HomeMy WebLinkAbout19726-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19874 Date APRIL 26, 1991
THIS CERTIFIES that the building ACCESSORY
Location of Property 3130 MANHASSET AVE.
House No. Stree%
County Tax Map No. 1000 Section 43 Block 4
Subdivision Filed Map No.
GREENPORT~ N.Y.
Hamlet
Lot 18
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 18, 1991 pursuant to which
Building Permit No. 19726-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 ACCESSORY SHED AS APPLIED FOR.
The certificate is issued to
(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
EMMANUEL TZANNES
Building Inspector
TOWN OF SOUTHOLD
BUILDIHG DEPARTMENT
TOWN HALL
$OUTHOLD, No ¥o
BUILDING FERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
19 7 2 6 Z Dot, ...... .~./. .................................. , J~..'~/
/
Permission is hereby granted to:
....................................
County Tax Map No. 1000 Section ....... ...~.....~... ....... Block .......... ...~.... .... Lot No ....... ./.8 ..........
pursuant to application dated .... ~.. ..................................... 19..?/..., and approved by the
Building Inspector.
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:
I. 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 architec~. 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
4 "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.
; · 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
j Date.. ~.."- .~..'~. ~ .~ .~/.
:ew Construction .... .~. ..... Old Or Pre-existing Building .................
,ocation of Property....~/.'P.~.....)~..,~.~.~., ~.~ . . .~.~o.~.. ......... J i~.~..~.~/~ ......
House No. Street Hamlet
)nwer or Owners of Property ...... ~.~..~.~. ..... .~.~..~..~.?. ................................
>/
~OUnty Tax Map No 1000, Section .............. Block ............ Lot. OJ
ubdivision ....................
................Filed Map ........... · Lot ......................
ermit No.. l.~..~.~..~.."~. ...Date Of Permit..~.l~..'~.~ ..... Applicant ...... ~ z~....'.~.~, .....
ealth Dept. Approval .......................... Underwriters Approval .... . .....................
lanning Board Approval ........................~
equest for:
ee Submitted: $ .... ~.~.~.~
Temporary Certificate ........... Final Certicate ...........
YIELD
FOUNDATION ( ~ s t )
FOUNDATION (~nd)
ROUGH FRAME &
.PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
AH~;:~ ~XE~E INDICATED, ~HALL RAVE. f'12 TXIC :: C
'Tfl ~L'~"t/2' LESS THAN T~ [ND[CATED
~[b 1150.p,s.i,? S~ZEDA~IND~CATE~ AND :SET
~EA~NG. QR M~TH ~ULL ~[A~N6 TO .[N~]CATED
: ~RU ~LTEb,' ,THE ~ STRUCTURE SH~L BE
SU9 [LOOE ~HALL 8E 314" UN~E~LAYHENY ]NT-APA PLYWOOD
:O .F~ HATER ~ARAGE. PROV[~E' 'ALL PAODtN6 TO A~I6N
AND':.CEiLINGS AS RAY ~..~E~]RED..~ EX~XO~ MALL.
~ ~L ~E t~2' CD E~TER/~R APA, '
~A~E OR ~TTER ~D ~ALL HAVE PULL VERTICAL
TO Fo~T]ON 9EL~. STUDS SHALL 9E 5ET 16'
.L' ~VE BZNG~ ~OTTOR PLATES A~ OOUg~E TOP PLA~E5. ' -
~L]NG SHALL 8E AS PER ~TATE CO~E HAH~L DR
50 9PECIFICATIO~S FOR p~DD~CI5 ~E~ ~ r
FIRESTOPPXN6 AS ~ER 717.4 STATE CODE.
IRS ~ALL BE F~T~V ASSE~Eb AND SHALL CO~PLY WITH
-BO3 STATE'
L~: SHALL CO~Y NITH )O"POUND 'PER L1NEAL [eOT IHPACT
. REtIREmENTS k~ PER BO).9 STATE CO~E.
"'~ SE~CBN1) FLOOR PALLS
'
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
CZ TEL.: 765-1802
Examined ........ , 19 .~(]/
........ /
Disapproved a/c .....................................
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ...................
ClIECK ......
t,O, ~ FY · CALL ...................
HAIL TO: ~
....~; ~7~. J.&~. .
(Building Inspecto~)/f7~'4 ' ' "
!"" APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date ................... 19...
~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 throuCtout 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 ali 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 applicant)
State whether applicant is lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ....~)TI ry3CHO[,¢.~.../ .... .~...~K2R~. tq .~:.~. ........................................
(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 .... ~ ............
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
[. Location of land on which proposed work will be done.
r Hamlet
County Tax Map No 1000 Section O~D . Block .. P~ .......... o .... ~.f~ ......
Subdivision Filed Map No ' Lot
(Name)
L Stateexistinguseand~ccupancy~fpremisesandintendeduseand~ccupancy~fpr~p~sedc~nstructi~n:
a. Existing use and occupancy .,
3. Nature of work (check which apPlicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal ........... · . Demolition ............. Other Work .........
~ 1t Do~i <D~O .... (Description)
4. Estimated Cost ..... ~ . Fee
~ (to be phid on filing this application)
5. If dwelling, number of dwelling u~its ............... Number of dwelling units on each floor ................
If garage number of cars
6. If business, commercial or mixed Occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, lit any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure witt} alterations or additions: Front ..... Rear .......
Depth .. w~ .~.+ ,. ' ................
............. , ,,~,~,,~ ...................... mumt~r of Stories ........... ,.., ..
8. Dimensions ofe..cntire new construction: Front... ]~. ......... Rear .4~ ./..o~. .. Denth ./.c~. "i 'i '..'
Height ..... '~. ....... .NumbsrofStories .................. ' .... · · ~ . '.i' i .....
9. Sizeoflot: Front ...... ~'~'"i ......... Rear: ....
10. Date of Purchase
............ ~ ....... ' ......... Name of Former Owner .......... ~.~ .~... ..............
11. Zone or use district in which premlises are situated .....
12. Does proposed construction violat~ any zoning law, ordinance or regulation: ........ .A4/.~ .....................
13. Will lot be regraded ' .
14. NameofOwnerofpremises~'~ .'-[~o~...~.e~.. Address2~/,~lq.fillbqrem°vedfr'°m°remiaes: Yes N~o
Name of Architect . Address Phone No
Name of Contractor ...... i .... Address ................... Phone No ......
15. Is thzs property within 3o9 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all b¢ildings, 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.
ITATE OF NEW YORK,
;OUNTY OF .................
(Name of individual signing contract)
bore named.
NOTIFY BUI~NG DEPARTM~V~
785-~802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
~. FOUNDATION ~0 REQUIRED
FOR POURED CONCR~E
2. ROUGH ~ FRAMING & PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C,O.
ALL CONSTRUCTION SHALL ME~
THE REOUIREMENTS OF THE N.~
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIRLE FOR
DESIGM OR CONSTRUCTION ERRORS
being duly sworn, deposes and says that he is the applicant
[e is the ' "'
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly a~thorized to perform or have performed the said work and to make and file this
pplication; that all statements contained 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 i
........... · /.g ......... day of...!..'~ ~., ,, 19 ~./. "
rotary Public, ...... County ' / i i . ',
efUrARYPUBtC, StateofldewVm4t '~' ........... / ...... · · ~" ,
' ' NO 47 7 /
. ,..~. ~,0 ~7~.,~f~lk~ot~ .... .~ .~ . . ,- ~,~ ! , (Signature of apphcant). ,