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HomeMy WebLinkAbout19356-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19469 Date OCT. 23, 1990 THIS CERTIFIES that the building STRUCTURAL REPAIR Location of Propert~ 55755 MIDDLE ROAD C.R. #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 AUG. 29r 1990 pursuant to which Building Permit No. 19356Z dated AUG. 30r 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 STRUCTURAL REPAIR TO EXISTING ROOF OF ONE FAMILY 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 & VIRGINIA DIETRICH FORM NO. ~ TOWN O~: SOUTHO~.D BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS P~:P.~IT MUST B£ K£PT ON THI: PP.£MISFS UNTIl FUll COMPLETION OF THE WORK ^UTHORIZI:D) County Tax Map No. 1000 Section '~/"~' Block // Lot No ......... ~./,..~5,,..-~,..... pursuant to application dated .... ....~.... .................................., / Building Inspector. 19~.~..., and approved by the Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 i · APPLICATION FOR CERTIFICATE OF OCCUPANCY ;~ -' A. This application'must be filled in by t'ypewriter 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 %lectrical 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, indus.trial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from'architect or engineer responsible for the buflding. 6. Subm/= Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 19~) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing ali property lines, streets, building and unusual natural or topographic features. ,., 2. A properly completed application and a consent"to inspect signed hy the applicant. If a Certificate o£ 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 $i0.00 ~ua~u C~rcificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.~, Commercial $15.00 .,ew Construction .... ~ ...... Old Or Pre-existing Buiiding...~.C./~.~%~.~. "'' of · ~o= mu. Street ~ Ha~et ..... Onwer or Owners of Property. *.~ /~f~'~ · .... ' .......... ~ ........ ~ k.~ · co~.ty z~ ~ ,o ~ooo, s.==io. ..... M~ ..... UZo=~ ..... Z ......... ~o~.../~ ............... Subdi~ision * ................. Filed Map ' flemlth Dept. Approval.., · ...... Underwriters Approval ........................ ~ .. P1 App 1 ' "" arming Board rova, ............ .: · Request 'for: . Temporary Certificate ........... Final Certicate.. ~ ..... Fee Submitted: $ ...... ,~.~,.~.~. ............. · "-. tof a/ o ..... ....: ....... ~o z/~ ,' .- TOWN OF $OUTIIOLD OFFICI.: OF BUILDING INSPF, CTOR P.O, BOX 728 TOWN IIALL SOU rlIOLD, N.Y. 11971 September 17, 1990 TEL. 765-1802 Charles Thompson box N Peeonie, N.Y. 11958 RE: ROBERT & VIRGINIA DIETRICK To Whom This May Concern; %.lc are unable to complete your Certificate of Occupancy becaume3of, the following reasons. / /~An application for Certificate of Occupancy is not on fil~. (ENCLOSED) /~,~'lhe--/ ' check is(cA~Xk~h~Fd{/not ou file.) $25.00 /-/ I;o !lo. nlrb Dept. Approval on file. /_--/ No final inspection has been made. PJease contact our office on this matter. Thank you for your cooperation.' Building Permit ti I 9 3 -5 6 Z Dui ldin,-.f Dept. "**/~/ ~Io Plumber Solder Certificate on file. ( all permits involving plumbing being is:;ued after April 1,1984 ) FOU~;DATION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FI;IAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examined ' .~.~.~. ?..//~/~..~,.., 19.' 'TEL.: 765-1802 Approved .V.~../.,~. .... 19 ...Pe~itNo. ~.. ~ Disapproved a{c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .................. a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 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. 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 wilt issue 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 Southolfl, 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 c~lg ~jt~h all al~plicable laws, ordinances, building code housing code, and regulations, and to admit authorized ~nspectots on premises'and in bu,ldmgs for necessary inspections. ':Q7~'i~.(:'~7~'; .. ' '.' '~ .~ ' (Signature of applie~t, or name, ff a corporation) . AV.,// .!?r-',:.,. '~:" "' ./fO ~.o,~.,>~ ~¢o,~c.~ .. .,... ,;, ~, ~, ~ .. ~, . (Mailing address of applicant) State whether apptjgantrJ~ .~wner lessee, agent, architect, engineer, general contractor, electrician, plmnber or builder. · ..... .,,... ........................................................................ N me of owner .4.. V.,: ........ = a ................ ~ ~ :~ ~0 .... ~ ,'' :' ' (as"'on the tax roll or latest deed) If applicant ~s a cm]~o.~anqr~,~gna, B~re oi umy authorized officer. (Nmne and title of corporate officer) Builder's License No .... ~, .3.o~..~.,'7~../J-a/~.. .... Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...................... > ....... ,~ ................... .~/.W. I.C,'G; f. .t:'l ~ ~. .[yo~o41 .,.i, ,,~,-, c~ .............. House Number Street Hamlet ' C~)unty Tax Map No. 1000 Section ..... ./Tr..a'~. ........ Block ..... ./ ............ Lot.. ~ .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition ........... Alteration .......... Repmr .... ........... Removal .............. Demolition ............ Other Work...~.. ......... P'C~l,q[~'~ F*o~¢c~ ~Ce~/~lo~ O~ V'oO~ ' ~_ (Description) ' f (to be paid on filing th~s apphcation) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... I ................................................................... 6. If business, commercml or rmxed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nun]ber 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 ............... Number of Stories ' Height ....................................................................... 9 Size of lot: Front J Rear ' Depth 10 Date of Purchase ~ Name of Former Owner 11. Zone 0r use district in which pr~mises are situated ..................................................... 12. Does proposed construction viotate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: . Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .......... . ................ Address ................... Phone No ..... ' ........... PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and. indicate all set-back dimensions from property fines. Give street and block aumber or description according to deed, and show street names and indicate whether interior or corner lot. AP, oROV[D AS NOTED FEE: y: NOTI~EPA~ 765-1802 9 AM TO 4 PM (=O"'R THE FOLLOWING INSPECTIONS: 1. FOUNr,)ATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF !S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sign ng contract) above named. He is the ............................................ · ............................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du y authorized to perform or have performed the said work and to make and file this application; that all statements conl ~ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Ho. 4707878, ~ Couma/ .... ;' ........... Term Expires M~r~h ~, 19.-,~ ure of applicant) '.