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HomeMy WebLinkAbout19718-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPD~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20066 Date JULY 11, 1991 THIS CERTIFIES that the building Location of Property 27756 MAIN ROAD House No. County Tax Map No. 1000 Section 18 Subdivision ~DDITION Street Block 6 Filed Map No. ORIENT~ N.Y. Hamlet Lot 21.10 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 12, 1991 pursuant to which Building Permit No. 19718-Z dated MARCH 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 DWELLIN~ AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JOHN & LINDA S~BATINO N/A -~/~ng Inspector Rev. 1/81 leORM NO. It 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) NO- 19718 Z Permission is hereby ~~..~ /=-~.,~ _..~.~......¥...~ .................. ..~.z.~../.~ ....... ~....~ .................. o ~~ "_"~ .. ~ .~.. ...... ~~ ....... ~ ......... County Tax Mop No. 1000 Section ........ ~..~.. ....... Block .[ ........ ~,. ......Lot No ...... ..'~..,?/.../.,,~.... pursuant to application dated .....~..~"-~ ' 19....~/.., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF $OUTIIOLD BUILDING DEPARTMENT TOWN ~LL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUP i. This application must be filled in by typewriter OR ink and submitted ro the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of ail 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 Oampiiance from archi=ect or engineer responsible for the building. 6. Submif Planning Board Approval of compleued 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 ali 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. ' 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 $ - ~/~-f- ~-~, ' Date ..... I~5.00,~ Commercial $15.00 ew uonstruction.?~.~. Old Or Pre-existing Building .. ~ ~''v ........................... ocation o~ Property.....~. 770-G ~q~ .......... House No. Street ......... ~"'' ~ .......... Hamlet nwer or Owners of Property....~.~. .............. ,unty Map 000, Sectio, .... ..O.!.E. .... Bloc' 0 ................ ~ot ...... C~'.. ~. j. ~ '-~ :bdivision .......... ............Filed Map ..........L .......... · . o~ :trait No .... t Date mit...%.. ...Applicant.. · · \j~..~. 'alth Dept. Approval ................ ......... Uoderwriters Approval ..... . ............ anning Board Approval .... quest for: Temporary Certificate... Final Certicate....~.. .... e Submitted: $ ............. ' A,;';£;LY;.'". ..................... TOWN OF SOUTItOLD OFFICE OF BUILDING IN~PECq'OR P.O. BOX 728 TOWN tlALL SOUTItOLp, N.Y. 11971 June 28, 1991 TEL.,765-1802 John Sabatino 27756 Main Road Orient, N.Y. 11957 To Whom This May Co.ncern, We are unable to complete your Certificate of Occupancy because .of the following reasons. //An application for Certificate of Occupancy is not on file. '(ENCLOSED) /_--//~o Underwriters Certificate on file. /7 The check is~f~/not on file.) $25.00 /-/ No Health Dept. Approval on file. /--/ No final inspection has been made. Please contact our office on this Thank you for your cooperation. Building Permit I; 1 9 ~ 1 8 Z Building Dept. ***/--/ bls Plumber Solder Certificate on file. ( all permits involving plumbing being issucd after April 1,1984 ) matter · FIELD J_,,S,~,.tOI !IDATE ii COM~gNTg FOUNDATION ( ls t ) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: "' I '765-1802 * BUILDING DEPT. INSPECTION ] FOUNDATION 1ST ~ ] ROUGH PLBG. ] Fou~DATION 2ND I- ] INSULATION [~]~ FRAMING [ ] FINAL REMARKS: ~~.~~ O, L'tj~ . ~.u'u~ !It[ TOWN OF SOUTHOLD t t ~ ~ ~ ~,;t TOWN HALL [J ~'~'~? [ ~¢~. ~: SOUTHOLD, N.Y. 11971 TO~ -., ;; ~ ........... TEL.. 765-1802 Examined 7~' ........ ,19.~ ¢ Approved ~/~ ,19~e~itNo ~/~ · ....... ........... z Disapproved aTc ..................................... ................. . ............ BOARD OF H£AL'T~Y' .~ SURVEY ~ . . <~.: ~<'.'. ....... :: ClIECK ~2 ........ ~ ...... ~EPTIC FORH ~ ........... MAIL TO: (¢ firK2. . ........ / 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 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 commenced 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 insl~ectio~.__ ~ ,, ,~'~_ ~_ ~ ...... r-~4~..,~ .-X cr~3. ~..~'W..~ .o:o:o:o:o:o,.~...~.'-,. .......... -'- (Sighxa~ure of applicant, or name, if a corporation) ({%, ............... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... Q-.d.(J. ~....~..'/~. U..'PT.-.-~-. ~.~..('J. ........................................... (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... ~..~..N. '.~.f~ .............. 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 Hamlet ~ f, /6 County Tax Map No. 1000 Section .... Q[ ~ ......... 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 ~..~.Lt?d...~..~.~. /.~ ~..-~...~.~L~ b Intende~d~tse~d:xyCcupancy ' :' k ( ch appli able)' Ne B tiding Additi Alt tio 3. Nature of wot check wht c . w u .......... on .......... era n .......... Rep r .............. RemovalDemoiit,on /, P i Fee 4. Estimated Cost ...... I ..................................................... ......... , (to be paid on filing this application) 5. If dwelling,, number of dwelling qnits ............... Number of dwelling units on each floor ................ . If garage, number of cars ..... , .................................................................. 6. If business, commercial ormixedloccu anc, s ecif nature and extent of each type of use , P Y P Y ..................... 7 Dimensions of existing structures~ if any: Front Rear Depth Height ............... Number of Stories ........................................................ Dim i f "h It ti dditi F ens ons o same structure wtt. a era ons or a ons: font ................. Rear .................. Depth ..................... i. Height ...................... Number of Stories ...................... 8. Bimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .... i ..... Rear ...................... ~ Depth ............... ... ...... 10, DateofPurchase .... ' ....:'ik'~"~:'"~ . Nemco F ~x,~ ~ .......... former Owner ~t~ .......... .~..;~..~..so~ 11. Zone or use district in which premises are situated..P,~.~.t. 0.~.-~4 .TI ,~. ................................ 12. Does proposed construction violate any zoning law ordinance or regulation' A/5) ...... 13. Will lot be regraded /tfi.Q .:, . . Wi * ' ....... · .......... .... · ~ ..... _. ........... 11 excess fill be removed from premises: Yes 14. Name of Owner of premises ~ ©~ .3.~4-3 [%~ .~ V.q. Address PS..~,..*~. ~. ,. 9.~. ~;¥~. Phone No..'h .L.'~ ~.~..~. t. ..... Name of Architect .......... ~ ............ Address ..... ~ .......... Phone No... ~ .......... Name of Contractor ........... ~ ............. Address ...... ~ .......... Phone No... ~ .......... 15. Is this property within 300 feet of a tidal wetland? *Yes.....~'~%%.. No ......... · If yes, Southold Tdwn Trustees Permit may be required. .. i 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 namber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ........ S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing kontract) above named, i ,~- He is the ......................... ~ ................................................................ I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly at~thonzed to perform or have performed the said work and to make and file this application; that all statements containe(t in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner se~forth in the application filed therewith. worn to before me this NOTAI~ pmitIC, state a i~= ¥~ ,-'~ k,,) (Signature of a~plicant) 0