HomeMy WebLinkAbout19050-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219807 Date MARCH 19, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 7985 MAIN BAYVIEW RD. SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 09 Lot 33.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 18, 1990 pursuant to which
Building Permit No. 190502 dated MAY 25, 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 DWELLING.
The certificate is issued to PATRICK & JOAN MARKHAM
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
~'~'l.~
ui1 ing Inspector i
Rev. 1/81
i
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219806 Date MARCH 19, 1991
THIS CERTIFIES that the building ACCESSORY STRUCTURE
Location of Property 7985 MAIN BAYVIEW RD. SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 09 Lot 33.4
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 18 1990 pursuant to which
Building Permit No. 190502 dated MAY 25, 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 ACCESSORY STRUCTURE AS APPLIED FOR.
The certificate is issued to PATRICK & JOAN MARKIIAM
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
Bui ding Inspector
Rev. 1/81
r
1'OHM NO. #
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TQWN HALL
SOUTHOLO, N. Y.
BUIL®ING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Na i 9 ~ 5~ Z Date 199'.CJ.
Permission is hereby granted to:
.%~,~.~:..~.....~l..~
. . . . . ~
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.
~ . . . . . . . . . . . .
to ...1..5'.:'ir.9~!4:~.4Q
.....SA.... ~il~:SxS.....Qu2~K~ S^......4~r~.....th?.....~~....~.........
~.~.eR, ~
. Q --y ~j~
at premises locate at .':1.9.a.~:.....~a~->......~-a.... ~..1.4Azs?....~........S~s?:':!l.(~:5~~........
.
County Tax Map No. 1000 Seetion ......d...~..$..... Block .....~'..`.j.......... Lot No.....,,~{...-,:.~~.
pursuant to application dated 19.4.x., and approved by the
Building Inspector.
Fee 5...~.~/:.
Buil ing Inspector
Rev.6/30/80
~ _ m ~ .
~~FFOL/(~~~ TEL. 7G5-1802
p t, OG~ ~ TOWN Or SOUTIIOLD
(~;~a~; ~ Ol~['ICE OP BUILDING INSPECTOR
~`w~a ~Y'~ z P.O. BOY 728
~ ~c T01YN FiALL
yf/Ol ~ ~~pt" SOUTHOLD, N.Y. 11971
9~y/ga
To 49hom This May Concern,
we are unable to complete your Certificate
of Occupancy because of the following reasons.
/?j An application for Certificate of Occupancy
is not on Life. ~-e-~'Q-~~-
/ / No Underwriters Certificate on file.
The check is (^~•'t /not on file.) ~a S~ v0
No nca1L-h Dept. Approval on file.
No final ic~s,pecCion has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Buildi.n~[ Permit It / d S ~ Z
Building Dcpt.
No Plumber Solder Certificate on file.
( all permits involving plumbing being
.issued after April 1,19£? )
~p ~
~ -
Form No. 6
TOWN OF SOUTHOLD , t~;,'_ z /
BUILDING DEPARTMENT ' ~ ' 't
a r.
TOWN HALL
yes-lsoz r,;~~r MAR I X1991
df ~~k
_
• APPLICATION FOR CERTIFICATE OF OCCUPANCY
.1. 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, pzoperty 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(16 of 17. lead. `
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compli.ante frcm 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 Che 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 dwel"ring $25.00, S pool $25.00, Accessory building 5.00,
Additions to accessory huilding Businesses $50.00.
2. Certificate of Occupancy on Pre-e sing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
CpdaCnd Certificate of Uccupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .3 - r ~/.7- - g /
::cw Construction........... Old Or Pre-existing Building
Location of Property......' 9 ~~..........~ai~;r, Qo~ ~d~co.........~t~.-e~7l,i%f_=m'~.....
House•No. qq Street Hamlet
Onwer or Owners of Pro ert ~Q"/'~ `~/C ~ V o~~'-' ~ ~`1 t`•'•
P Y Jr`
County Tax Map No 1000, Section... ,~.~.....Block ........Lot.:....
