HomeMy WebLinkAbout19892-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z20026 Date JUNE 24~1991
THIS CERTIFIES that the buildin~ ADDITION
Location of Propert~ 375 TUCKERS IA~NE & 50 GRISWOLD ST. SOUTHOLD
House No. Street Hamlet
County Tax Map No, 1000 Section 59 Block 11 Lot 07
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 20, 1991 pursuant to which
Building Permit No. 19892Z dated MAY 28~ 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
GEORGE & KATHERINE FISHER
'~'~ '/J ~ Building Inspector
Rev. 1/81
I~OB.~ NO. 8
TOWN OF SOUTHGLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~- 19892 Z
Permission is hereby granted to:
...~....k.~.~. .................................................
......... ~ ......... ~...~ ............ .~......~. ..........
,o ..~.~.....~....~.L.~~ ................ ~...~..~. ........
at prem,ses located at ...~...~.~....~'.~:~...~.J~['~...~.....'~...-~.......~.;~......~....:....~
County Tax Map No. 1000 Section ...... ,,(~...~,,~., ...... Block ........ L.{ .......... Lot No .......0.,..~, ............
pursuant to application dated .......... ~~..~..~ .............. , 19..~..~.., and approved by the
Building Inspector.
Fee $..-~....:...~..
Building Irtspector
Rev, 6/30/80
Form No. 6
TO~fN OF SOUT~OLD
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 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 archiuect or engineer
responsible for the building.
Submi~ Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
pre-exlstzng 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 - $i00.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10o00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
ew Construction.~...~. ...... Old Or Pre-existing Building.~, ........
House No. Street Hamlet
ewer or Owners of Property ............................................................
ounty Tax Map No 1000, Section ...... .'~.~. .... Block ................ Lot .................. .
~bdivision ............ ~ ..... -
................. ~z±e~_ ~tap ............ Lot .............
_'reit No../. ~.~.~..~..~..Date Of Permit.....~/..~..~../.~./.Applicant....~..~-.~..~.~..~..../.~..-...... Z.~.
~alth Dept· Approval ., . /~-/~
................. % ..... Underwriters Approval ......
Lanning Board Approval ....... ~.:~...¢ ........
~quest for: Temporary Certificate .... ..~..... Final Certicate ...........
'e Submitted: $ ................ ~ ~'I[ . '
APPLICANT
rlzLD I,,S..~ON IfD~m COM~gNT~
FOUNDATION --~
FOUNDATION (2nd)
2.
ROUGH FRAME &
.FLUMBING
®
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONA'L COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION
FRAMING
REMARKS:
ROUGH PLBG.
2ND [ ] INSULATION
[/~I~L
DATE
INSPECTO~
TOWN OF SOUTIIOLD
OFf:ICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN IIALL
SOUTIIOLD, N.Y. ! 1971
June 14, 1991
TEL. 765.
Mr. George Fisher
375 Tuckers Lane & 50 Griswold Street
Southold, N. Y. 119~I
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because.of the following reasons.
/~/ An application for Certificate of Occupancy
is not on file.
/~/ No Underwriters Certificate on file.
The check is(~k/not on file.)$25.00
/~/ No Health Dept. Approval on file.
/~/ No final ins.pection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Dui]ding Permit t~ ~ .9 ~ 9 _g_ Z
Bu.£1ding Dept.
***/~/ No Plumber Solder Certificate on file.
all pcrlnits involving plumbing beinq
issued after April 1,1984 )
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
'isapproved a/c .... . ........................ ~
(Building Inspector)
BOARD OF HEAL'I'It
3 SETS OF PLANS ~ ......
SURVCY ...................
ClIECK ....................
SEPTIC F 0 R,*I ..............
..........
HAIL TO:
APPLICATION FOR BUILDING PERMIT ,
Date . ' . , . ..
INSTRUCTIONS
a. Th/s application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
s 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
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ion. ·
c. The work covered by tbJs 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
dl 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
i1 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
qding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
: applicant agrees, to comply with all applicable laws, ordinances, building code, J~using code, and regulations, and to
, nit authorized inspectors on premises and in building fQr necessary inspections~:~/.¢.._
(Signature of applicant, or n~a~e, if a 9orp~ration)
. · ......
(Mailing address of applicant)
engineer, general contractor, electrician, plumber or builder.
te whether applicant i~essee, agent, architect,
/;.- 'r
,ne of owner of premises - t9 ~E
(as on the tr¢ roll or latest deed)
pplicant is a corporation, signature of duly authorized officer. ,'
(Name and title of corporate officer)
Builder's License No /..~'~ ~0Yl-/[5' / ? O ~(_.) ~'~.~
Plumber's License No .........................
