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HomeMy WebLinkAbout20233-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20458 Date JANUARY 8, 1992~ THIS CERTIFIES that the buildin~ ADDITION & ALTERATION Location of Property 950 SOUTH HARBOR ~ SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 75 Block 3 Lot 13 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 21, 1991 pursuant to which Building Permit No. 20233-Z dated OCTOBER 25, 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 FIREPI~CE AND CHIMNEY ADDITION ~ CLOSE IN PART OF PORCH AS BUILT OF EXISTING ONE FAMILY DWELLING. The certificate is issued to JEANETTE H. GOLDEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED H-025842 - DECEMBER 4, 1991 N/A '~~~uild~ng Inspector Rev. 1/81 ffO~,M NO. ~ TOWN OF $OUTHOLD BUiLDiNG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N~ 20233 Z Permission Is hereby granted to: __ __ ...... ~ ' Cou.ty Tax Map No. 1000 Section ....... .~..~ ..... Block .........~. .......... Lot No ......... ./..~.... ....... pursuant to application dated .... ./..~.~./~../. .................................. 19..~./.., and approved by the Building Inspector. Fee $.. --~-...~.~ Rev. 6/30/80 Form No. 6 TOWN OF SOUTI~LD BUILDING DEPARTMENT TOWN IIALL 765-i802 APPLICATION 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 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 i% 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 "pro-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 I. 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, Coramercial $15.00 Date Jan. ~,. 1992 ..ow Construction ........... Old Or Pre-exiating Buildin ............... Location of Property ........ ~arbor Lane 8outhold, Ne~ York q t3. ......................................................... ltouse No. Street Hamlet ' ' Onwer or Owners of Property... J~AI~TTE GOLDEN CJouary Tax Map No 1000, Section .... ~ ........ Block .... ~ ......... Lot...13 Jubdivision ................. Filed Map Lot ~erm£t No 20233-Z ~ 10/25/91 ................ Date Of vermit ................ Applicant...jB3j~TTl~ C~LDR~ tealth Dept. Approval ......................... · Underwriters Approval · .imzng Board Approval .............. eqnest for: Temporary Certificate. .. Final Corticate ........... Submitted: $ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ IFOUNDATION ZND [ ] I~.ATION [~]FRAMING [ ~/J'~INAL DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]' ROUGH PLBG. FOUNDATION 2ND [~'i'~suLATIoN [ ] FRAMING [ ] FINAL REMARKS: ,,/ o ' 8. 9. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .. ~. ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... Close in part of porch/ gzvFjT-~arrt-/oxJ ~/~ ~e,~e?/~ (Description) Estimated Cost .................... $ ~[ ~ .0.Ct 0 ...........Fee ...................................... ~" (to be paid on filing this application) If dwelling, number of dwelling units ..... one ...... Number o f dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... H§igl~t' . .............. Number of Stories ........................................................ Di~ [~$i0ns of same structure.with alterations or additions: Front ................. Rear .................. D, }[1~( ................... ;... Height ...................... Number of Stories ...................... D [~jonJl~l~t~e~ cqn~s,fi~ction Front. Rear Depth Hi ~ ............... ~ufii~er of Stories ........................................ S~, o~~,;~.~>x{.~.~;;,× ....... Rear .... ].0.0t ............. Depth ...2]_0.' ............... D~ ~~ ~.~.u~.z.~/..u.u .............. Name of Former Owner .... Rev....[-lammond ........... Z~ 5'e-b~-u~e' district in ~h~ch premises are situated ............................................ Does proposed construction violate any zoning law, ordinance or regulation: ............. no ................. Will lot be regraded .......... ~ ............... Will excess fill be removed from premises: Yes No Name of Owner of premises 3oane.t.~.e · tt...Gotdor~ddress .. @.50 · $o.u~.h. Har. l~l~one No... 516..765..56 O 8 Name of Architect ........................... Address .. Soul:ho.l,d,. N.Y.. Phone No ................ Name of Contractor .......................... Address ................... Phone 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. ?.K')T~FY 8UIL.D]~G DEPARTMENT AT 765-~8~2 9 AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: ~. FOUNDATION ~10 REQUIRED FOE POURED CONCRETE 2 ROUGH ~ FRAMJNG & PLUMBING 3, iNSULATiON 4, FINAL COBJSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY CODES, N~ RESPONSIB~ FOR DESIGN OR C~RU~ON ERRORS STATE OF NF~Y_OR.K,.. _ . COUNTY OF./C,~...... S.S ......... ~.~4Ffi? ~. ~..~.. ~k,. ~..Q ./.~...~.ff.. ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ~Ie is the ...... ~..~-~..g/].~..~. ........................................................................ (Contractor, agent, corporate officer, etc.) · ' , and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of lhil~nowledge and belief; and that the work will be performed in the manner set forth in the application flied therewith. Sworn to before me this ........... /.~ ...... day of. ~C~,J~,*~. ......... , County .... ..... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined .~,/~< Z~. ..... , 19 Approved,/~. ~//Z;,',',',',',',',',~ ~7 ....... 19 9/Permit No.~'~. ~. 3~.~ · ' Dmapproved a/c ............... i ...................... "1 i ............................ ................. , 2t APPE'ICATION FOR BUILDING PERMIT Received ........... ,19... Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location 6f lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this apblication may not be commenced before issuance of Building Permit. d. Upon approval of this appliclation, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises availab!e 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 shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o'f buildings, additions or alterafions, or for removal or demolition, as herein described. The applicant agrees to comply wil.h all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premmes necessary inspectiens. (Sign~f applicant, or name~f a corporation) State whether applicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner fp ' Nmne of owner o remises..Jea, nette .H; · ~ot~e~. .................................................. (as on the tax roll or latest deed) If applicant is a corpprgtiqn, signatt re of duly authorized officer. (Name and title of corp( rate officer) Builder's License No ......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which prop ~sed work wiI1 be done.. 9 50..Seu.bh · ~ar. bor..R, oa~t.,..South, ol~l.,..NY ...... House Number Street Hamlet County Tax Map No. 1000 Section .......... .~4.~7... Block ..... .~ ........... Lot ..... /.,~. .......... Subdivision .......... ~ ............. Filed Map No ............... Lot ............... ..... !(Name). 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy , ........ lPJf~-.v, qt~..h.o.¢~ ..... _~ .................. b. Intended use and occupancyI ....... clos.e. ±n..part:..ot5. p ~.o...,~.~D...,~/~,ae,..