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Home My WebLink About20276-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20361 Date NOVEMBER 20, 1991 THIS CERTIFIES that the buildin~ Location of Property 210 BENNETT ROAD House No. County Tax Map No. 1000 Section 40 Subdivision CEDARFIELDS ADDITION GREENPORT~ ~.Y. Street Hamlet Block 5 Lot 1.2 Filed Map No. Lot No. 2 conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVE~4BER 12, i991 pursuant to which Building Permit No. 20276-Z dated NOVEMBER 13~ 1991 was issued, and conforms to all of the requirements of the applicable provisions of the lawd The occupancy for which this certificate is issued is DORMER ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A DONALD BRACKEN & DIANE CARROLL ~a~,~ ~. . Budding Inspector Rev. 1/~1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREAAISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2 0 2 7 6 Z Date ...... ~..~.~...J..~...... Permission is hereby granted to: rem,ses I at t ¢~/~ . ~ ~..' ' pursuant to application dated ...~.~...~.~J......~/...:~. .......... , 19..~./..., and approved by the Building Inspector. Fee $....~.....: ........... '~... Rev. 6/30/80 Form No. 6 TOWN OF SOUTIlOLD BUILDING DEPARTMENT TOWN IIALL 765-1802 Ai~PLICATION FOR CERTIFICATE OF OCCUPANCY ',. 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. 3. 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 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 Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .~....~/..-~...~..?../. Location of . ' }louse No~ .-- ' /7 S treg~ ....... /- ~' ' 'Y '~'u~ie~t ............ Couuty Tax Ma~/jO:p,S:~t~..~...~. ....... Block ..... ~ ....... Lot.../,.~ · ............. z:"ZL .......... .e.zILh O~pt. Approval .......................... Underwriters Approval ............ ./. ......... · '!.muing Board Approval 2eq,est for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................. ......... ¢ o ' PL C, NT INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Buffding Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 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 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD NOVEMBRR 15, 1991 DONALD BRACKEN & DIANE CARROLL 100-30 S JERSEY AVENUE SETAUKET, NY 11733 RE: l~aelllng, located at 210 Bennett Rd., Greenport To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xxx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is ~L~/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 9 20276-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. FOU~DATION~_ _ --. , { 1st_J_) FOUNDATION (2nd) 2. ROUGH FRAME & .PLUMBING ® INSULATION PER N. STATE ENERGY. CODE FINAL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Exauffned..J~J..~..~.~..~, .~>.. J.~ 19 '\pproved .~....0'?Sfi~....~..../.,,~., 1991. Permit No ............ Disapproved a/c ..................................... ................. . ............... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. tIOTIPY~ CALL ................... HAIL TO: INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~'ts 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 ,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 this applicatibn may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit imll 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 purp~fi~ whatever until a Certificate of Occupancy :mil have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issua~'~.BuildingT~ Permit pursuant to the ;,uilding Zone Ordinance of the Town of Southold, Suffolk County New York, a~it~.litt~lplicabte Laws, Ordinances or .egulations, for the construction of buildings, additions or alterations, or for removMiS5: d~iPdtion, as herein described 'he applicant agrees to comply with all applicable laws, ordinances, building cod~.~tousing c(~e, and regulations, and tg dmit authorized inspectors on premises and in building for necessary inspectio~,//ff/~. -- '~, PP' ,' ' n)- ., :'.'/.~.~.: :~ .:...~ .~.~.. ¢.4:...&...~:.~ .~. .~.~. /. /. '.:::' ' q'Mailingkiddress of applicant) ;rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .......... .:..: ...... -.. qame of owner of premises {~~..~....-~..~...-~.../... :~. ~~ '~. :ii (as on the t.~x roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electmc an s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............. tIouse Number Street Hamlet (./ County Tax Map No. I000 Section .................. Block ..... ..~. .......... Lot... I.: Subdivision .... h~e) .............. Filed Map No.. . ....... Lot .......... State existing use and occupancy of premises and intended use and occupanc~ of proposed construction: b Intended use and occu anc · p ~ .................................. Z..),,' ~ ............ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ...~. ...... P~p~atr/ . ~,.~ ~..f].. ;/? .... .Re/'nov~ . . .~ ........... DenLohtlon' .............. pther Work ............... (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 ........................................... 6 If business commercial or mixed occupancy specify nature and extent of each type of use ..................... 7. Dimensions of existing stmcturesl if any: Front ............... Rear ........ ~ ..... Depth ............... · Height ............... Num er of Stones ................................................. ith ....... Dimensions of same structure w alterations or additions: Front ................. Rear ................. Depth .................... I. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9 Size of lot: Front · · ........... i .......... Rear ............... Depth 10 Date of Purchase ~ ............................. ' Name of Former Owner I 1. Zone or use district in which prmgises are situated ..................................................... 12. Does proposed construction violaie any zoning law, ordinance or regulation: ......... 13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... ; ................ Address ................... Phone No ................ Name of Architect ........... ; ............... Address ................... Phone I~9. ............... Name of Contractor .......... i ............... Address ........ \ Ph,,ne No .5. Is this property within 3010 feet of a tidal wetland? *Yes ~ ? · If yes, Southold Tawn Trustees Permit may be requir~ ...... ~ .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all se bec i ~ · · , . . . . kdmensmns from rg jg oy no%7; ctreet and b,oc nqmber or description according to deed, and, show sg;e~et~es and indicate whether OCCUPANCY 0R USEISUNLA UL OF 0CCUPA C¥ -- i ,APPRQV£D AS NOTED FEE: NOTIFY BUILDING DEPARTMENT Al' AM TO PM FOR 'rile FOLLOWING INSPECTIONS. 1. FOUNDATION TWO REQUH:~ErJ FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING :3. INSULATION 4. FINAL CONSTRUCTION MUST 1:3E COMPLETE FOR CO ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE NY. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIF,'LE FOR DESIGN OR CONSTRUCTION ERROHE; FATE OF NEW y,O-R.K,f', p_ //.. S S ' OUNT¥.OF..._~,'¢~.~ 'i ...... ~) ~'~'/d" '.~. t'.~¢~ ~..~. ~.~1, ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing ~ontract) ~ove named, ~' is the ............. ,... ~. {-XJFL~ ~ ' (Contractor, agent, corporate officer, etc.) aid owner or owners, and m duly at~thonzed 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 tile )rk will be performed in the manner ssi forth in tile application filed therewith. /om to before me this' va_ ..... ¥ /3. ......... · >.., ....... d~}y of ........ , 19 ~tary Publi . Notew Publlc~ State of New Yed[ .... ~..';. r ;..:.. F7;. ?..'~.~..~. ~ .~..v~...~ ........... No. 487950~ _ Qualified in Suffolk C~unty t~-~ ~ (Signature of applicant) commission Expires De~ember 8,1~.~-~~