HomeMy WebLinkAbout19608-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20245
Date SEPTEMBER 25r 1991
THIS CERTIFIES that the building. ADDITION
Location of Property 125 LIGHTEOUSE ROAD SOUTHOLD~ N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 54 Block 3 Lot 26.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 4~ 1990 pursuant to which
Building Permit No, 19608-Z dated DECEMBER 2~ 1990
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 GREENHOUSE ADDITION ON AN EXISTING DECK & FINISHED ROOM
OVER EXISTING ATTACHED GA~AGE~ & SPA AS APPLIED FOR.
The certificate is issued to JOVAN & JOAN CALr. AHAN (owners)
of the aforesaid building.
SUFFOI~ COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/'81
N-193037 - JUNE 21r 1991
· /~ JBuilding Inspector
/?
l~it~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FUII
COMPLETION OF THE WORK AUTHORIZED)
N-e 19608 Z ~t, .....,~..~.../...~... .................................... , 19 .......
Permission Is hereby gmnt~d~to:
· ..~~. ~ .,,,~<~,..~,......,:..~.~?.z/
~'.,,~ ,. ,,,.~"~.,~......~.. ~ .~~. ,.,~.
4,~-~.....,~......~~.~,~.~ · ~,m.,--..~---..~---
~t ~.mi., ~ ~ ..... ~~~~ ....... ~ ....................................
County Tax Mop No. I000 Section .... · .~-..../... ....... Block ......... ~ ..... Lot "o ....... · .~....,,'~,..~.....-~
pursuant to application dated ....... ../...~....~.... .............................. , 19.~ and approved by
the
Building inspector.
R~. 6/30/80
TOWN or SOUT, OLD .'
BUILDING DEPARTMENT
TOWN I~%LL
765-1802
~PLICATION 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. Appreval 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 i% 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. ,\ccur~te survey of property showing all property lines, streets, bnilding and
unusuul 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 cf Certificate 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 ......................................
Construction ........... Old ~r Pre-existing Building ...........
. oc a t i o n of P ? e r t y . . . . . .'% L :] . .T. . 4 d . . .
House No. j Stree~ Hamlet
or O ners of ............ ................. -- .......
;oun~y Tax ~ap No 1000, Section .... .~...- .... Block ...... '
;ubd lvision .................................... Filed Map ............ Lot .................... . .
'erm£t NO./../. ..Date Of Permit ................ Applicant. .. :f;k ..... ] .... ' .......
!ealth Dept. Approval .......................... Underwriters Approval...t~.~
'!arming Board Approval
.. . Final Certicate...~ ....
equest for: Tempora~ Certificate ....
ee Submitted: S .............................
765-1~02
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
DATE
INSPECTOR
FOUNDATION
FOUNDATION
2.
ROUGH FRAME &
(1st)
(2nd)
PSUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
r
i ~v, 6k¢,6 ¢ fb
I
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN tIALL
SOUTIIOL~), N.Y. 11971
SRPTgl~ER 16, 1991
TEL. 765- 802
JOHN & JOAI'I CALl.SlAt;
125 LIGHTHOUSE ROAD
SOUTHOLD, NY 11971
To Whom This May Co~ncern,
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
/_~/ An application for Certificate of Occupancy
is not on file. '(ENCLOSED)
/~No Underwriters Certificate on file.
/~/ The check is(~/not on file.) $25.00
/_-/ No Health Dept. Approval on file.
/_--/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit ~ I 9 6 ' 0
Building; Dept.
***/~/
8 Z
NO Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
tl~ ~[[[~ ,~'ll~lI~ !/1 ,/ TOWN OF SOUTHOLD
u u~ TOWN HALL
~0~ o~ ~O~OLO · ~OUTHQ~. ~_
' ' .............. TEL:
BOARD OF HEALTH ..........
..3 SETS OF PLANS
SURVEY
SEPTIC FORH
;:3 .....
To,
...
Oal,ilding~,,r'sp e ~ t o r )
APPLICATION FOR BUILDING PERIVIIT
INSTRUCTIONS
~ a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Ihxpeetor, witl
sets of plans, accurate plot plan to scale· F~ a~offiing to schedule.
b. Plot pl~ showing location of lot and of bulldogs on premises, relationship to adjoining premises or pubic stre~
or areas, and givNg a det~led description of layout of property must be drawn on the diagram which is pa~ of tNs apF
cation.
c. The work covered b~ tNs applicatmn mat npt be commenced .before issuance of BuBdNg Pe~it.
g. Upon approval of this application, the Building Inspector will issued a Building Pc~it ~o the app~c~t.
shall be kept on the premises avaUable for ~spcctio~ throu~out the work. Such pe~
e. No bulldog shall be occupied or used in whole or ~n part for aUy purpose whatever Until Ce~ifiCate of Occup~t
shall have been granted by ~e Build~g Inspector. a
APPLICATION IS HEREBY MADE to the BuildNg Depmment far the issu~ee of a B~Iding Pemit pumuant to t~
Building Zone Ordinance of tke Town of Southold, Suffolk County, New York, ~d other applicable ~ws, Ord~ces
Regulations, for the construction of bufld~gs, additions or alterations, or for ~emoval or demolition, as here~ describer
The applicant agrees to comply wit~ all applicagle laws, ordin=n' ·..
