Loading...
HomeMy WebLinkAbout19441-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19426 Date OCTOBER 9, 1990 THIS CERTIFIES that the building. ADDITIONS Location of Property 55 SKUNK LANE & 37070 MAIN ROAD CUTCHOGUE~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 85 Block 3 Lot 2.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 28, 1990 ~ursuant to which Building Permit No. I9441-Z dated OCTOBER 5, 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 ROOFED DECK~ STAIRS & DOOR AS BUILT. The certificate is issued to PHYLLIS RAYNE BYER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building l~spector Rev. 1/81 I~O~M NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOV/N HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 19441 Z Building Inspector. Fee $.. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 i · 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: L 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 ~lectrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system ~ less than 2/10 of 17. 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. B, For existing buildings (p~ior to April 9, 19~_7) 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. C. 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-ex/sting Building - $100.00 3. Copy of ~ertificate of Occupancy $5.00 over 5 years $i0.00 wuacuu C~rcificate of Occupancy - $50.00 .5. Temporary Certificate of O~cupancy -~ Residential $15.,0,0, Co~ercial $15.00 Date . .ouse ~o ~ '"' ...... '":'"'"'~"~ .......... " , Street . /0 Hamlet -[,~- -.~ Cou tyTax 'p o ooo. sectio ..... ....... 5. ...... ..... / 5ubdi~lsion · .................. Filed Map ............ Lot ...................... ...... Date Of .... Applieaat ............................. ~ealth Dept. ApProval .......................... Underwriters Approval... ~ Planning BOard Approval .............. * '', '' FLE INSURANCE COM.I~ANI 1 BUILDING DEPT. INSPECTION [ ]FOUNDATION SST [ ] ROUGH PLBG. [ ] FOUNDATION AND [ ] INSULATION [ ] FRAMING [,~INAL DATE /~/'~/~ INSPECTOR Alteration ' 3. Nature of work (check which applicable): New Building.,.......- Addition ... ................. · ' Rbm S~i i Repair .............. oval .............. Demolition .............. mm ng pool ............... Tennis Court :... Accessory Building .......... Fence ....... Other Work: ........... 4, Estimated Cost ......................................................................... (to be paid on filing this application} 5. If dwelling, nmnber of dwelling units ..... 3 ......... Number of dwelling units on each floor ................. Ifgaraee,, number of cars ....................................................................... ' ' 6. If business, commercial or mixed occupancy, specify natnre 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 with alterations or additions: Front ................. Rear ................... Depth ...................... Height ...................... Number of Stories ....................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ................ Height Number of Stories ' 9 Size of lot: Front Rear Depth .. lO Date of Purchase Name of Former Owner .............. 1 I. Zone or use district in which premises are situated ...................................................... 12 Does proposed construction violate any zoning law ordinance or regulation: ..... 13. Will lot be regraded . . · h .... /J. ......tP ..... Will excess fill be remov, ed from premises: Yes ~... No.. 14. Name of Owner of pr;~ni;es ~./~ ~J,~lg.. [~()ic~fl,).ff, .p.~f.~{~rddress . .,~..~.~ilA~./.% .L./3.~V~-.. Phone No..?-fXq..C..Y:~:5.{.. Name of Architect Address Phone No ..... Name of Contractor ...... feet of ~' ti~l~'l 'wetland? *'Ills .... NO.t.~.. v~o per ty. X;.d~t~,h..~i~:h.f, .~;;. Address .............. Phone No .......... ;.~z... 15.Is this · If yes, Southold Town Trustees Permit may be required. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY OR USE IS UNLAWFUL WITHOUT C£RT RCKi'E OF OCCUPANCY STATE OF NEW YORK. S.S COUNTY OF ................. APPROVED AS t~OTED _ ~ N~IFY BOIL~DEPAR~NT AT 765-,1802 9 AM TO 4 PM FOR THE FOLLOWING ~N~PECT{ONS: 3. FOUNDATION '~O REQUIRED FOR POURED CONCRETE ~. ROUGH ~ FRAMING & PLUMBING 3, ~NSULAT~ON ~ FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O, ALL CONSTRUCTION SHALL MEET 1HF~ R~OU~R~MENTS OF THE N,Y, ~%~1'~ CONSTRUCTION & ENERGY .,4"FS NOT RESPONSIBLE FOR :~ :,';N OR CONSTRUCTIOI~ ERRORS .............................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ....................................................................................... '- · (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this application: that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in thc manner set forth in the applicatioo filed therewith. Sworn to before me this Notary Public,, . ~ ~.: . .~..f:~..~]..0~.'. ....... Cou~. Ng. 4707878 Suffolk Ceunty,,,t ' ' .... ~rm Exp res M~mh ~O, tg--,.~ an t ) FORM NO. 1 TOWN OF SO~0THOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 Examined ......... , 19 ~;. Disapp~'oved a/c .............. i ....................... APPLICATION FOR BUILDING PERMIT BOARDOFHEALTH..r~... , .... ::.:::: SURVEY ............... CHECK NOTIFY~ cm L . MAIL TO: INSTRUCTIONS Date ...... a. Tiffs application must be co: npletely filled in by typewriter or in ink and submitted to the Building Ihspector, with 3 sets of plans, accurate plot plan to s~ale Fee according to schedule. b. Plot plan showing location Of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of lhyout of property must be drawn on the diagram which is parr of this appli- cation, i e. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this appli{ation the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises availabile 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 Togn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o? 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 prerr tses and in building for necessary inspections. ........... ;i';33ii;;;b ............ State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. a er premi s .... ~ ............. . '.. . ..j ............ ,' (as on the tax roll or latest deed) If applicant is a corporation, signatu3e of duly authorized officer. (Name and title of corpo?tei officer) Builder's License No ......... i ................. Plumber's License No Electrician's License No Other Trade's License No : I. LocaUon ofland on w ~ich propoied work wilI be done; House Number Street, County Tax lisp No. [000 Secti6n ............ Block .... Subdivision ................. . ................... Kiled Map No. (Name) '~ State , ' : · . ~. existing use and occupancy ,of premises and~ltended use and occupalftc, y of proposed~xmstruetJon: ~ A. L~xisting use and occupancy' .................... ~-~ .~. B Intended use and ocdupancy . . Hamlet Lot . . .............. Lot ......