HomeMy WebLinkAbout19753-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19920
Date MAY 20, 1991
THIS CERTIFIES that the building
Location of Property 53345 MAIN ROAD
House No.
County Tax Map No. 1000 Section 61
Subdivision
RENOVATION
SOUTHOLD~ N.Y.
Street Hamlet
Block 1 Lot 13.1
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 29, 1991 pursuant to which
Building Permit No. 19753-Z dated APRIL 1, 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 RENOVATE EXISTING STAIRS, BUILDING #8~ FEATHER HILL
The certificate is issued to PUDGE CORP.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/a
Building Inspector
Rev. 1/81
~OBM NO. ~J
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWH HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PRE/~ISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO- 197§3 Z
Permission is hereby granted_to: -- ~-~ ,
.~/...~.~.. ........ ~~ ............
.~.~.~....LV..~.~.? ...............................
~--- ,....~
~ ~"~-~......~.~.:....L.,. ~. ~....,..
~~.....~.....~...~ ....... .~...~.....z.....~~...~
~ '
at remises located at ...............~...~....~.~ ....... ~.~ .....
c~ .../...~.:..I ..........
County Tax Map No. 1000 Section ..... ..~...~.J. ........ Btock .......... J ........... Lot No.
pursuant to application dated .... ~^^.~..~.t.....O'/~..R~........~....~ ................. , 19..~.)..., and approved by the
Building Inspector.
Fee $ ........................
Building Inspector
Rev. 6/30/80
I,,IAY 1 4 Iggl
TOWN OF $OUTHOLD
BUILDING~DEPARTMENT
TOWN'HALL
SOUTUOLD, NEW YORK
765 - 1'802
I1971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
DATE ........
NEW CONSTRUCTION .~ .... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........
Location of Property.~C.~..~..~itlj..~l~.~.~....~A~.~.~.~.=..-.~.~..[~ ...........
O~er or O~o~rs o~ Propert~ . .$0 4)ge" C-oA~.. .................
Su~bdivisi°n ....................... Filed Map ........ Lot ..........
Health Dept. Approval .................. Underwriters Approval ..............
Planning Board Approval ................
Request for Temporary Certificate .~ ..... Final Certificate .... ~ ..........
Fee Submitted: $ ....................
rev.
¢o
~tPPLICATION FOR
"This application must b
Inspector with the foil
I. Final sUrVey of prop,
streets, and unusual
FORM NO. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765 - 1802
3ERTIFICATE OF OCCUPANCY INSTRUCTIONS
filed in typewriter OR ink and submitted to the Building
~wing; for new buildings or new use:
~rty with accurate location of all buildings, property lines,
natural or topographic features.
2. Final approval of Dm~ith Dept. of water supply and sewerage-dlsposal(S-9 form).
3. Approval of electrlc~l installation from Board of Fire Underwriters.
4. Sworn statement fromlplumber certifying that solder used in system contains less
than 2/10 of I% lead~
5. Commercial . .
buzldmngs~ industrial buildings, multiple residences and similar
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings ~Prior to April 9, 1957] non-conforming uses, or buildings
and "pre-existing" land iuses:
1. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or qpographxc features.
2. A properly completed lapplicatlon, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership o.f the entire lot prior to April 9, 1957.
· If a Certificate of Occnpancy is den~ed, the Building Inspector shall state the
reasons therefor in ~ ' '
wr~tzng to the applicant.
3. Date of any housing ~ode or safety inspection of buildings or premises, or other
pertinent informatio~ required to prepare a certificate.
C. For Vacant Land terrific!ate of Occupancy:
I. Aa application for vacant land Certificate of Occupancy shall' he submitted,
and a certified abstr!act of title issu6d by a title company showing single and
separate ownership oS the entire lot prior to April 9, I957 shall also accompany
the application. If ~ Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
~- CERTIFICATE OF OC UPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to AccesSory buildings, $25.00 - Businesses $50.00.
