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HomeMy WebLinkAbout20050-zFORM NO. 4 TOWN OF SOUTHOLD BUIIJ)ING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20283 Date OCTOBER 16, 1991 THIS CERTIFIES that the buildinq Location of Property 420 GLENN ROAD House No. County Tax Map No. 1000 Section 78 Subdivision ADDITION SOUTHOLD~ N.Y. Street Hamlet Block 2 Lot 22 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 10, 1991 pursuant to which Building Permit No. 20050-Z dated JULY 29~ 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 ENLARGE EXISTING DECK ADDITION TO ONE FAMILY DWELLING 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 PAUL & RITA HOLOBtGIAN Rev. 1/81 B6ilding Inspector 1~o~ No. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) No- 20050 Z Dote ....~..~.~..Z ............... : ...................... , i~.~/... Permission is hereby g[ante.~to: ~ ,/ J/////, . ~ g lOP / d N .............................. ~ ......................... .......... ,o ~, ~m,,,,~,~ ~, ...... ~...~....~~_~~ ............................................... ~~..~ ......... z,.-~z~.~...~..~.~.~z~.Z~ ~ ~.J.....<..~. .................................. Coun~ Tax Map No. 1000 Section ......... ~ ...... Bilk ....... ~. ......... Lot No ......... ~.~. ....... pu.uan, tO application dat~ ..... ~O ........ ~ .... / ............... , 19.~, and appr~ by the Re¥. 6/30/80 BLDG. DEPT. TOWN OF SO~JTHOLD Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN I~LL 765-~802 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_D 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 C~pliance from archiuect or engineer responsible for the building. 6.Submi~ 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. :. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to d~ellieg $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 - $I0.00 4.Updated Certificate of Occupancy _ $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date Old .......... ew Construc on ........... Or Pre-existing Bu .... ocation of Property. -~. ~.4~.. fC.~..~..~, t(~0~-~ ~..0.~. ~.../J~...~ .~. IIouse No. Street Hamlet ',wet or Owners of Property..~.~.4....~l..~.~r~ /~0~. :unty Ta~ Map No 1000, Section. ~g ....... Block..· ~ 2-- ~bdivision ............ ......... .Filed Map ............ Lot ............ :reit No.. · · · Date Of Permit .... ~-.Applicant... .. . .q,... alth Dept Approval ' · ' .... Underwriters Approval anning Board Approval quest for: Temporary Certificate .... Final Certicate. a Submitted: $ .... - ....... FOUNDATION ( ls t ) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING 3e INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 0 INSPECTORS (516) 765-1802 VICTOR LESSARD, Principal CURTIS HORTON, Senior VINCENT R. WlECZOREK, Ordinance ROBERT FISHER, Assistant Fire Building Inspectors THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD May 17, 1991 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Paul & Rita Holobigian 169 Wetherill Road Garden City, N.Y. 11530 Re: Premises at: 420 Glenn Road, Southold, N.Y. Suff. Co. Tax Map #.1000-78-2-22 Dear Mr. & Mrs. Holobigian: In order to issue a Building Permit for your proposed construction for buildings located on lots adjacent to tidal water bodies, we will need a waiver of jurisdiction or a permit from the New York State Department of Environmental Conservation, and if within 75 feet of tidal water bodies or wetlands you will also need action by the Board of Town Trustees (waiver or permit) Very truly yours, SOUTHOLD TOWN B~~ Thomas a. Fisher, Building Inspector TJF:gar Phone Numbers: DEC 761-7900 Town Trustees: 765-1892 New York State Department of Environmental Conservation Building 40--SUNY, Stony Brook, New York 11790-2356 (516) 751-7900 NO PERMIT NECESSARY - TIDAL WETLANDS ACT Thomas C. Jorling Commissioner Dear ~. A review has been made of your proposal to: _~.~/~?~~~ Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the project is listed in Part 661.5 of 6NYCRR (Tidal Wetlands Land Use Regulations) as a use not requiring a permit or notification letter of approval. Therefore, no permit is required under the Tidal Wetlands Act (Article 25 of the Environmental Conservation Law). Please note that any additional work, or modification to the project as described, may require authorization by this Department. Please con- tact this office if such are contemplated. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. Very truly yours, De~pu t~y ~e~ p~ ~i t A~s ~ 765-~.802 BUILDING DEPT. . ~!NSPECTION [ ~3~'FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND[ ]INSULATION FRAMING [] FINAL REMARKS: ~~_~ ~/~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION [ ]FRAMING £~FINAL ~ _ MAY 1 3t~. ~ FO.M NO. 1 ............................... i~,!~ TOWN OF SOUTHOLD BUILDING Dt~PARTM ENT !v',~,v?] ¢~u ' :,~UTi !GI.D TOWN HALL ................................... '~' SOUTHOLD, N.Y, 11971 · ~ ......... Permit No. )isapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT , ' , ' INSTRUCTIONS BOARD OF HEALTH ......... ,,~--~'3 SETS OF PLA~IS .......... .