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Home My WebLink About19504-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Zt9611 Date DECEMBER 24r 1990 THIS CERTIFIES that the building CHIMNEY & FIREPLACE Location of Property 55755 MIDDLE ROAD (RT 48) GREENPORT House No. Street Hamlet County Tax Map No. 1000 Section 44 Block 01 Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated Building Permit No. 19504Z NOV. 1, 1990 pursuant to which dated NOV. 7, 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 REPLACE CHIMNEY & FIREPLACE ADDITION TO EXISTING DWELLING. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 ROBERT E. & VIRGINIA L. DIETRICH N/A JdngInspector lt'OB, H ~0. S 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) Ne. 19504 Z ..~.~..,......,...../..../..~. .... , , ___ ..... ~.~...~... ........ ~....~..~....~~.~......~.........~.~..-..~ at premises I(~ated at ....M~......~...Z...~.~.~. . ~.~~....~. . ............................. ... . ... . .... County Tax Mop No. 1000 Section ........... ~... Block ......... ~ ........ Lot No ...... ../..~ ..... pursuant to application dated .... ./.~.~../~.. ................................ , 19...~..~., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF 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-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 architect or engineer responsible for the building. 6. Submi~ Plamning 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 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 $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building...~.~. ........... Location of Property ....................................... Hoose No. S~reet Hamlet Onwer or Owners of Property ......... ~? ..................... County Tax Map No 1000, Section....~.~ ....... Block...f ............ Lot..~ .................. Subdivision .................................... Filed Map ............ Lot ...................... f ~' permit./J.~. ?. ~. ~. ..... Applicant.. L~. ~.~...~..~..~.~. Permit No..l.~.~.0..J...~..Date Of Health Dept Approval Underwriters Approval .. . Planning Board Approval ........................ i...~...' Request for: Temporary Certificate ........... Final Certicate... Fee Submitted· ..... TOWN OF SOUTtIOLD OFFICE OF BUILDING IN£PECTOR P.O, 130X 728 TOWN IIALL SOUI'IIOLD, N.Y. 11971 Decemb.er 13, 1990 R & R Masons, Inc. Box 251 Orient, New York 11957 TEL. 765-1802 RE: ROBERT & VIRGINIA DIETRICK To Whom This May Concern, We are uuable to complete your Certificate of Occupancy because .of the following reasons. /~// An ;Ipplication for Certificate of Occupancy is riot on fil~. (ENCLOSED) /--/ No UnderwritersCertlfleate' ' on file. /.~_F~ The check is(~q~Y~X~not on file.) $25.00 /-/ I':o .'Io. alth Dept. Approval on file. /_--/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Bulld~.n., Permit tl I 9 5 -0 4 Z Building Dept. ~**/_-/ No Plumber solder Certificate on file. ( all permits involving plumbing being .[s:u,ed after April 1,1984 ) cc to: Robert & Virginia Dietrick Box 64 - North Rd. Southold, N.Y. 11971 OU~DA~ION (1st) OUt'IDATI O~,~ ( 2nd ) OUGH FRAME & .FLUMBING ~SULATION PER N. Y. STATE ENERGY CODE Fi;;AL ADDITIO~;A'L COMMENTS: Z BLDG. DEPT, TOWN OF SOt}THOtD d ././..~/~. 19..~. TEL.: 765-1802 Examine .......... , Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 BOARD OF HEALTH SURVEY CHECK ...... ~..~¢?~ NOTIFY~ CALL ..... ~.2~,~,~../~.7. (Buglding !~pector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tl'ds application must be completely filled in by typewriter or in ink and submitted to the Building Ifispector, with ~ sets of plans, accurate plot plan to scal~. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streers or areas, ando~Vm=-' ' ~ 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 Regulations, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein described. The applicant agrees to omply wtth all apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectom on premises and in building for necessmy inspections. ..... ~F.~.~...z~.~¢~,.~.-Z~.,o~. . · (Signature ot applicant, or name, ils ~o~'l~orat~o'n') ' ' -, ../7o~ .