HomeMy WebLinkAbout19613-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19814 Date MARCH 26, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 38910 MAIN ROAD ORIENT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section IS Block 8 Lot 30
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 27, 1990 pursuant to which
Building Permit No. 19613-Z dated JANUARY 2, 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 DORMER ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to MARTIN J. BANCROFT JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
~~1./ _
Bui ding Inspector
Rev. 1/81
roses xa s
TONrN OF SOUTHOLD
tU1LDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
tl11LDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 1 ~ 6 1 ~ Z Date 19. j
Permission is hereb ronte~~jt~o~~ C ,ys~
.fie...®i... ....7?
:....,,...lt9..~f .
~f~`
of premisG~ated of ....:~~lA.. ~0~~
y ~
.
County Tox Map No. 1000 Section Bloek .......+Gl~.......... Lot No....4r~..®...........
pursuant to opplieation dated ..........l.~~s°t..T 19 and opproved by the
Building Inspector.
Fee S..•
B ing I or
Rev. 6/30/80
+ Form No. 6 ~ 2 R (I M 2
r TOWN OF SOUTfIOLD U L5 IS '1 V L5 D
BUILDING DEPARTMENT ~ 2
TOWN I-IALL
765-1802
BLDG. DEPT.
TOWN OF SOUTHOLD
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 17> lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and install.stions, a certificate of Code Compliance from architec= or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
i. 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 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 Occupancy - Residential $ 5.00, Cgommercial $15.00
Date . A. 1 .
~ew Construction.. O+l(d~Or Pre-existi~nP/~~ Buil~,d`ing.
.ucation of Property ~.1.V............l:.l~~J~1....~~...........~.~l~~.IV.
House No. Stre Hamlet
~nwer or Owners of Property...1 .-.~~~ll~.l...~:..'~•~v:..~ • • • - • • • • •
1~ `r1~
'ounty Tax Map No 1000, Section....~i~.J ......Block ........Lot...~.ti-f...........
ubdivision.~.7 .Filed Map............Lot......................
ermit N~7.4::3.~....Date Of PermitY::3~?'6~ I...Applicant...~. s.~/.y~
calth Dep[. Approval....~:.~ .................Underwriters Approval...,. N.~
Lanning Board Approval....~G~/,~ -
equest for: TemporaGr~y Certificate........... Final Certicate...~ •
ee Submitted: $...(;.5;; /y~
c~.>u. ~ a3~ ~ ~ ..'1.1. . ~ ..........i . .
LI ~ APPLI ANT
c'lELD it:SPc:CTIUN ~~llATE ~ COMMENT° \
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I1ISULATIOPI PER N. Y.
STATE ENERGY
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, ~~l \~l) 1 II\\l Jl~~\~~I`V V I~. ~ Ai ~ rduer9an 41w.
I ' ~ I /4•(`P } Ctnlsn of Mln PNrvJlmot nvl b0mhq
N~vK Vgti O Male.x"sunewfa in.ca ~ealN
C- R G ¢ 6.+O:napp sePl Phall Mrt py ynpldared
~;eo n„aa^19,.n~q ..WReralia aueocW. ~
pIZ~F,tJI ~ ¢ Guaroni~PlndinttM hereon shetl vn
x~ cnlvmtha sarPOn tarwhnm Me survq
~ .ye,. ~ :T^ ',~~a y Is Meoerad. mnd on hk balralf mthe
iYJWN OF ~Ul-FIOL? NY. 'cot. <s7Fh nnener„-anY.sor~rn~an;ala,en~anu i
' - L:a>1D SJ lentlinn mM
tuocn Ilrtad hamon PM
to the eaar;raea of fia lonE1n01ryt4
anion. Guaran.eaP ere not rconAemhb
i to n2taianel lnrotubono or aulvequer" ~
owners.
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GU A2AN,Tl~FC TO SOUThO LO SAVINGS BANfC~
I 1Af<A~~;ftr~ "fp PLG~n„C A6=T[:J~l, iNC.
I A` :;t3RVE4'F~U----~ JCT. ~i 1~8y .
SUFF CO.TAX MAP UAI"A+ IOOCi- I S•8 - 30. -
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41` ~..Ai~pV 1~?Vi: J.C, V^.1i11'_"N Yl1 i[T~ t'-.Y
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10048-2
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L~IJ Lea ~ \°J I_~~ BOARD OF HEALTH ,f
ill 3 SETS OF P ANS :Y:K,:::::::
1l FORM NO. 1 SURVEY .~°.K: ,
28~ I} TOWN OF SOUTHOLD CHECK .
~ BUILDING DEPARTMENT SEPTIC FORM , , , . , ,
Bt DG.
