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HomeMy WebLinkAbout20044-zFOR~ HO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20223 Date SEPTEMBER 18, 1991 THIS CERTIFIES that the buildin~ Location of Property 50 GULL POND LANE GREENPORT, N.Y. House No. Street County Tax Map No. 1000 Section 35 Block 3 Subdivision Filed Map No. Lot NO. ADDITION Lot 4.2 Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 22, 1991 pursuant to which Building Permit No. 20044-Z dated JULY 25, 1991 was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION TO EXISTING O~ FAMILY DWEIJuING AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED STANLEY F. SKREZEC, JR. N~A Building Inspector Rev. 1/81 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) N9 20044 z Permission is hereby gmnt_~.ed ........ ~~~_.~ .................... ,o .~/.~~....~ ~:.. '~~..~~;~... ~ .......... ..~..~.....~~:~....~ ....... ~~ ..... ~ ..................... at premises I~oted at ....~ ...... ~..~~, ............................................. ~..~ ~.x ~o, .o. ,000 Se.,,o. ....... ~.~...- ~ .. ,,~k ....... ~ ......... ~o,.o ...... .~...~... Building Inspector. and approved by the Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD 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 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 Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupanc~ - Residential $15.00, Com~ercial~ $15.00 ~/ / ,, Date ....... j~/. . . .-~.'/.~../.~. ............... ~ew Construction ........... Old Or Pre-existing~f. Building...~' ..... / ...... /. '. ocatio .... ........ , .... House No. Street Hamlet/ Onwer or Owners of Property...~/~.:~..~ecT.....~.~'.~. ~.~.~%~.~...~.~*~-- ~ County Tax Map No i000, Section...~.~~'~ ..... Block ...... ..~ ....... .................. Lot.iiii.~.'.'i. ........~-- Subdivision.. ~ .~.' .~'.~. ~f~... ~b~ ~ ~' ~ ' '~'~' '~~f ..... Filed Map..~.~../.~...Lo~t ..... ~ ............. Permit No.p~. ~..V.V. ~.Date Of Permi~...~.~./.Appltcant.~+..~-~' ~.~.~ Health Dept, Approval .......................... Underwriters Approval ......................... Planning Board Approval.. ................... ... / Request for: Temporary Certificate ........... Final Certicate....~...... Fee Submitted: $..~.,~..~.z ~. .... co ?'iELD ~.S, ~, iON FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ¢ ADDITIONAL COMMENTS: .... ":~ I .. ' ',.- ~ .,. ~ ~ 0 ~ ..... "D'C LI~ ~ ~ '.: ,.~'~'..' ~ to ... ":~" ~ ' ~r" ' ~' ~t~-~71979' ~,.~. ..- . . ~ , , . ,,. , d '~:'~ Chief Of Gene,al , q s-f- .,. ~ ual~OND ."' ,..,~B ~ ~. , .- /~.o r ~t"' .. ',"' . ' .: ..... ,~. '- qi "'~ ....'~ · ., .' (.',. ,-'~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~//~"~'~' ........ 19 .~.dPermit19 ?.Z .~.. ~ .//~ , Approved..~. ~.. ........ No ........... Disapproved a/c ..................................... · ,('B uildih~X-'In spec t or ) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS SURVEY ClIECK . CALL ............... HAIL TO: ate ......... i ......... , 19... INSTRUCTIONS .. · a. This application must be completely filled in by typewriter or in ink and submitt6~t to the Building Inspector, with 3 ets of plans, accurate plot plan to scale. Fee according to schedule.. b. Plot plan showing location of lot and o~' buildings on premases, relahonsh~p to adjoining premises or public streets ,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this applie.ation, the Building Inspector will issued a Building Permit to the applicant. 'Such permit' hal! be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in 'd'hole or in part for any purpose whatever until a Certificate of Occupancy hall 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 .uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or '.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as~ereln described. 