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HomeMy WebLinkAbout19187-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPkRTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19581 Date DECEMBER 13~ 1990 THIS CERTIFIES that the building ADDITION Location of Property 6500 NEW SUFFOLK ROAD NEW SUFFOLKt N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 4 Lot 34 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 9, 1990 pursuant to which Building Permit No. 19187-Z dated JULY 12~ 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR JOHN & DOROTHY BEHR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building/InSpector' Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTM;NT TOWN HALL $OUTHOLD, H. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLDTION OF THE WORK AUTHORIZED) NM '~18/ Z Permission is hereby granted to: ~..~..~~.....~~ ~...~_4.~. ....... ............... i'i;.~ ~i~'~~.;;];;~.'.;~;;"~;./. ~, ................. ...... ot premises located at ...... ~,,.,,.~.,,,~., .~., ....... ~,~..~~,,.C__~ ~ .......................................... ~.~....~.~~....~.~ .................................. . County Tax Map No. 1000 Section ..... /..../.....~.. .... Block ........ ~ .......... Lot No ...... .3....~.Z ..... pursuant to application dated ...... ~ .............. ~ ....... , 19~.....~.~ and approved by the Building Inspector. Building Insl:mctor Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 fl-om plumber certifying' t~a~'t~e 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. 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 ....----- ............... Date L'ew Construction...~. ..... Old Or Pre-existingf~uild~i~g.?~ ...... ,-. Location of ...... House No. ~reet Hamlet ' 0nwer or Owners of Property .... J~...~ .~.~.~...~A~ .............................. ~o..,~ ~,, ,~ ,o ~0oo: ~,~t~o, ..... zz.: .... ~,o,~ ...... ~ ........ ~o, ..... at ............. Subdivision. · No...~'~>'~__...,.~. ........................... Flied Map ............ Lot ................... Permit Health Dept. Approval ......................... · Underwriters Approval..~ ................ Planning Board Approval ........................ Request for: Temporary Certificate ...... Final Certicate. ee Submitted: ~..~ ...... FOUNDATION ( ls t) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING e INSULATION FERN. STATE ENERGY CODE FI~;AL ADDITIONA'L COMMENTS: STURTEVANT MILLWORK CORP. FAX (516) 667-6773 OCCUPANCY OR USE IS UNLAWFUL , WITHOUT CERTIFICATE OF OCCUPANCY APPROVED AS ~.'~BO FOX. fiG INSPEGTtON~ ~. ~ouNOATION ~ ~UREO CO '~ ~ COMETE FOR CrO THE REGuIREMENTS ~TATB coNaTRUCTION ~aa. NOT RESPON~v~ ~N OR ~NSTRUCTION APPROVED AS NOTED ~OYiFY BUILDING DEPARTMENT AT '~:~;~-1802 B AM TO 4 ~ FOR ~E ~eLLO~NG ~ ~OUNDATION - ~ REQUIRED ~OR ~URED ~ :. ",~AL - CONSTRUCTION MUST . <~OMPLETE FOR C,O. . ~ CONSTRUCTION 8HALL MEET THE REQUIREMENTS OF ~E N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRU~ION ERROR8 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTNOLD, N.Y. 11071 TEL.: 765.1802 Permit No./...y. / Z- Disappruveo ai~-" ................................... BOARD OF HEALYH ............ 3 SETS OF PLANS ............ SURVEY ........ ~ ............ CHECK ...................... SEPTIC FORH ................ NOTIFY~ CALL ................... MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 lhyout of property must be drawn on the diagram which is pan 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 bc 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 S6uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for z:emoval 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 premises and in building for necessa~~ · '-(s'~ 7dio'~f,c;dtiF, i)"' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ) ;f applicant is a corporation, signature of duly authorized officer. title of ~orp;ratd orficlr') 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; ...... ...... llouse Number ' Hamlet // ............ County Tax Map No. 1000 Section .... /. ] ........ Block ......... Lot ." Subdivision ..................................... ~iled Map No. (Name) ........ Lot S!ate existing use and occupancy of premises and intended use and occupancy ~of proposed construction:~,, B. Intended use and o¢cupaney.~...,..~.'/,.'~...'~.~'-.... ~~ ~..,~-..,,..~. I. Nature'ofwork (check which apptiiable): New Lng .......... Addition .. . Alteration ........... Repair .............. R#moval .............. Demolition .............. SwLmraing pool ............ Tennis Court ....... Accessory Bu~_/.dzng .......... nee ....... Other Work ............ *. Estimated Cost ~.~'.-/~ ~t. ~. ~. ................... Fee .... 4'"'~', ~ .~, , .. o (to be paid on filing this application} ~ Ifd Iii b fd Iii " Nt b fd Iii its h fl · we ng, num ere we ngumts ............... tm ere we ugun oneac per .............. Ifgaraee numberofcars ..... -~.If business, commercial or mixed o~cupancy, specify nature and extent o f each type of use ................. 7 Dimensions ofexistingstructures if any: Front . Rear Depth Heieht .............. . Numbc~' of Stories .................................... Dimensions of same structure with alterations, or additions: Front ..... ...... . .... . Rear ........ Depth ...................... Height ..................... . Number of Stories .......... .. $. Dtmens:ons of entire new constmctton: Front ............... Rear. ............. . Depth ............ Heieht Numbe~ of Stories · ~ Sizeoflot: Front ' Rear Depth 3. Date of Purchase ......... Name of Former Owner 1. Zone or use district in which premises are situated ....... 2. Does proposed construction violatelany zoning law, ordinance or regulation: .......... 3, Will lot be regraded · ·; ; ... Will excess fill be removed from premises: Yes .... No 4 Name of Owner of premises ..~ ' Address Phone No ' Name of Architect ............ ~ .............. Address ................... Phone No ................. Name of Contractor ~ ' Address Phone No ' :5.Is this property loe&te~ within 300 feet of a tidal wetland? ~YES .... NO .... ~If yes, Southold Town ~rustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly.all buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or comer lot. · (Name of individual sign ~g icontract} bore named. : (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly author zed to pe,rform or have performed tile said work and to make and file this [~plieation: that all statements containe, I in this application are true to the best of his knowledge and belief; and that .~ork will be perforn~ed in tile manner scl forth in the application Hied therewith. ,worn to before me this( ,~ ' ' · :otary Publfc~....~...~.. Cou[nty ,~x ~ NO4~_?~I~kcO..J~ ~:;;/,,., ' , ' ~ ('$ignamrcofapplicant} Qualified in ~uwtM~ urn~ -//~ '