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HomeMy WebLinkAbout19045-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19094 Date JUNE 1~ 1990 THIS CERTIFIES that the buildin~ Location of Property 15955 MAIN ROAD House No. County Tax Map No. 1000 Section 115 Subdivision ACCESSORY MATTITUCK~ N.Y. Street Block 1 Lot Filed Map No. Lot No. Hamlet 6 conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY t8~ 1990 pursuant to which Building Permit No. 19045-Z dated MAY 24~ 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 EXISTING ACCESBORY GARAGE AS APPLIED FOR. The certificate is issued to WILFRED RULAND (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 ~uilding Inspector FOI~,~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .................. ....m~..~.~_ ~...o..1~. ................................................... .... ~~.......o~.:.~.,....!./.~...~.~,-.. ............. , , ,o ...... at premises located at ...~.~...~..~...'~. .............. .'. .......... : .................................................. County Tax Map No. 1000 Section ....... J.l..~.. ....... Block ...... ..~....~ ........ Lot No ....... ..~....~. .......... pursuant to application dated ......... .....~.....~...l.~ ................... , 19..~.~., and approved by the Building Inspector. 'Building Inspector Rev. 6/30/80 APPLICATION FOR CERTIFICATE OF OCCUPANCY TO%IN 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/I0 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 - $I00.00 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 New Co t ' .'.~ ~r~-. 1 ~Location of Property .................... ~.\~..~.%...~J.~.~.~.)..~.~%. .......... House No. Strdet Hamlet~ Onwer or Owners of Property.......... ~.~...~.~ ......................... . .. County Tax Map No 1000, Section....~.~g .... Block ...... 1 ........ Lot .... ~ ................. Subdivision Filed Map Lot . Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certica~..~...~ Fee Submitted: , ............................ . ;. ..... 'X 'N H~J NOIZVq~SNI 'E (puE) 'E NOIZVGNf]O~ (~sL) NOi£VGNflOd .{ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD. N.Y. 11971 - TEL.: 7G5-180:3 BOARD OF~HM~H ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK SEPTIC OR ....... NOTIFY~ CALL ........... T;i ........ Examined ..... , . MA I L ^Pp P j? ...................... roved ....... , ermit No D,sapp,oveda,c .... "ira i ..................... .......................... (Building Inspector) ' APPLICATION FOR BUILDING P2n~v~ ~'I'0~ OF~ Date ..... ..., INSTRUCTIONS a. This application must be completely filled in by typewriter erin ink and submitted to the Building Inspector, 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 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 will issued a Building Permit to the applicant. Such pennit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole erin 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 B ' Permit pursuant'~p the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and otb bi . ' Regulations, for the construction of buildings, additions or alterations, or for femovai~io~e, aLsas~;;reOinrd~esa~rei~s or T!m .appli.cant agrees to comply with all applicable laws, ordinances, bui/din~ cod~ h/~,d,,-,,-~r-'''- ~ ~ ~. b.e.d. aomk autrtorized inspectors on premises and in building for necessa ins ct'~ ~' ~,-,, ,,. ,,, ant r gumnons, ann to . pe ,ons.'-7.?~'"?>~~' · · .~.o ma ~. · .%'ot~.,.. ¢,~.&.o ;i ~,~..,- .AIW,,. · ' · (Mailing afldress of' fipphcarlt) ~,State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or lder. , ....................... ~hv,.~x o~ Name of owner of premises .... ...x~...(~.' .~.' ~i. i~.' .' .~i ................ '.. (as on the tax roll or latest deed) If applicant is a corporation signature of duly authorized officer. Builder's License No ........................... Humber's License No ........ ' ................. Electrician's License No ....................... Othe~ Trade's License No ....... ; ........ ~ ..... 1. Location of land on which proposed work will be done; b St ......................... House Num er reet, amlet Subd~v~smn ................ (~'a;J~) ................ Eded Map No ............... Lot ........ . 2' ~t~teex~s~inguseand~cc~pa~cy~fp~em~sesandint~nd~dusem~cct~ancy~fpr~p~sedc~ns~tcti~. ~~~~~~.~ A. Existin~ use and occu-anc,, ' ~5 ~ ~ ~ ended use ~ ~v-,~J .... .-......~..,,~.~............ ~ ~ ' Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .......... · ...... Rl~molval . .' .......... ;. Demolition ............ Swlmraing poolos ........ stimatedCost......__ ..................... Fee ............. ......... .. . ... -- (to be paid on filing this application) 5, If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ............... lrgarage,_ numberofcars ....................................... . · . . ; .............. ............ 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7 Dimensions of existing structureh if any: Front Rear Depth Height Num'ber, Dimensions of same structure with alt~i}ions or additions: Front ................. Rear.... ........... Depth .................... .. I'leigl~ ...................... Number of Stories ..............." 8 Dimensions of entire l~ew constmction:,Eront Rear Depth Height ~;~ ~; Number of ~ories . 9 Size of lot: Frofit ' s Rear ' ' ~ ' ' Depth 10. Date of Purchase :i',~ ~; ....: i Name of Former Owner Zone or usa ' *:' ' "" ': ' : ' ' situated 11. d~n~'b~3.~Chxch premmes are ................................................. 12 Does proposed Construction violate 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 Architect . Address Phone No Name of ............................................................. Name of Contractor ........ i ........ Address ................... Pho~ne~Nor. ..... '~ ...... ; .... '5.Is this propert:'~ i;'c'a.~d' within lO0 feet of a tidal wet:laud. 'ES...'.NO .... ,*If yes, $outhold Town Trustees Permit: may be required. ' PLOT DIAGRAM Locate clearly and distinctly all~ buildings, whether existing or proposed, and. indicate all set-back dimensions from .... ~v"~t~4~?~ n~/b~tt'oetand block 'number or description according to deed, and show street names and indicate whether FEE ~ff. --- .~'/ ~'./,., ~'~ 765-1802 9 A~./~ TO ~, ' ~'"" "~E FOLLOWING 1, FOUNDATION '~Vr '~; C~¢IRED FOR POURED CONCRE7 E. I 2. ROUGH . FRAMING & 3. INSULATION 4. FINAL ~ CONSTRUCTY- BE COMPLEaE FOR ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY COOES, cN~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW<Y_OI;~, O~r ) ~ ( UNTY OF .......... :(.~.'.. ............ ) county . ' ........... ; ~ ~ ~ ~ d , says that he is the applicant (Name of individual sigfiing contract) above named. ~i~ th ' ' (Contractor, agent, corporate officer, etc,) .: of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contMned in this application are true to the best of his knowledge and belief; and that the work w~l be performed in the m~ner set forth in the applicationfiled thcrc~vith. / Sworn to be/bre me%~this day' of ~~-- 19.'~-0 ............. ...... ..... ....... · .. ..