'he applicant agrees to comply with aliapplicable laws, ordinances, buildiog~e6__d_e_, .housing c~u:ge, a~/ffe~ulations,~nd to ~mit authorized inspectors on premises and in building for necessary in~p/~ns. .... 15~gnature of atyP'licant, 9.,r ~aim.e,~jf a"corlSoration) .... tare whether applicant is owner, lessee, agent, arch?ct, engineer, general contractor, eleftrician, plumber or builder. tame of owner of premises ..... . .-~....~.~...x~.Z..~. .... . .~..~....C_~.~..~.~?..~ ~ ~4 ......... · / (as on the t.ax roll or latest-t/deed) · applicant is a corporation, ?gnature of duly authorized officer.. (Name and title of corporate officer) Builder's License No ...... ~.L~. p2; .~./~ ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. i ...... ........... . - HouseNum~er St;eet ': ........H~"'' /' :7'~'~' .... County Tax Map No. 1000 Section, ..~ ..... Block ..~ ......... Lot ..... ~d' .~. · .... · .... ..... ......... ..... cot.. State existing use and occupancy of premises ~nd intended use and occupancy of proposed construction: ~ , b. Intended use and occu " '~A~ ~ ~2 ~~~2 ~ ~ pancy ..... ~ ....o.... v..~ ........... ;ff~x. ~~~... 3. Nature of work (check which pplicable): New Building .......... Addition ... te~: !; ...... ~ Repair .............. Ren royal .............. Demolition .............. 4/ Estimated Cost ' ~.~..~. ~ ~cription) ' Fee If dwelhng, number of dwelhngjunits...~: (to be paid on fihng this apphcatmn) ' If garage, number of cars .... [II{ ..... ' ....... .~ Number of dwelling units on each floor...~ ........... 6. If business, commercial or mixqd ¥cupancy, specify na~¢re an~ extent of each type of use ......... 7.: ~icensions of existing stmctu~es, ]f any: Front... :~ f,( ... Rear ...~G %~ '~2~,h '¥ ~ .... ny]ght .. .............. NumberofSto~es ..2. ~.~.. · .......... v ....~., ........ D~ensmns o[ ~e st~cture With alterations or additions' Front .... ~'&~ ~'' ...... ~ ...... ~' 5 :' ' > ?~ ..... Depth ..... /~ . ~ ~h, ~,~ ~ ~'.~ ....... ~: .... : ....~. "'?" ~'~" 'o,,'~.,...~. ~: ..... Number of Stofie~ ...... ~ ........ 8. ~mmn~on~ menure newconstmctmn Front ~.~ ~ ~ Rear ~ ~" ~ - ' ..... .... ......... ~ ......... veptn ............ . Height ........ i · ....... Number of Stones ...... ~ ~ ...~ ...... . . . 9~. Sizeoflot: Front ..... ; ~.~ ........... Rear ~O .... De ......... 0.' Da re of Purchase ...... Jq ~.O ........ . ......... Name of Foyer Owner .~.~ ~~. ~ ~.~. Zone or use district in which p~emises are situated ........ ' 2. ~,~s. pr?osed constructi¥ {~te any zoning law ordinance ~'r;~{a}~.' ' ' ~ ~:~ ~ ' ' ~ '" ...... ~'~ ~ ~ ........ ' '7 ....... wm excess nu oe removed from premises~ ~ ~No 4. Nme of Owner of premises ~ M~? .~Fdr~ddress ~0. ~.~.p/~.. ~5 ~one No. ~.).2 T/~ ~. ~.. Nme of Architect ........ ~ ........ g .... Address ................. ~.. Phone No ............. ,.. N~e of Contractor ~5~'' r~ ~ ~5.. Address ~. 5. Is th~s property within i300 feeC of a tidal wetland? ~Yes ........ No..~... '' ~If yes, Sou¢hold yown Trustees PermEt may be required. PLOT DIAG~ Locate clearly ~d distinctly ~] bufld~gs, whether existing or proposed, ~d. indicate ~I set-back d~ensions from ¢ope~y ~nes. Give street ~d block~ number or descfiptioh accord~g to,ced, and show street nines and ~dicate whether ~tefior or comer lot. I ~ ~ ~7 ' TO REMOVE EXCE~ gILL / . ,, )O~y OF.... ...... ~ .... ~ . ~' '~~-..~,... being duly sworn, deposes and says that he.is the applicant t a ne ~individual signing c~tract . ove named. . (Contractor, agent, corporate officer, etc.) said owner or. owners, ~d is dul~ authorized to perfom or have perf0~ed the said work and to m.~e and file this 91ication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ,rk w~I be perfomed ' m the m~ner, set forth in the application filed therewith. 'om to before me this ,. . .... ..