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HomeMy WebLinkAbout19119-zFOR}4 NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z192t7 Date JULY 16~ 1990 THIS CERTIFIES that the building. DECK ADDITION Location of Property. 5 BRIGANTINE DRIVE HOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 71 Block 02 Lot 17 SEC. 1 subdivision HARBOR LIGHTS EST. Filed Map No. 4362 Lot No. 8 conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 6, 1990 pursuant to which Building Permit No. 19119Z dated JUNE 11, 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 ROTTEN DECK ADDITION OF EXISTING ONE FAMILY DWELLING. The certificate is issued to ROBERT LEVY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 / B~ilding Inspector ]FOI~[ NO. ~ TOWN OF SOUTHOLD TOWN HALL $OIJTHOLD, N. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ ';~1 19 Z ~ ....... ~..~....~~~...~...~..~~....~:~..~ ..................... o,~,,~,,e,,~o,~' ~o,...~....~...~.~~...~~.. ............. ~;~....~ ............... ................................................... ~..~... ,/.~,~;~ ........ ~.~.~..~..~ ............ Count~ Tax Map No. 7000 Section ....... .7.~ .......... 8~o~k ..... ~ ............ 'at No ...... ./..~ .......... pursuant to application doted .... ~./~... .................................... , Building Inspector. 19.,~..~..., and approved by the Rev. 6/30/80 Form No. 6 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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. Con~nercial building, indus.trial 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, Swinm~ing 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 Date ......................... New Construction ........... Old Or Pre-existing Building..~..../.~. ~.~f. ~%gZ~C~-- Location of Property ..... ~. ...~...~ .~../.~off~.%~ ~/~z House No. Street Hamlet Onwer or Owners of Property .... .~.4)~.-- .... County Tax Map No 1000, Section ..... 7./. ...... Block ...... ~ ....... Lot ..... 7..~. ............. Subdivision .................................... Filed Map ............ Lot ............. ~Iealth Dept. Approval .......................... Underwriters Approval ?lanning Board Approval.. F~..~. .................. ~equest for: ,Temp°rary Certificate ........... Final Certicate.~?..~.. '~ee Submitted: $ ..... ~..~..~.~.. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ~FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FIliAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND [ ] FRAMING REMARKS: ROUGH PLBG. INSpLATION [~INAL DATE .t LOT '5t © ~ , --- ~.DG. DEPT. ~i~Z 'll~W~OFSOtnh~.O .. FORM NO. 1 TOWN OF .qOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTI*IOLD. N.Y. 11971 BOARD OF HEALTll ' '~r.'~' - · ' 3 SETS o~ CIIEC~ ...... 1.7.~.~. ........... SEPTIC FORH ................ Exanilncd .. , ~,// ,.., 19 .d./? Appro,.ed .... ;/././. ..... Disapproved ale ..................................... ................................... ~ ~ ,-5 .......... APPLICATION FOR BUILDING PEFIMIT NOTIFY: 'HAIL TO: INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building, fit~ector, with 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 .' ' o cation, otVm= a detailed description of l~yout of property must be drawn on thc diagram whichi~lra~ of tkis appli- c. Thc work covered by' th.is application may not bc commenced before issuance of. Buildin,, Permit. . ' d. Upon approval of this application, the Building Inspector will issued a Building Permit tg=thc applicant. Such permit shall be kept on thc premises available for inspection throu~_&out the work. e. No building shall bc occupied or used in whole or-n part for any purpose whatever until a Ccr~ifi~ul~ of Occupancy ' shall have been granted by the Building Inspector. ' APPLICAT/ON IS HEREBY MADE to the Building Department for the issuance of a Building Permit Imrsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable I.a~s. Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, az herein described. Thc applicant agrccs to comply with all applicable laws. ordinances, building code, housing code, and re'g~ations, and to admit authorized inspectors on premises and in building for necessary inspcctions...