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Home My WebLink About19845-zNo Z2000 0 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date JUNE 20r 1991 THIS CERTIFIES that the buildin~ Location of Property 200 CONKLIN RD. House No. County Tax Map No. 1000 Section 139 Subdivision GARDEN HEIGHTS ADDITION (AKA GRAND AVE.) MATTITUCK Street Hamlet Block 04 Lot 12.2 Filed Map No. 577 Lot No. 19-20-21 conforms substantially to the Application for Building Permit heretofore filed in this office dated__ MAY 3~ 1991 pursuant to which Building Permit No. 19845Z dated MAY 7, 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 SCREENED IN PORCH ADDITION TO EXISTING DWELLING. The certificate is issued to EDWARD/ALTHEA StDOR (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF2tLTH APPROVALu N/A NO ELECTRIC AT THIS TIME. UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 /Building Inspector FOII, M ~;0. 9 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) N~_ 1~845 Z Permission is hereby granted to: .~ ~ . ..... ~t pr~mf~, ~t~ ~t.....~ ....... ~~.....~;~.....~....~~/ co~ ,~ u,p ~o. ~ooo s~,o~ ...~ ......... m~k ......... ~. ...... ~t ~o ....... ~.~...~ Building Inspector. Rev. 6130/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING ~EPARTMENT TOWN It/ILL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUP~ 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 buii'dings and installations, a certificate of Code Compliance from archiuect or engineer responsible for the bu.'.lding. 6. Submi~ Planning Board Approval of completed site plan requirements. ;. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "p~e-existing" land uses: k. 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 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 C, ertificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ........... . ew Construction ........... Old Or Pre-existing Building..~ ..... Itouse Mo. Street Hamlet ~wer or Owners of Property ~~ J ~XZfi/~ ~unty Tax Map No i000, Section..~ ....... Block....~ ........... Lot..J~.'.~. .............. ~bdivision .............. -..~'-.~ ........... Filed Map. - ...Lot. - ~rmit No. :%gY ...Date Of Permit. ~.~. ~ .... Applicant.~... ~e~ ........ 'alth Dcpt Approval ~ Underwriters Approval anning Board Approval... ~ ~ quest for: Temporary Certificate ........... Final Certicatc...~[.~ e Submitted: .,.. ....................... ..................... , ........... APPLICANT FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ~ 765-1802 BUILDING DEPT. INSPECTION [~ION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ~-4:~ING F~~INAL REMARKS: DATE o /5'0.09 Al 14°OZ'.~-O'°W:. - ,~';'~"'~ ' OZ '~'0 "--~'. - /.5O.09 ,II Examined lilly - 31991 ' 'i FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-180:2 Disapproved a/c ..................................... · - ''' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS It0ARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY .... . .............. CllECK · ................... SEPTIC FORH .............. LO~ L FY; CALL .................. .... 7.~~.~,&. '.. Date j~d~.y ,~. rt/ 19 ~/ 'a. This application must be completely filled in by Wpewriter 0r in ink hnd s~bmitted 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 of buildings on premises, relationship 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 application, the Building Inspector will issued a Building Permit to the applicant. Such permit ;hall 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 ;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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other a~plicable Laws, Ordinances or >,egulations, for the constracfion of buildings, additions or alterations, or for removal or demolition, as herein described. ['he applicant agrees to 9.omply. with. ail applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspecti_0ns~ -~ ~ , (Signature of applicant, or name, if a corporation) (Mailing address of applicant) grate whether appI!c,ant is Owner, lc§see, agent,' architect, engineer, general contractor, electrician, pIumber or builder. Xlame of owner o£.p~re~ises ~..~../~. ~.'~ ./.. ~ ~ 77-2~'~ :', , '-. ',~ ;~;" " 7' ':','z: : .' ........ (;; ;'n ;~e' ;~. ";~li ;; i:t;;t'~;;d'~ ......................... 'f applicant .... - ' ' ' ' ' ~s a corporhtlon;%~gnature of'duly authorized officer. ,' (Name and title of corporate officer) Builder's License No .... ],,.'~..0..~.. ~. ~., .~". ....... Plumber's License No ...... . .~...~.. ............. Electrician's License No ..... ./~'.~..'T~.. ............ Other Trade's License No .... . ./t?X~... ............ Locationoflandonwhichproposedworkwillbedone..c~.~..~.....~.....~ffd~... .(..~..~?. (,~:~t~t'~ .... .~. . .o. .................. c ,. ~ ~ ~. ~.~. ?. ~. . . ~. . .~. . .,w. ~. . . ~ ,:.~. ) ...... ~ n ~ z.o.~. ~ . . ~.~/. . ,. ~ ~ House Number Street Hamlet / County Tax Map No. 1000 Section .. ].~.~. .......... Block ..... .~. ........... Lot...t~-~-.... Subdivision..~..~./~..~..~.....~..~./.~. ?.?.~. .... Filed Map No. ~27. . Lot .]..~. :..,,~.. ,~./. (Name) ........ ' · ' ..... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occu ancv ~/x)~/,/~; ' P .~ ................ b. Intended use and occupancy...~? .~'. ?./.../,././.t:t.~.,,(~....~l;-/~.(i Lq.::.. :(..~.~.~ ~1~.~,.~ ........... 3. Nature of work (check which appiicable): New Building ..... Addition .......... Alteration . Repair .............. Removol .............. Demolition .............. Other Work ............ .... 4 Estimated Cost · " · · · ....................... Fee (to be paid on filing this applkation) 5. If dwelling, number of dwelling u~its ... '~... Number o f dwelling units on each floor..77 .... If garage number of cars 6 ' If busme'ss ........................................................................ · , commercial or mixed 6ccupancy, specify nature arid extent of each type of use '-- . 7 Dimensions of ex~isting structures if any Front 7...,? ~ Rear .2...7 ' 'A' ' .', "L.' ~ .......... e~ght ~ Num~erofStories~oq,). Z~r.~g4/.ttvO. {'Z/ _O.,q,,e,,96:-~ ~cprn O'~. Dimensions of same structure w~thlalterations or additions: Front '~2' ' " .................... Rear . ~..~ .............. Depth .. 2~. ................. l Height · ' '¢'~"" ........ Num her of S~ories . .~,~. ........ t',* ...... ' '¢.' ' ' .4.o. 8. Dimensions of e~ntire new construction: Front .../.3/..~'. ..... Re r /~.5. .';. .....Depth . Height .... 7. .......... Numbe~ of Stories...(/~). ~ ....... 9. Size of lot Front /¢7.~ i r,~. / · ._ · ...... I .......... ~'" · · · ~. ~'.."' ....... nonth ! 10. Date of Purchase /¥~o ' ,, .~ ' ...... ~'~'7,; ...................... · · · ". ....... i .............. i' e4ame or vormer Owner dom6., bf./Y~. "~'/~'~'%'7 g/ff. 11. Zone or use dmtnct m which premises are situated 77' . ' 12. Does proposed construction violatel~anv zonin- law ora; ........... , -' 13. wm lo~ De regraued ~ ~ ,,,., .... ' .......................... ....... i ................ *yin excess nn oe removed from premises: Yes 14. Name of Owner of pr?..~mises 4~yt~tT/g~.)~....3'./.Z?~-..~'adaress . .~r~.~'5 _g,,j~ (4(. ~. .... Phone No. ,{:'./.K :-a.q~. '. Name of Architect . ~ .......... { · ·/'.~',~ ...... Addres~ ..... ./7.../.t~/e..r-,/~. ~.... Phone No... ~... ........... Name of Contractor~qZ/3. O./,~.~-4~.$' [t,~f~.~.5~.~.~' .,O,~td~ffe~s/.O.6~.</.~,g..,~.' ,.... Phone No .~.' . ....... 15. Is this property within 3001 feet of a tidal wetland? ,vg~ ' ' ' . . ' ...... · If yes, Southold Tow~ Trustees Permit may be req~g~[ ..... ~o..~w. .... · '. ! 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 nuraber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. AP, PROVED AS NOI'ED, 765-i802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - IWO REQUIRED FOR POURED CONCRETE ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CO~ISTRuc~ION MUST SE COMPLETE FOR C,O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CON~I~RUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEW YORK, ;OUNTY OF S.S ....... '~"~' '~'" ' '/~' ' · '~' '/' 'O'O'A° .......... being duly sworn, deposes and says that he is the applicant (Name of individ~al'sig~i~l~'c'ofl~c'ti bore named. ' is the agent corporate officer etc ) i (Contractor, , .... said owner 6r owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best o,f his knowledge and belief; and that the ork will be performed in the manner set forth in the'application filed therewith. · · ,yom to before me th~s