DC:{'i TOWN HALL
TOWN OF50UTI~-0OLt7y~ $OUTHOLD,N.Y.11971 NOTIFY;
TEL.: 765.1802 cnLL
Examined , 197/ MAIL TO : Sry~ .
APProved 199 Penni[ No~C.~~:~~ .
...P~F•O7LC~Gi
' Disapproved a/c
r.
(Buiding In ector)
APPLICATION FOR BUILDING PERMIT
Date .,+G~e.~.. ~.7......, 15~f~
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of tot 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 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
Re;ulations, 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.
(Signatu,~rJe of applicant, Cr~name, if a corpor~a?tron)
~~•..~t-24~t...7.1' . J..C4'al1rG ~..~~f~V
(Mailing address of appli~ant)
State whether/ a/pplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~jU: / of C• t-- ........~1.~.1..../ .
Name of owner of premises {i+1 v:Ta.~'O.... ~ ,C,~ caell .C.~/'.~? ~`7~.... ~V' .
(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. . N„~, , , , , ,
Plumber's License No . . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done;
p, s
f[ouse Number Street. Hamlet ~ ~ ~ ~ ~
County Tax Afap No. 1000 Section ......f ,S......... Block ~ Lot . ~.d........ , , ,
Subdivision Filed 1<lap No. Lot .
(Name)
' State existing use and occupancy of premises and intended use and occupancy of proposed construction:
A. lSxisting use and occupancy...."./.»~,~e.. .P.w.r1y:.C;~GC/t•%~,~t
B. Intended use and occupancy....SSr'w~~G...,1`a.n.r,/,./., „~a,cgrGl~{~~J
- ?
r .
3. Nature of work (check which applicable): New Uuilding Addition • - - • • Alteration •
Repair Removal Demolition , , . • .Swi:nni
~e°~ •a~ .
Tennis Court Accessory Building..........Fence .......Other ork:...........
4. Estimated Cost ~6.4 P. Cz o f? Fee .
([o be paid on dins this application .
5. IC dwelling, nutnber of dwelling units ........j...... Number of dwelling units on each floor •
If garage.numbcrofcars
6. If business. commercial or mixed occupancy, specify natttrc~and extent of each typc~ fuse .
7. Dirttcnsions of existing structures, iC any: Front .....~.2....... Rear 6.^s........ Depth
Hci^ftt Number of Stories
Dimensions of same structure with alterations or additions: Front Rear ..1 y............ . .
Depth ~ IIci t • ............Number of Stories ,
3~•- gh /a•
Dimensions of ej~tfre new constntction: Front G.-2. ~ Rear ....G.L Depth ::.37. • - • • • • •
Hcigltt ....;~C`fi ........Number of Stories .
9. Size of lot: Front ....a,J.i
• • • • • • • Rear ~„l..R., Depth ...3G.-Z............... .
l0. Date of Purchase .............................Name of Former Owner
11. Zone or use district in which premises are situated . .
12. Does proposed construction violate any zoning law, ordinance or regulation :
13. \Vill lot be regraded \Vill excess fill be removed from premises: .Yes , No . .
l4. Name of Owner of premises .,Ma,~{,,,,n. ,C3wn.~Yv~f. Address . Ma%r..!.'Qr.~ . Q!utr:+>< Phone No.. 3~.~ ~.z7~` .3. • .
Name of Architect ..~'c.,,,.,Gec.~x.. RJS.eGrG~ES.. Address CqX {.o,.t. CCw}41. „cPhone No.:Y.3$4-.7 ~52. .
Name of Contractor ~F+c,r•l~ ;,..T1,eu,~4.tah ...Address ,lax 7/. ?.~ecorn,c.~t... Phone No...7. ~.:-,.~.7/~7.. .
15.Is this property located vitfifiin 300 feet of a tidal wetland? ~YES....NO
*If yes, Southold Tovn Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly all buildings, 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 comer lot.
STATE OF ~E1V YORE, S.S
COUNTY OF .
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says [hat he is the applicant
(Name of individual signing contract)
about named.
Hcistltc
(Contractor, agent, corporate officer, etc.)
oC said owner or owners, and is duly authorized [o perform or have performed titc said work and to make and Cilc this
application; [hat all statements contained in this application arc true [o the best of his knowledge and belief; and that the
work will be performed in dtc manner set forth in the application filed therewith.
Ssvom to bciorc me this '
............R~~.........dayoC....!~!k 19 .v4
Notary Public, . ~~0.4..... County
NELEN K DE Y~ C,/.7.4?~;r, .
NOTARI' PUBLIC, SWe of New Yak Si^nature oC applicant)
No. 4707878. SuOdk CouMyr~,
Tam Expires March 30,19 ~r '