~ . .,. . (S:gnaturc ot applicant, or me, ifa CDr or~ ~o'n~ ' ' ' (Mailing address of applicant} State whe'ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pinmber or builder. " Name of owner o£premises ' ' ............. (;s the t'a'x'roil 4'te t ir applicant is a corporation, signature of duly authorized officer. Builder's License No ........... Plumber's License No ..................... Electrician's License No. O/her Tradc's L/ccnsc No ' · Location of land on which proposed work will be done; llouse Nun: her .............. ; .... Hamlet .... "' "'~' * ' '' " · .' County Tax Ma o 1000 Section .......... · Block . · ......... , .... ot.12 ~ubdNifion.. ' Eiled Map No ~ ~G ~ (Name) .......................... State e ' ' . x~gtmg use and occupancy of premises and intended use aud occupancy of proposed congtruetio~ a. Ex~Sting use and occupancy · Intended d occupancy .. .X. . .%~ ' ' '. 3. Nature of work (Check which applicable): New Build ng .......... Add tiaa ......... ._,_'dlcfal~lk..i.;'~ ~ ..... R_ep~ar..z, ~ ........ R~mo~al .............. D~molition .......... a. S.~~. I~, ..... ~ ~ : ~ Y ~ux~xng .......... Fence ...'...~.~ther t49Ek ..... [..~ ..... 4. Estimated Cost ~ ~o~ .......... ~.. · · ~.~'' . (to be ~6h filini;'this'a~li~ S Ird Ill Cd iii its N b ' · wa ng. numbero we ngu{~ .......... ; .... tim erofdwellingunitsoneachfloor...~. ............ If garage number of cars - 6. If business, commercial or mixed )ccuoancy. svccif~ nature and extent of each type of naa .................. 7. Dimensions of existing structures, ir any: Front..,...~ ~ ..... Rear ...... ~ ...... Depth ... ~ .......... tgi ~. CSt He ~t ........... Numb:r o ories .................................... Dimensions of same structure writ alterations or additions: Front .... ~ ~ ........ Rear ...~.~ ........... ' Depth ............. ~ ....... I' Heist .. ~. ~ ............... Number of Stones ...... T ........... 8. Dimensions of entire, new constructional Fro.t ...... >~. Height ..... ~ ....... Number of Stories ' ' 9. ...... ...............; ................. .... ,04 cc .... .... .... 10. Date of Purchase ............ ~ ................. Name of Fomer Owner ............... 11. Zone or use district in which premises are situated..,..~....................'' ]~.. .... . . . ]~'~ '' 12. ~,~ pr.oposed construction violate any zoning law, ordinance or regulation: ...~P. ................... 13. wallot~eregmded .; ....... ~.~ ............... Willexcesa fiIlbe removed from premises: Yes~]~]~a'.'. 14. N~e of Owner o f premises .~1 ~. ~ ~ ~...' .... Address . ~ ~. g~ ~.~.qZ .... Phone No .... ~ ............ N~e of Architect .......... ' l ............... Address ................... Phone No ..... 7~ ...... N~e of Contractor .~¢~..~.~t ~vO.,X. ~ ..... Address 15.Is this property loea~led vtthln [ 00 feet of a ,tidal werXand~ ~YgS .... HO .... ~If yes, Southold Iown[Trunrees PermiC may he required. PLOT DIAG Locate cle~l~ ~d dist~ctly ~I bu~d~gs, whether existing or proposed, ~d. indicate ~I set-back d~sions from prope~y ~nes. Give street ~d block nBmber or deschption accord~g to deed, ~d show street nmos and ~te whether interior or corner lot. ' STATE OF NEW YORK, S:.S ........ ........... il ' ' ' ' .............. t of individuals nit contract) above named. being duly sworn, deposes and says that he is the applicant Pre is the I (Contractor. agent, corporate officer, etc.) of said owner or owners, and is dulyJauthorizcd to pe,rform or Imve performed the said work and to make and file this application: that all statements contaihed in this application are trnc to the best of his knowledge and belief; and that thc Work will be pcrfommd in the manner ~ct forth in tire application filed therewith. Sworn to before mc this ~ . ........... ~. ........... day of. ] .............. 19 HELEN K. [~E VOE NOTARY PUBLIC, State of New Y~d( , * ' No. 4707878, Suffolk Count,s; . Term Expire March 30,19.-.7./. ; ($rgnarurc 0 f a ppJJc__l:)