' .1'~ '"~t ~ /'~/ '-
~ ~, _ ~ uu~nmg a~aress oI app~c~t
State whether applicant is owner, lessee, agent, ~chitect, engineer, general co~traotor, electrician, plumber or builder
.................
.............
(as on thc t~x roll or ~atest deed) .........
~¢ applican[ ~s a corporation, s~turc o[ duly author zed oF~csr.
(Name and title o~o~Orate'officer) '
~lumbcr's L~ccnse ~o ..... ....
Other Trade% License No
1. Location of land on which proposed work will be done,
ousc umber ~ ~lreet ....
Hamlet
................................. F, iled Map No.
St (Name) .............. Lot...~
' 2re existing use and occupancy of premises and intended t,~e and occupancy nf proposed Construction-
A. Ex~stxng use and occupancy ....... · .
B. Intended use and occupancy ........ ...
: /~
Nature of work (check which a0plicable): New Building .......... Addition .... .L~. .... Alteration .........
Repair ............. R~moval Demolition ........
Tennis Court ......... Accessory Building .......... Fence .........
{ts he paid ~n' qling thix applica~mn}
If dwelling, nu nbcr of dwelling units ............... Number ~f dwelling units on each floor ...............
If garage, number of cars ...................................................................... .
If business, commercial or mixed occupancy, specify nature and extent of each type of use ....................
Dimensions ofexi~ttng structures, if any: Front ....... ~-~... Rear ............... Depth ...~.~ ......
Hcieht Number of Stories ~ .............
Dimensions of same structure with alterations or additlonx: Front ... j~~ . Rear .................
Dcp~h ...................... }lei~t .................... Number of Stories ..............
Dimensions of entire new construction: Font .... ,~~. Rear ............... Depth ..............
He g ~t .............. Number of Stohes .....
Date of Purchase -~'./-~- · · Z ~. r. ............ Name of Fo~,cr Owner /~m,Z ~-~,d'- ~",q i-~..
Zone or use district in which premises are situated., t~ ~. 1 ~ ~.,v .~ ~ ~ ~ ..............................
Docs pcopc.~ed construction vi~iate any zom{ng law, ordinance or regulation: .. F% S~- .................... ;..- -
WNI lot be regr~ded ........ ~N) ~2...$ ....... ... WilLexces~ ~I1 be rqmoved from proem: ~
Nme of Architect .... ~'~ ' ...... x .......... A~dr~ ....... ~< .......... Phone No..& ~-~ ~-
.............. ;. ................................ . ·
Id_La [ki~ 9roperty located within· ]00 feet ~f a tidal wetland7 ~ES ....
~If yes, Southold Town Irustees Permit may be required.
PLOT DIAG ~M
Locate ele~ly md d~tMctly ~I buHdMgs, whether existing or proposed, ~d. indicate ~l set-back d~enz{~r.'. ::
prop~y Eries. Give street ~d block number or description accord~g to deed, ~d show street ~mes and ~6ic:te
intehor *r comer lot.
7e;5~. ~8.q2 9 AM TO I F'M FOR
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MUST
~E COMPL~E ~R C.O.
ALL CONS~UCTION 8N~
THE REOUIR~EN~ OF ~ N.~
STATE ~NS~u~N &
CODES. N~ ~S~NSl~
DES;GN OR C~S~U~N
STATE OF NEW
COUNTY OF. ¢~.~.E¢.q ·K. ..... S.$
... :5 .c.c. 8.. n .................
(Name of individual signiug contract)
above named.
being duly sworn, deposes ;md says that he is the appliee:.
J-'re i$ the ........................................... d ....................... ~ ....................
(Contractor, agent, corporate officer, cfc.)
of said owner or owners. :md is duly author/zed to perform or havc performed thc said work and to make and filc th
application: that all statcmcnt~ contamed in this application arc true to thc best of his knowledge and belief; and that lC:
Work will be perfom'~ed in the re:tuner set forth in thc application filed therewith.
Stvom to before me this
· .. flay ...................... 19,
~ otary Pubhc, ./ ...... ~. County
RAn[N W.'
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