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Home My WebLink About20278-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20562 Date MARCH 4~ 1992 THIS CERTIFIES that the buildin~ Location of Propert~ 175 BIRCH LANE House No. County Tax Map No. 1000 Section 83 Subdivision ADDITION CUTCMOGUE, N.Y. Street Hamlet Block 1 Lot 30 Filed Map No. Let No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 13, 1991 pursuant to which Building Permit No. 20278-Z dated NOVEMBER 14, 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 & AROUND INGROUND SWIMMING POOL AS APPLIED FOR. The certificate is issued to ROBERT & CAROLYN CONWAY (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/a N/a Rev. 1/81 IrOu't~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO_ BUILDING PEBJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) /./ /~/ 20278 Z m,o ......... ~ ..................................... , ,~..?/. . . ...... ~.'.~~ ...,~:~:.~ ./~-- ,o at prem,:::', ':T"::'::.::~.~:: .... '.~...~::: ................................................................ Coun~ Tax Mop No. 1000 Section ......... ~ ..... Bilk ........Z. .......... Lot No ....... ~.~ ......... pu~uant to application dat~ .......... ~ ............................... , 19.~, and oppr~ by the Building Inspector. .............. Re~ 6/30/80 ,, ~ ~ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 A~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. 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, Connnercial $15.00 ~ Date . . ./,..~. ..................... I1 / I ........... Xew Construction ........... Old Or Pre-existing Building ................. location of Property ..(.?..~.. .......... .~-~. ~.~__o~. House No. Street Hamlet Onwer or Owners of Property...~....~.~.~/~.~...~...¥..~..~....~ County Tax Map No 00, Section ..... .~. .... Block ...... Z Lot "ubdivision Filed Map Lot Permit No ............. Date Of Permit /~, ~. .... Applicant ............................. Health Dept. Approval .......................... Underwriters Approval .................... Planning Board Approval .... /~.../~.. ............. Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $... ~c5', FOU~DATION FOU;~DATION 2. f2nd) ~OUGH FRAME & .?LUMBING INSULATION PER N. STATE ENERGY CODE Fi;~AL ADDITIONAL COMMENTS: · '~ .vv~.; NE'QUIRE ~0~' POURED CONCRET~ 2, ROUGH . F~AM~NG ~ PLUMBING 4,, F~NAL COnSTRUCTiON MUST ~E OO~PLETE FOR C.O~ ALL CONSTRU~ooN SHA~ T~E REQUIRE~E~S OF THE N.~ STATE CONSTRU~ION & ENERGY CODES. N~ RESPONSIB~ FOR DESIGN OR CONSTR~ON ERRORS 'cEsSPOOl', sE~IC lANK AND wELL p. stRVIC~- LOCAltoNS OR WAlE ..,~ ~E NOT 'HE EXISlENC~' OF RIGHT OF ~N,D-.OR/EASEMENTS OF F ANY,-" NOT SHOWN 2o × ;40 19~ff./Permit FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... ....................... :::::~~:::iT>'-Zins~ct~{;~'~'' '~ APPLICATION FOR BUILDING PERMIT BOARD OF HEALTll ......... 3 SETS OF PLANS .......... SURVEY ................... CIIEcK .................... SEPTIC FORH .............. CALL ................... HAIL TO: NOV 1 3199 D'i~te ......... 2 ........ ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 ;ets of plans, accurgte 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 detldled description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Budding Permit to the applicant. Such permit ,ball 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 .ball 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 ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. I'be 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 inspections. ...... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State ~vbetber applicant is~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Xameofownerofpremises ...~,....~27q4~.~ ..~'...g~. ~. (as on the tap: roll or latest deed) It' applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... q?./~./¢/..~..~. ............ P u nbcr's License No ........ .~..41 .............. Electrician's License No. ////¢ Ot er Trade's License No ..... ./~.../¢. ............. Location of land on which proposed work will be done. / 7c.5- ,~. '¢~'~..~.d~ ' llouse Number Street Hamlqt County Tax Map No. I000 Section ~:-~ Block · ] ......... ' Lot ....~.0 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 / l' ,~ ,,~ , 7,, "., 7~ %..., ~. , ~ /'~'~.. ,,:, ..... ¢.,,. ...... ~ ..... b. lntended use and occupancy ..... ~ .... ~~,,,,~ . :' ~ ~ ~:' %~ ~'~''t~e 3. Nature ofwor (check whi,ch~_apph.cable): New Building ......... Addition Repair ............. r, mnoval 0 · Dcm-'"' '"'' ....... ' ....... .......... ummn .............. Other Work ........... ~ ' ' (D rip ) I (to be paid on filing this application) 5. If dwelling, number ofdwellin~ units .. · If garage, number of cars , ............. Number of dwelling units on each floor ................ 6 If business ' ' ' ~ ..................... commercial or m~xgd occupancy ..... specify nature and extent of each type of use ' ' 7 Di'mensions of existing structures if any: FrOnt Height Num" ber of Stories ............... Rear .............. Depth ............... of same structure alterations or additions: Front Depth i Height ................. Rear .................. 8 Dimensions of entire new consiruction: ............... Number of Stories · Front ....... ' .................. Height Number of Stories ............... Rear ............... Depth ............... 9 Size ofl~: ............. ' ............. · Front Rear ........................................... 10 Date of Purchase i ......... ~ ...................... Depth ....... · '~ .............. '.. · Name of Former Owner " ..................... I I Zone district in li ch premmes are situated ' ' · or use W ............................. 12 Does proposed construction violate any zoning/aw ..................................................... 13. Will lot be regraded i , ordinance or regulation: ..... · ~ ..~ · · ...._:. ........ Will exce,ss fill be removed from premises: Yes No 14. rqamemownermpremises .4~. ~.~x/y.~:. Address / Name of Architect .. i ' '~ .... ... · ................ *-none r~o ............. · ' ~ .............. *touress ................ Phone No ............... Name of Contractor i ........ ~ ................. Address ................... Phone No ......... . ....... 15. Is this property within 00 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Town Trustees Permit may be required· · ". i PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and. indicate all set~back dimensions from property lines. Give street and block humber or descriptioh according to deed, and show street names and indicate whether interior or comer lot. i APPROVED AS NOTED DATE: 8.R # ~ ~EE: ...... BY: ~ MOT/FY' BUILDING DEPARTMENT AT 7G5-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: L FOUNDATION '~O REQUIRED FOR POURED CONCRETE ~, ROUGH ~ FRAMING & PLUMBING 3~ ~NSULATION 4. F~MAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ME~ T~E REQUIREMENTS OF THE N,E ~TATE CONSTRUCTION & ENERGY CCDES. NOT RESPONSIBLE FOR DEStGN OR CONSTRUCTION ERRORS OU,NT¥./I~F ..... ~-~.~ ( ~. )OVC ~3Incd. , ...... bein,~ duly sworn, deposes and says that he is the applicant ' (Co;tr;ctor: ag;nt: corporat; ...................................... officer, etc.) said owner or owners, and is duly a'uthorized to perform or have perfonned the said work hnd to m~e and file this plication; that all statements containdd in this application are true to the best of his knowledge and belief; and that the )rk will be performed in the manner sdt forth in the application filed therewith. 'om to before me this ~ml~n E~ ~~''*~ ~ / (Signature of applicant)