~ ~/...O.~,,%/. W., ,~.../j..o. ¢: 2.. ,, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameo£ownero remises .. ,... .. ... ~ ~.k~,t. C4.. .~.. ,.' ' ~.- .................. (as onYhe tax roll or latest deed) If ap~gant is a corporation, signaturo_aL.qkuly aullaorized officer. Builder's License Nb .......................... Plumber's License No ......................... Electrician's License No. Other Trade's License No.~.¢. .~...'~ ....... 1. Location of land on which proposed work will be done; .... ~:~.. z ~.~ ....... . .~..,..~.~/~.... ~o ~.~. ............ ~..~.~ .~.~.~. :~ .......... House Nun] ber Street, Hmnlet ......... . N ~"<ff ' / Z/.~. County Tax Ma o. I000 Section ............ Blbck . Lot ...,' Subdivision ..................................... R lcd Map No ............... Lot ............... (Name) ~ State · ' ~' ex st ng usc and occupancy of premises and intended use and Occnpancy o£ proposed construction: A. Existing use and occupancy · B. Intended use and occu ancy .... ~.~.~.~/~... 3. N/ature orwork (check which applicable): New Building .......... Addition ~'//2'~_ ~. Alter~rta ' ' '~ll'~l' ' '" Tennis Cou~'t ......... Ae,eessory Building .......... Yehee .... Other Work; ......... 4· Estimated Cost ....,t ............... , (to be" "'paid on filing this application) 5 Ifdwelli b etd Ill un'it N b fd Iii its h fl · fig, hum er we ng s ............... tim er o we ilg un on eec eot ........... . If garage, number of cars ...................................................................... 6. If business· commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front ..,............ Rear ............... Depth ............. Heieht ............... Number of Stories ................................................ ' ...... Dimensions of same structure witti alterations or additions: Front ................. Rear ................ Depth .................... . ~ Height ...................... Number of Stories .................... 8 Dimensions of entire new construction: Front ... .. Rear Depth .............. Height .Number of Stories ' 9 Si orlot: F Rear Depth '2:"i ........ 10 D teofPu chase . NameofForm O~ . · · .. . 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................ 13. Will lot be regraded .......... .................. Will excess fill be removed from premises:. Yes .... No. Name of Architect ........... i ................ Address ............. ..._f... Phone No ............ ..~.. · Name of Contractor .~'"~4/i~.Zq/~.q ~o.~j'..f~,r ..... Address ~.~,.-g~/..(2vla'P.r... · Phone No..</.22 r~7.~:. 15.Is this property locat'ed within 300 feet of a tidal wetland? mYES .... NO .... ~If yes Southold Town iTrustees Permit may be required. · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property Hnes. Give street and block number or description according to deed, and shoxv stree~ names and indicate whether interior or comer lot. OCCUPANCY OR USE ]S UN WFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, S.S COUNTY OF ................. · . APP, ROUED AS NOTED ./ NO~:IF¥ BUILD~RG OEPARTI~;,RT hT 76,~,1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ], FOUNDATION ~0 REOUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. iNSULATION 4. FINAL CONSTR~ION MUST BE COMPLETE FOR, C.O, ALL CONSTRUCTION SHA~. ME~ THE REOUIREMEN~ OF THE N,Y, STATE CONSTRU~ION & ENERGY CODES· N~ RE~PONSIB~ FOR DESIGN OR CONSTRU~ON ERRORS (Name of individual signing contract) above named, being duly sworn, deposes and says that he is the applicant Ftc is the ...................... ..................... ; .......................................... ; · · (Contractor, agent, corporate officer, etc,) of said owner or owners, and is duly authorized to perform or bare performed the said work and to make and file this application; that all statements conthined in this application are true to the best of his knowledge and belief; and that the work w/Il be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ { ....... day of ..... ?.'/..t~.. ........... 19 .~.0'. .~.. .......... County HELEN K, DE VOE NOTARY PUItLIC, StYe of New york No. 4707879, Suffolk Countyt~/ Term Expires ~l~rch