--~SURVEY ................... .~.~-ClIECK .................... SEPTIC FOR~I .............. CALL HA I L Date,..~, .~ lO 19~,]. , a. Tiffs application must be completel.y filled in by typewr/ter or in ink and submitted to the Building Inspector, with 3 ts of plans, accurate plot plan to scale. Fed according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets · areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 ail 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 all 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 tilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the construction .of buildings, additions or alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code and regulations, and to mit authorized inspectors-on premisbs and La building for necessary ~sl?~Cti~}sf} __. ,, (Si=nature of appl{cant, or nam'e, ilII a corporation) "" I¢D CF'r'.I / tv',f o · .:., , ' ~ ', ' (Mailing address of applicant) ate whether applicant Js '6wn~r, lessee, agen~,-.architect, engineer, general contractor, electrician, plumber or builder. '.' ,').)t-t.'l ,~ ~;)~1 ,,, ,'." .::' '(a~'onthetrr~trollorlatestdeed) a ' ' ' ~[' ,,. · .;'~ 1'~% l~, ~'.r,~ ' *<'i ' ~ pphcant ~s a corporatmn,.stg, n~a~fe of d.uly au~l:~z~d officer. " ' (Name and title of corporate officer) Builder's License No. . Plumber's License No ......................... Electrician's License No ....................... OtherTrade 's License' No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... Snbdivision ..................................... Filed Map No .... Lot . (Name) ......................... State existing use and occupancy ofpremlses and intended use and occupancy of proposed construction: a. Existing use and occupancy Sl*qCg ............................. 7. .. b Intended use and occupancy (check which ap[~licable): New Building .......... Addition Repair ........ Removal .............. Demolition .............. Other[~l~. !...' ........ 4. Estimated Cost... : esc on ......... I .................. Fee ............ : (to be paid on filing this application) 5. If dwelling, number of t welling u;nits J Number If garage number of cars ............... of dwelling units on each floor ' 6. If business, commercial or mixed [occupancy specify nature and extent of each type of use · Dnnensions of existing structures if any: Front Rear .......... '.. Depth J i ..... H.eight .', · Number of Stories ............... D~mensions of same structure w th alterations or add tions: Front ..... Depth ' Height ................. Rear .................. ............................................ Nnmber el Stories 8. Dimensions of entire new construction: Front Rear ...................... .............................. Depth ............... He ght . ............ Num ~ of Storie~ .... 9 $1zeeflot:Fr~nt...IQO!.~.$...~j[ ......... Rear .... ,t.O.~. ............. Depth..*!¢.' ........ I0. Date of Purchase .... I . i ............... Name of Former Owner . .~tl,/~..tg.O .............. 11. Zone or use district in which pren3ises are situated ..................................................... 12. Does proposed construction vic at~e any zonim, nw ,~4'· NW.%l;tofb;::~;;d:fd . , _. o ~_, ~.,~lnance or regulation: ................................ 13. ' , 14. pr~ ~is' ' ' ~.~ILi~ ~ i~.[~.' ........ Will e~s~/1, ~em_ eyed from premises: ,. Yes No .... i ............ Address . ~ t~ ~ p Name of Architect .,, &i0~EW'<~ fY~ ;~"f .... hone No.~ ...................... aaaress ............ ; ...... Phone No ........... Name of Contractor . ....... '3' q ............... Address ................... Phone No ................ 1-5. Is this property within 00 feet of a tidal wetland? *Yes...~.... No ...... · If yes, Southold To~n Trustees Permit may be required. ''' "'. i 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 descriptioh according to deed, and show street names and indicate whether interior or comer lot. APPROVED AS NOTED ' 785-1802 9 AM TO 4 PM ]~"OR THE FOLLOWING ;NSPECTIONS: 1. 'FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C;O. ALL CONSTRUCTION ~SHALL MEET THE REQu{REMENTS OF THE N.Y. SlaTE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ?ATE OF NEW YC~RK, I )UNTY OF ..... fka~O~ .... S.S I £ ........... i duly sworn, deposes and says Ob'. ~ .~O.o ........ '..( ....... being that he is the applicant Name of individual s~ning cSntract) eve named. is the ....~.t~4.O .~ .C7. ............. i ............................................................... (Contractor agent corporate officer etc ) said owner or owners, and is duly autlmrized to perform or bare performed the said work and to make and file this ~rl}Cation; that all statements contained lin this application are true to the best of his knowledge and belief; and that the will be performed in the manner set I~orth in the ap >l'eatmn filed therewith. om to before me this ............. ....... ~ary Public, .. '. N ~. B..I_, ,ZA~[~"~ -"8 rRAK 0 WSKi /. ~'ary Publk:, 8t~,te Of Netv 'York" ' Nc:, ~0-46855C~ I · ,. _/ L_ '" ¥' "' ....... .................