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Home My WebLink About20039-zFOPR4 NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N~Y. CERTIFICATE OF OCCUPANCY No Z~20516 Date FEBRUARY 3~ 1992 THIS CERTIPIES that the building Location of Property 500 GILLETTE DRIVE House No. County Tax Map No. 1000 Section 38 Subdivision ACCESSORY Street Block 2 Filed Map No. EAST MARION, N.Y. Hamlet Lot 6 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 25, 1991 pursuant to which ~ilding Permit No. 20039-Z dated JULY 23, 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 DETACHED ACCESSORY DECK AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF~LTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A JOHN M. CAMPBELL //Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. NO_ eUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 20039 Z Date ..~.~ ...................................... , ~9.~/... Permission is hereby grant~J to:/) ,~// ~,'.. '~....o...e . . ~~~~..,.~ ...... ~z.~e , , .... ~--~ --~~~~ .......... ~..=. ...... ~ ....................................................................... ~,,,,~,~,~,,~ ~,..'~ .~ ........... ~~.....~ ................................................... .................. , .......................... ................................................................... County Tax Map No. 1000 Section .......'~.....~.~.. ....... Block ........ ~ ....... Lot No .........~... / pursuant to application dated ........ .~.J .aT~...~...~... .......................... , 19...~...'./., and approved by the / Building Inspector. Fee $,,, .~,,. ,~~ Rev. 6/30/80' Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN UALL 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 ali 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. B. 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 I. 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 Occupaocy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date · .ew Construction..~...t~. ..... Old Or Pre-existing Building ........... HOuse No. Street Hamlet :uunty Tax Map No 1000, Section ............. Block ..... ~_~ ........ Lot ...................... ubdiv£sion .................................... Filed Nup ............ Lot ...................... ermit No..~. · .... Date Of Permit . ..P~. ZL ...... Applicant... .~.... eal~h Dept. Approval .... . ........... .......... Underwriters Approval ' !,uming Board Approval ........... ~qnest for: Temporary Certificate ........... Final Certicate ........... Sobmitte : $ ........................ - ?'t£LD ~,,S,_~,~ON [tDATE t! CO~MENTS FOUNDATION ( ls t) FOUNDATION (2nd] ROUGH FRAME & -FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY B5 JOHN STREET, NEW YORK, NEW YORK 10038 Date ~pplicatlon No, on file THIS CERTIFIES THAT only the electrlcaJ equipment ~ ~scribed beJo~ and interlaced by t~ eppllca~t ~ed o~ the above application number i~ the premises of in the followlng Ioca{{~l}~. ~ Ba.s~tne~t~ ¢ Ist Fl. ~ 2nd Fl, Section Bilk Lot FIXTURE FIXTURES RANGES COOKING DECK~ OVENS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: R V I C ('~R~,~;I~ O~, NY , '~ Q44 GEN~AL ~ANAGER Per ~ ~ ~hh cerfificat~ mvs~ no~ be ~tered in an~ m~nn~r; re~vrn ~o ~he o(fice o( ~e ~rd [( ~ncvrrec~. $nspe~ors m~y be identified b~ ~heir credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICA'FE MUST NOT BE ALTERED IN ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING REMARKS: INSPECTOR DATE ~i'/~?~!i;',~ ,s FORM NO. 1 ~ "J ~;':"~' '' TOWN OF SOUTHOLD -' '~,-'"~[~7-'~6~;? TEL: 765-1802 Exam~/ Approved...~ ......... 1~. me~it No. Disapproved a/c ..................................... ................. -., .............. INSTRUCTIONS ?~ ~.c. BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIlECK .................... SEPTIC FORH .............. NOTIFY= CALL ................... MAIL TO: t 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 m, 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 applicatio.n 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 alt 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 owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. lO?PZ_t o ............................... - ........................ Nameof owner ofpremises d0~b/ ~' ~J~P ~'~'-~' ~ ~//~''~'- ........... ....................... ('a; ;~'ih'e';~x';o',i ;; i:t;;t'~;:d') ..... ~' ~ ~Z0 ~ IV If applicant is a corporation, signature of duly authorized officer. ~ (Name and title of corporate officer) Builder's License No ..... .t:?. F4/.~.4~..~ ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. . . .o. .... .O j. ..... ............ .m:. Z. ..... ,. e .,-/ .... , . l /. House Number Street Hamlet '.~e~ ~ . ,c~.., ..~.. ....... Lot. ,~..d~Z~. .......... County Tax Map No. 1000 Section ....... ; ......... Block . 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 / I~lq~tl .......................................... 8~'l~[:g ~ :,~,, ................. b. Intended use and occupancy ................................. t£,,).,; ....... ....,..............' ~.' .. 3. Nature ofw.or (check wh:ch apphcable): New Build:ng .......... Add~tlon .......... Alt~h~t~['~.~.. Repair ' ' · ' ............ Remqval .............. Demohtlon .............. Other Work. ~.~. ~, .~.O/1..~5-.~ ' 0~'2~ (D ripti0 ) 4. Estimated Cost ........... Fee ; (to be paid on filing this applicati~n)~ 5. If dwelling, number of dwelling 0nits ............... Number of dwelling units.on each floor...,,, v we ....... · 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 structure*, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ' Height Numberof Stories 8 of tmcti R D pth . Dimensions entire new cons on: Front ............... ear ............... e ............... Height ............... Number of Stories .............. 9. Size of lot: Front ...........; .......... Rear ..................... Depth .............. 10. Date of Purchase ........... ; ................. Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed onstruct~on wol~te any zomng law ordinance or regulation: ................................. 13. Will lot be regraded ......... ; ......... ' 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 ......... 4 ................ Address ................... Phone No ................ 15. Is this property within 3~0 feet of a tidal wetland? *Yes ....... No ...... · If yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property Lines. Give street and block umber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. // 1 FOUNDATION ~ TWO REQUIRED FOR POURED CONCRETE i 2. ROUGH - FRAMI ,N,,G & PLUMBING ,/] 3 INSULAT ON "':" , 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL iMEET THE REQUIREMENTS OF THE N.Y. SI'ATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLEI FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, S.!S COUNTY OF ................ ~.. , . ......... J~.~..~. · · · · .~.: · · · k~..~..~..P..~..C~. · ·~. .......being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) above named. ~ He is the , , (C , , · e. reec.) of said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this application; that all statements contai~ed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this ...... · ~.'. · .' ........... day of Notary PubLic, ~~ ........ ,19 ..~ County //(Signature/oDapplicant)