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Home My WebLink About19477-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19473 Date OCTOBER 23{ 1990 THIS CERTIFIES that the building Location of Propert~ 325 RICHMOND RD. House No. Street County Tax Map No. 1000 Section 51 Block 06 Subdivision Filed Map No. ADDITION SOUTHOLD Lot Lot No. Hamlet 21 conforms substantially to the Application for Building Permit heretofore filed in this office dated OCT. 22, 1990 pursuant to which Building Permit No. I9477Z dated OCT. 22~ 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 SCREENED PORCH ADDITION AS BUILT. The certificate is issued to (o~ner) of the aforesaid building. BUFFOLKCOUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 ALF. XANDER BONDARCEUK N/A /~~u~l~in/gtn/~ctor TOWN OF $OUT~IOLD BUILDING DEPARTMENT TOWN HALL sOUTHOLD, N. Y. BUILDING PERMIT ~I'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPS_ETlON OF 'THE WORK AUTHORIZED) No- 19477 Z Permission is~ granted to: , ~/~..~..~.~/..~.~......~~.~.. ~_~~.,~/...=~.../,.'.. ........... ~./..'.. ........... ;~.....~. ...................... : ............................ .._..~; .................................. .............................................. ~_.,~/.:...~.~,,. ........................................................................ County Tox Mop No. 1000 Section ....~. ,/,, .......... Block .......... ~.. ......Lot No... ,,.~:~.../,,,, ........ pursuant to application dated ..... ~..~.....~ ............... , lg...~...~ond 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 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. 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. 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. 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-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 j Date .......... New Construction ........... Location of Property...~'~.. .............. I.~.~[ ~.~..~.~.~! ......... House No. Street ~ Hamlet Onwer or Owners of Property ............. County Tax Map No 1000, Section...~..] ........ Block ........ .~ ...... Lot .... ~..I .............. Subdivision .................................... Filed Map ............ Lot ...................... Permit No...l.~.?~.~.~... ate era ../.~.~..Z~.l.~..Applicant ................... D Of P it .......... Health Dept. Approval .......................... Underwriters Approval ................... ,.. . .. Planning Board Approval .... Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $'''(~'~/,..~ ...................... '''~' ''''~''' ''~'''~'''~' ~ , i .................... APPLICANT FIELD FOUNDATION { 1st ) FOUNDATION (gnd) ~OUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE F~NAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [~~L ~; FORM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL ;~OUTHOLD, N.Y. 11971 /.¢.._~__ · , ~.- TEL.: 765-1802 Examined............. I · ~ .... , 19~ Permit No. Disapproved a/c ..................................... .......... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... C}tECK ...................... SEPTIC FORH ................ NOTIFY~ CALL Date ................... 1.9... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Ihspector, with 3 sets 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appLi- cation. ¢. 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 Bu/lding 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to (Signature o/' ~pplicant, or name, if a corporano'n) ' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Na wn rfp ...~..WT.' . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ' ' ' Builder's License No. Plumber's License No ..................... Electrician's License No ..................... Other Trade's License No ...................... Location of land on which proposed work will be done; }i;~;e NumbJr '' - Street, Hamlet vT · Count ax Map No. I000 Soction ................ Block · ' ............... Lot .~..1.. ' Subdivision ..................................... Eiled Map No. (Name) .............. Lot ........ State existing use and occupancy of premises and intended usc and occupancy of proposed construction: A. Existing use and oc ........ ' .~./~r/~'~' /Z'~.~<'c/ B. Intended use and occupancy .............. I. Nature o£work (check which applica e): New Building .......... Addition .......... Alteration ..... .~ . .'.., · ........ DemohUon ............. o p el ............ Repair .............. R~moval .i ..... . · Swiraraino o ' , Tennis Court ......... Acce}sory Building ....... Fence ....... Other Work: ....... t. E,tim:ted Cost.. o.."7: .....i"' ~ o ~ -- .. · · · (to be paid on filing this application} units on each floor If dwalling, number of dxvetling units I ............... Number of dwelling ................ Ifgara-e number of ears ! ................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... . . Dimensions of ex sting structures, if any: Front ............... Rear ........ : ...... Depth ...... ..... Height ............... Number of Stones ................................................. ... D!,m. ensions of same structure with al~c. rations or additions: Front ................. Rear ...: ........... Depth .................... Hpight ................... Number offitories .............. 8. Dimensions of ent,re ne~v constmcUon: Front ..... /.~ ........ Rear .... ~ ........ Depth .. ~.av ...... Height Number ~f Stories ' 9 Size of lot: Front , ' Rear Depth .......... 0. Date of Purchase ............... , .............. Name of Former Owner ............................ 1 Zone or use district in which premises situated 2 Does proposed construction violate ny zoning law ordinance or regulation: .. .............. 3. ,Will lot be regraded ........................... Wiil excess fill be removed from premises: Yes .... N~ ..~ 4. Name of Owner of premises ...... .........' .... Address ............. .... . . Phone No .............. .. , Name of Architect Address Phone No · Name of Contractor ' Address Phone No 15.Is this property located within 300 feet of a tidal wetland? *YES .... NO .... ~If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM dhags, whether existing or proposed, and. indlcate MI set-back dimensions from ber or description according to deed, and shoxv street names and indicate whether Locate clearly and distinctly all but property Lines. Give street and block num interior or corner lot. APPJ{dVr~A$ ,OTED . N OTI FY."~L(II~DING D E pA~(!.~I~:rA~/ ' 7fi~4802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - ~OREQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. ~hlSU LATION 4, FINAL' CONSTRUCTION MUST gE COMPLETE FOR ALL CONSTRUCTION SHALL ME~ I'H~ ~E~UIREMENTS OF THE N,Y. ~'~ CONSTRUCTION & ENERGY ,SC*DES~ NOT RE~PONglBLE FOR ~: ,{~r~ O~ CONS'FRUCTION ERRORS STATE OF NEW YORK, ' ,,. ~ COUNTY OF ............. [~'~=.. S. ......... .................... . ............... I being duly sworn, deposes and says that he is the applicant (Name of individual signingl contract)' above na~ed, i He is the ~ ' . ' i (Contractor, agent, corporate officer, etC,) of said owner or owners, and is duly ~uthorized to pe,rform or have performed the said work and to make and file this application: that all statements containbd in this application are true to tim best of his knowledge and belief; and that the work will be performed in the manner sot forth in thc application filed therewith. S~vorn to before me this l & dayof' De~ 19.~.0 Notary Public, HEt£n & DE NOTARY PUgLIC, StYe of ~w YodL . He. 47071178, Suffolk County,.. lerm I[xpires ~roh 30,19 ~/,I (Signature of applicant)