~. Certificate of Oc~cupancy on pre-existing dwelling - $ ~00.00.
3. Copy of Certiflca~e of Occupancy - $5.00 - over 5 years - $]0.00
4. Vacant Land Certificate of Occupancy - $20.00
5. Updated Certiflca~e of Occupancy - $50.00
6. Temporary Certifi6ate of Occupancy - $25.00 Residential
$50.00 Co~m~ercial
rev. 10/14/88
APPLICATION ON BACK
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
.PLUMBING
3.
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
?-
BLDG. DEP¥,
T~WN OF SOUTHOLD
Examined . .....
d ..~ f ,19~t.PennitNo. f.~.~.~..~..~.
Approve ........
................................
~ (Building Inspector)
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY .
SEPTIC FORH ..............
t:OTl FY ~
CALL ...................
MAIL TO:
Date ....... Ma~qh.2i .... 19i[.
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 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.
PUDGE CORP
--' (Signature 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 ................ .I:'.Up.C-.E..COB.l?.. ...............................................
(as on the t~'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 ...................... x.5'~_~ ,~ ~,~
Location of land on which proposed work will be done...F.e.a.t.h.e.r..H.i.l. 1. ,..B.u.i. 1. ,d.i.n.g/!8.: .M.a.i.n..R.o.a.d.: .S.o.u.t.h.o.l.d.,. NY
House Number Street Hamlet
County Tax Map No. 1000 Section .... .6! ............ Block 1 Lot. 13.1
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
!. State existing use and occupancy of premises and intended use and occupancy of proposed e~onstruction:
a. Existing use and occupancy .................. .R.e.tg~U_. Spac~ ............................ : ..........
b. Intended use and occupancy Same ~
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Remoyal .............. Demolition .............. Other Work .......... ' .....
4 Estimated Cost $.~ ~QQQ ~'0.0. Fee
~ (to be paid n fihng~ti~]s apphcatmn)
5. If dwelling, number of dwelline u~nits
~ . · .............. fqumocr oi uwellmg units on each iloor ................
· If garage, number of cars ...... i ....................................... ', ................... ' .......
6. If business, commercial or mixed ioccupancy, specify nature and extent of each type of use ..................
7. Dimensions of existing structuresi if any: Front ........... ~.... Rear ........ :, .... Depth ..............
Height Number of Stories
Dimensions of same structure with alterations or additions: Front ..... Rear
Depth ' Height Number of Stories
8. Dimensions of entire new constrffction: Front ............... Rear ........... Depth ......
Height ............... Number of Stories .........
9 Size of lot: Front ' Rear
J ~ ~' Depth
10. Date of Purchase
1 1. ' ...... l ................. ~ame oi vormer Owner .............................
Zone or use district in which premises are situated ................. ; ......
12. Does proposed construction violate any zoning law, ordinance or regulat]on: ...' ............................
13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .... i ................ Address ................... Phone No ................
Name of Architect ........... i ................ Address ................... Phone No ................
Name of Contractor
.......... i ................ Address ................... Phone No ................
15. Is this property within 3~0 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold Town 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 n~mber or descriptio~ according to deed, and show street names and indicate whether
interior or coruer lot.
STATE OF NEW YORK,
COUNTY OF ............. S.S
............................... : .................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing' contract)
~bove named.
Fie is the
, (Contractor, agent, corporate officer, etc.)
f said owner or owners, and ~s duly authorized to perform or have performed the smd work and to m and file this
ppllcatlon, that all statements contained m this application are true to the best of his knowledge and belief; and that the
~,ork will be performed in the manner set forth in the application filed therewith.
worn to before me thru
.............. o~.. 7. ...... day of..'~.~. ........ , 19 .q./.
~Totary Public .... . .... .~.. .. County
· HELEN K, DE VOE
NOTARY PUflt,C, State oiNew York ' '~/'/
N0.470787~1, Suffolk C0unty6'? (S ature of ~p licant
Term Expiro,~ M~tcl~ 30, ?