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Home My WebLink About19000-zFORM NO. 4 TOWN OF SOUTt{OLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19139 Date JUNE 13, 1990 THIS CERTIFIES that the buildin~ ALTERATION Location of Property 2100 JACKSON ST. & 350 FOURT54 ST. House No. Street County Tax Map No. 1000 Section 117 Block 10 Subdivision Filed Map No. NEW SUFFOLK,N.Y. Hamlet Lot 18.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 30{ 1990 pursuant to which Building Permit No. 19000-Z dated MAY 8, i990 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 REPLACEMENT OF EXISTING DECK WITH NEW ONE. The certificate is issued to RUSH FORQUER {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 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 19000 Z Permission is hereby granted to: .......................................... ...... .................................................. i'~'"'"'~' ..................................... .';¥£~'Z; ....... ';"~' ......... ~"'1~"~'~ at premises located at ~.../....~,,...,~.~...~r~.,..~..,.6~.,......~..,T......~..~.?....~....~..,.: ...... ...~.,.~...~ County Tox Map No. 1000 Section ....... ].l..."). ........ Block ....... 1.,,~,, ........ Lot No ......),,,8;..,.1 ..... to application dated ..... ~,......~....~. .................. , 19.~..~., and approved by the pursuant ~J Building Inspector. Fee $..,~?...:..~ .... 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, 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. ~ B. 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 Temporary Certificate of Occupancy - Residentia~ $t5.00, Commercial $15.00 D~te New Construction ........... Old Or Pre-existing Building ................. Onwer or Owners of Property ........ , .................................... County Tax Map No 1000, Sectzon...lJ..~. ..... I , ~ Permit No. \ te Of rmit ~ ~ qO ¥-~ ~ kJ CC~O ~ ~ealth Dept Approval Underwriters Approval Planning Board Approval ........................ / Request for: Temporary Certificate... Final Certicate .......... TOWN OF $0UTHOLD OFFICE OF BUILDING IN~PECrOR P.O. BOX 728 TOWN HALL SOUTI{OL0, N.Y. 11971 June 5, 1990 TEL. 765-1802 Herren Construction Co. Box 1442 Hattltuck, N.Y. 11952 RE: RUSH FORQUER To Whom This May Cogcern, We are unable to complete your Certificate of Occupancy because.of the following reasons. /--//An_ application for Certificate of Occupancy is not on file. (ENCLOSED) /~///No Underwriters Certificate on.file. /~/ The ~heck is(~Xnot on f~le.) $25.00 /Z/ No llealth Dept. Approval on file. /5/ No final ins.pection has been made. Please contact our office on this matter. Thank you for your cooperation. Dui]ding Permit tt I 9 0 0 0 Z Buildinq Dept. ***/Z/ No Plumber Solder Certificate on file. all permits involving plumbing being issued after April 1,1984 ) 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I/NSU~TION / FRAMING [~']~ FINAL DATE INSPECTOR FOUNDATION {1st) FOUNDATION ( 2nd ) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180:~ BOARD OF HEALTH 3 SETS OF PLANS SURVEY CHECK Disapproved a/c . . · (Building Inspector) APPLICATION FOR BUILDING PERMIT NOTIFY~ CALL .............. Date . CountyTa. ,,, pNo.,OOOS.cfion . 'B, ck ............... Lot...t.?.,..( .............. ...~0 ~ Subdivision . : ..................................... Eiled Map No ............... Lot . (Name) .............. 2. "' ' ° P' Y 'P ' ' ' q'Y fp p sedconstr ' : State ex stm,. use and occu anc of rcmtses and intended use and occupa c o rD o uctlon a. Existing use and occupancy....C~..~..C~. }.<.,__ ............. ' ' . ...... U.S.E.IS UNLAWI:UL P ' ' " iTi. i{jty[' CERTIFICAiE lumber s License No ...... Electrician's License No ..... ......... OF oCCUPANCY Otb rT d 'sL'e ~c No ra e ense ...... . ............... Location of land on which proposed work will be done, ......................... ~.~.q. llouse Num bet 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION ~V}UST BE COMPLETE FOR ALL CONSTRUCTION SHALL MEET' THE REQUIREMENTS OF THE N Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTtO~-~ Hamlet INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building lhspecior, 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 streers 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 tiffs 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 O,ccupancy shall have been granted by tho 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 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. Th~ applicant agrees to comply with all applicab~le laws, ordinances, building code, housin~ code, and re§ulations; and to admit aut~griz_ed inspectors on premises and in building for n¢cessa~r¥ inspections. . . . · - (Signature o~ applicant, or name, if a corporano'n') ' ' (Madmg address of apphcant) ~' ' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .... · .,%% e .,,v .t ...... .............. .... Name of owner of premises , ~--..~ ¥.~..%7 LO.. (~-C~..~- ~. . .... ' .............. E" ' ',' ~ ' ,- ~.-A-.. -- ' (as on the tax roll or ~;~~O~ ~' '.LL ' · G 'PARTMENT AT If{Z, ppl{~}ant is a cc~(poration, signatu:;e of duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE . (Na~e and title of corporate officer) 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ~ .~-.... · ·. · ....... ' e ' ' ... .$wimral-ng pool_ ............ Repair ....... Rgmoval .............. D moht,on .. ........ Tennl-s Court ......... Accessory Bul-l. dl-ng .......... Fence ....... Other Work ............ 4. Estimated Cost ' ' (to bo paid on filing this app/icat!on) $. If dwelling, number of dweiling units ............... Number of dwelling units on each floor ............. If garage, number of cars ..................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of tach type of use ................. if any: Front Rear Depth 7. Dimensions of existing structures, ·., ...................................... Heigl~t Number of Stories Dimensions of same structure with alteratioos 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 10, Date of Purchase ............................. Name of Former Owner .......................... 11. Zone or use district in which pr6mises are situated .................................................. 12., Does proposed construction vioiate any zoning law, ordinance or regulation: .............................. 13. Will lot be regraded ........ ~ ................... Will excess fill be removed from premises: . Yes .... No, " Phone No 14 Name of Owner of premises Address . . ....... Name of Architect ........................... Address ................... Phone No ................. ' Name of Contractor ................. : ....... Address ................. Phone No ..... ~ ...... i .... lO0 feet of a .tzd~l wetland? YES .... NO .... 15.Is this property located within ' ~If yes, Southold Town Trustees Permit may he 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 comer lot. STATE OF NEW YORK, ~'~' cOUNTY OF ................. ................... : : ............... , .... bmn~d.ulyswom, d~poses~d~aysthaI~i~tlmapplicant . . (Nam~ ofil~ividual sisainE contract) ~bo~ ~ is tl~ ' (Contractor, agent, corporate officer, etc.) ' of said owner or owners, and is d(~ y auflmrized to Im~form or have performed tim said work and to m~e and file this ~pplicadon; that all statements contained in Ibis applicgtion are ~rue to lira best of his k~owledgo and bdief; ami Umt the work will be performed in tim m~ner set for[h in tho application filed themwifl1. Sworn to b¢fore me ................ ~g, ~ ~ (Signatur~ of applic~O