'~ gyp, County ~p NOTARVPUBII' ofllx ~!?tF;r-~';-./J,e.'`fy(~/~.,`~x,,,........ 125089 i~tlllEy., (Sign9t~re of applicant) E1tQlp9i l9.`L'F- - t ~ ~ ~ - ~ -t - - 1- - - - - - ~ ~ - ~ ~ ~1 3 ~~a I ~ - J ~i ~ ~ ~ d ~ . - - - - - r - - - , - - - - - 1--; - - -r - - - - - - - - - - - +1-1- ~ - _ ~ - _ _ - - _ - _ ~ i - - - l - ---I - - - - I-{ - - ~ - - -I- - - - - - -'r - - - - - - - - - - - - - - - - - - 1 - - -t- I ~ - - - ~ - - - - ~ - - - - - - - - i - - - - I-_~ I - ~ - - - ~1 x i i ~ s - O - '~I ~ _ o - - - - II' ~ - - - ~ ---I- - - j - - x- i ~ - - - -1 - - - - - - - ~a- - - - - i i ~ - - ~ - - } i ~ - i - - - I . - - ~ - - - ~ C ~-i F ~ ~ i ~ - ~ - - - - - - - I , , - - - --j - - ~ -a , _ - { ~ ~ - --i - ! - - 'a~ - E-- - - i - - - ' - - j _ - ~ j~ i I _ _ _ _ _ _ _ _ _ ~ - - - - I- _--~----_----'-I C~ 2` i>,~,3;. pra ays 1P~- r ctrl t "#t a'K: ~ ~ ~ .N..~ x5„15 ~a 'S ~,c f! .altardcuoq . ~r '~r ~ ,tfi' q x.cr @TM r~'a ira coin v~ixxl~'.• 3 j of Hrs £J b 6" t$ Y9 A S.q,r p s< . ,w t~ . s ~ •<v `tP l: EUrV<ry al'pn thsti:~~ yS:;~" a rt a ~ -n S i,.-! 9 ttiayoi s irtk N w. l c. i e ~ N'`,y :~,~1 t,. a.cna sus shalt ^,pt ss mnvCFrr.. 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