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HomeMy WebLinkAbout19961-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z~20719 Date MAY 12, 1992 THIS CERTIFIES that the building. Location of Property 3595 BEEBE DRIVE House No. County Tax Map No. 1000.Section 103 subdivision ADDITION Street Block 9 Lot 10 Filed Map No. Lot No. CUTCHOGUE, N.Y. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 17, 1991 pursuant to which Building Permit No. 19961-Z dated JUNE 20~ 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 REAR OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT PAUL WREDEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9961 Z 19..~..(. Date / Permission is hereby granted to: .,~ ...~ ................... ~ ....... .~..~0..~ ............ ..~?.~C~....~.~.:.....~ ....... . ....~..~~....~.:~.:.....u...~..~.~:. ........ ,o..~~ ....... ~ ......................... ~~....~...~.......~....~~. County Tax Map No. 1000 Section .... I .~...:~... , Block ........... ..~ ........ Lot No....)...O. ................ pursuant to application dated ...... ...'~. ,~.. ........~...~. ............... , 19..c],!.,, and approved by the / Building Inspector~ Fee $...'~ .................. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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 - $i00.00 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, Commercial $15.00 Date New Construction ........... Old Or Pre-existing Building ................. Location of Property.~. .. ~ ~.,. ~ ............... ; .~ .... House No. Street Hamlet ~ Onwer or Owners of Property.~O.~f.~.~.~.X...~Z~ ...................... County Tax Map No 1000, Section..~.~ ..... Block ..... ~ ......... Lot ..... ~..~. ........... Subdivision ................................· . · . Filed Map .......... . . Lot ..................... . Permit No. ~. ~.~. ~.~.~..Date Of Permit. ~./~..~..O/~/..Applicant. ~~.../~.~.~__~ Health Dept. Approval .......................... Underwriters Approval ......................... Pi nning Board Appro al /,~' Request for: Temporary Certificate ........... Final Certicate ........... Co ?1 APP IC T FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & ,PLUMBING e INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ~]t~AL REMARKS: DATE _~//////~ INSP£CTOR~~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examiued ...~...I,A--t~,..~.~.., 19 .~1}. Approved.../~/,~,A~...~..~.., 19~. Permit No.I.~.~&.~ . Disapproved a/c .............................. .~ ................. . ............... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PL.%NS .......... SURVEY ................... ClIECK .................... SEPTIC FORH .............. CALL .... ~- ..... MAIL TO: Date ................... , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s~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 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 application may not be c~)mmenced before issuance of Building Permit~ d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall 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 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 of buildings, additions or alterations, or for removal or demolition, as herein described. The 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. -- ~ ,. (Signature of applicant, or name, if a corporation) · .... .......... %. (Mailing address of al(o~icaut) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ./~)~.~..~ .~. ~. ~.~.~q~..~..~. .............. .. ....................... (as on the t.a~x roll or latest deed) If applicant is a corporation, signature of duly authorized officer. : (Name and title of corporate officer) Builder's License Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ................ ............. ............... House Number Street Hamle~ ~ County Tax Map No. 1000 Section .../. ~.~. ......... Block .... .~. ............ Lot ./...~. .............. 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 .(4~ w~r;~,~Y../fic~,..~-zw.~~ ~'~~ b. Intended use and occupancy .................................. ~,,, ~ ~,z %.. <.e:~,r ..,.~, ........ 3. Nature of work (check which applicable): New Building .... ....... Addition .......... Alteration . ~ [,,~_~ i Repair ... i ~Remo~al .............. Demolition .............. Other Wo~ ~..~,~ .%Q.', .... ..... ~ ~. ~ ~ (D~scription) (to be paid on filing this application) 5. If dwelling, number of dwelling ulnits ..... /. ........ Number of dwelling units on each floor ................ If garage number of cars ! / 6. If business, commercml or mlxe occupancy, spec nature and extent of each type of use ..................... 7. Dimensionsotemst~ngstructures,,lfany:Front ........ ·...~..:.,Rear .. ............ Depth .... ............ Number of Stones ........................................................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth ..................... i. Height ...................... Number of Stories ...................... 8. Dimensions of entire new constrUction Front Rear Depth Height ............... Numlcer of Stories ....... ; ................................................ 9 Si e ofl F P~ea Depth · z et: rent .............. 10 Date of Purchase ' Name of Former Owner I l Zone or use district in which ' ' ' ~ premises are situated ..................................................... 12. Does proposed onstructlonvlola~eanyzomnglaw, 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 ........... i ................ Address ................... Phone No ................ Name of Contractor .......... l ................ Address ................... Phone ]~ ............... 15. Is this property within 3~0 feet of a tidal wetland? *Yes ........ No....~. ..... ' *If yes, Southold T6wn Trustees Permit may be required. 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 nt~mber or descriptio~ according to deed, and show street names and indicate whether interior or corner lot. APPROVED AS NOTED DATE:~R.P. ~ I e~(~~°! '~ FEE'. -. ] 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPEC?IONS. FOR POURED CONCRET[ 2. ROUGH-FRAMING.& PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY cODES, N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERROR8 STATE OF NEW YORK, COUNTY OF ........ S.!S being duly sworn deposes and says that he is the applicant (Name of individual signing contract above named. He is the ' (Contractor, agent, corporate officer, etc.) of said owner or. owners, and is duly authorized to perform or have performed the said work and to make and file this pphcatmn that all statements contmr~ed m thru application are true to the best of his knowledge and belief; and that the wo'rk will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this ........... /..~ (7' ~l~rV pu~e, State m New Yo~ (Signature of applicant) No. 49622441. Suffolk County Ten, F. xpi,m Ju~ '