Electrician's License No '
Other Trade's License No ......................
Location of land on which proposed work will be doue ........
louse Number Street Hamlet
ubdivision ..................................... Filed Map No ............... Lot ...............
(Name)
tare existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy ............... ~. x ......
, Intended use and occupancy ~ ~q E' o~.~,~)~a
3. Nature o.f work (check which apilicable): New Building .......... Addition .......... Alterat. io? .... .......
Repair ............. Removal .......... Demolition .......... Other 'Wor~3~ ,~ .i'~..
I ¥ (D scr ption
4. Estimated Cost ..........
! ./. (to be paid on filing this application)
5. Ifdwelhng, number old,veiling uhits ............. Number of dwellinz un ts on each floor .....
· If garage, number of cars ..... ! ........................ .~.. ., ...............
If business, commercial or mixed Occupancy. specify natu, re and extent of e ' . ........
7. Dimensions of existing structures '-' - ~.t ,, J ' ach type of use ........ . /
,,,uany: Vront ...... V..~..... ~,,.,, ~, , ,-, ¥
· ......... tacptn....~7..h ........
Heig ~t .
........... Number of Stet/es . [, . .
. Dimensions of same stru,,* ..... '~ , · ' ............................
,, , ~,--,~ wan alterations or additions. Fro-~ ~ ' ............
taepm ..................... t Heh,h* ......... lqear ..................
8. Dimension~nfantl ........ [. 't' ............. ;~ ........... Number of Stories .......
., . - ..... ,ow construetmn- Front .-~..'9 ~ · ',, r ...........
_.. ' .... ~tear . . ~ ......
t~eg~t · · · N'--i ~- / ........... Depth . C.
.......... ,,mo.~rot5t.ones . ! .. . ....
9. S,,iz~ oral,et: Front ..... ',' .~...~..~.....'hear' 'i' ' ' CtZ ....... /-":.''"'/LX~ ..............
10. t~are ott't rchase /O ~r'! 14- ........ · ...... Depth l./.
..... ~/.,.j.t...,..~m.. . . · ........... . ....
, , · · . . ,. ..:.. .NameofForner O, ncr ...... .~t~..//k/ ~ ~
! I.~Zone or use d,stnct m wluch premises are s~tuated 7~'t.c~..q[~ e- tOv-'rt ~_, t F.. ...............
~ 2. ~ocs proposed construction VlOlnt.g an .... ~-., , ' ' ' ;.' .......... ~- ' .... ' '"~':?-"-" ' '~'e-~ ...... , ..............
3. Will lot be regraded ..... -,~(ff~ ,,u.,,g mw, oroma.n, ce or regulation: ..... :./~.'./j ...... .,. ........
4. u u,,-.,wner Orprem~ses .. t.~.£ .u...rT.. t-..,~'.rt.r/,~dress . ~9,0..~,.d.g' ..~..~..~... Phone No. ,: .7~. ~. %~,
Nam~ ~er, o · ' ' ' '~h' ';! ' '~','~-,',:_t~_' Wdl excess fill be removed from premises: Yes
Name of Architect
NZ sam: ~:tfsCo cat] .......................... Address .... · Phone No ...........
5. nrtora °r'"~'~r' '~"~' '~' ~j~./~..t:.. ('~.J~..(~.Address .............. ' ....
............... Phone No ...........
p p rt:y w±t:hin 300 foal: of a t:±dal wetla~'d'?' ~Yes ........ No ......... ' ....
~t£ yes, Sour:hold Tonka Trust:ecs Perra±t may be required.
i PLOT DIAGRAM
Locate clearly and distinctly all buildings ,whether e, xisting or proposed, and, indicate all set-back m .... ~,,,,,
,roperty lines. Give street and block nufilber or oescription according to deed, and show street names and
~terior or comer lot.
.... being duly sworn, deposes and says~mt he is the applicant
(Name of individual signing cc ntract) .
ve named.
s the ..........................
'(Contractor .................................................
, agent, corporate officer, etc.)
aid OWner or owners, and is duly autl'orized to perform or have performed the said work and to make and file this
i~at/on; that all statements co~ rained in this application are
: will be performed in the manner set fgrth in the application true to the best of his knowledge and belief; and that the
filed therewith.
m to before/ne this
.......... · ..... dayof... ........
· fy Public, . ' . i .
/ / f, .................. ...~'~-.,~Countv .,.,~. -t'~
~ ~OYCE M. WILKIN$ i ' .'. ..... '
Not~y Pu~ Sml, of N~ ¥o~ ..................................