Subdivision ....................................Filed Map........../.~Lotl-.~.-.......... .
Permit Na..~ y0 Date Of Permit.'... g~pplicant.C.:.~.V.•.~:g~=~~:.~~=
Health Dept. Approval ..........................Underwriters Approval........................~:
~ ~ ;i
Planning Board Approval...... 5.:.......... ~ `f /,..'S7~
Request forte Temporary Certificate........... Final Certicate... ~ Q .~.~y ~,a..~
~ee Submitted: O O W ,
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c'IcLD IGS:' C:IUU ~IUATE ( COMMENTS
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FOUtJDATION (1st) - t~
FOUNDATIOIJ (2nd) _ _
2.
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P,OUGH FRAME & °o
PLUMBING S
AV,S
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3. by `
IIJSULATION PER N. Y. y
STATE ENERGY
CODE
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ADDITIONAL COMMENTS: x`i
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l~(~ S 765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
REMARKS: `:_.7
DATE ~ INSPECTOR
BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY 1
TEL.: 765-1802 CALL (qw) 9~ S~ •S~ 7 co 7
MAIL T0: /L'o%t ? / ~//LG
Examined ....~!1... 1S 19 k e~ ~ .
Approved .....'n 19 Permit No. ~ 9 a.~~ • d, ~....,~h ~ .
.a~~
Disapproved a/c ~ i : , _ ~
i,,y MAY 181990
(Building Inspector) `~~~.n..--_-~
70%IU(U U~;v"(}dJl`tv~;t.17
APPLICATION FOR BUILDING PERMIT w. M _
- Date . /YIg ~ 19 .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted t_o 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 will issued a Building Permit to the applicant. Such permit
s~iall 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
st1,a11 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 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.
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 necessary insp ctions.
~a.~,~:,
(Signature of"applicant, or name, if//a~~corporation)
(Mailing address of applicant) %o>os-
State whether applicant is owner lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises a,TRiC cn.oP• !J paw n'/ctR~C/~grw .
' (as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) ~ ~ t~-j~ f E~~~ i ~ ~ ~ -
Builder's License No . ~ t~~~ ~ ,I
f ~ MAY 18 i99CJ i.` ;
Plumber's License No .
Electrician's License No. 7Lrdt1."~,
Other Trade's License No . .
1. Location of land on which proposed work will be done. ...7.~. ~!F!...:V.'$ !iiFcv
y.................
House Number Street Hamlet 3~
County Tax Map No. 1000 Section 7 Block 9 Lot • • 3,3
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~ N'`•'r•y ~ • • • • ~•v~T~• o~..c=
b. Intended use and occupancy • • • C~•°•~•~l 4,~~
S'Nt d cc,~c6 ~ c c K.
3, RNeat air of work check whiRem plicable): New Building Addition . Alteration .
P,
P oval . Demolition , , .Other Work .
s~~~~ ~6 ~ ,1~~ 5'. ~-o (Description)
4.'. Estimated Cost ~t~K .,..1~'~ ~.c7.......... Fee . , . ~ ;fie, o v ,7S%a,~~+, L .
(to be paid on filing this application)
5. If dwelling, number of dwelling units . Number of dwelling units on each floor .
If garage, number of cars
6. If business, commercial or mixed occupancy, specify natureyand extent of each type of use , , ~ .
7. Dimensions of existing structures, if any: Front , . Rear Depth : , ,%Z,'~; ,
Haight . , :S..~ Nunjber of Stories ~ . .
Dimensions of same structure with alterations or additions: Front , Rear ~ , , , , , , , , , ,
p . ~ Height /J N1lmber of Stories .
, ..T'' rD ~
8. Dimensions of entire new const
Haight , Nu ruction: /2 x, ~'S', , , , fn ~ H . 1C th
Tiber of Stories . .
9. Size of lot: Front . . 9.7... Rear ,7, ~ , Depth ~ !.4:.. .
10. Date of Purchase 6. , 8:Y Name of Former Owner ~ :~.f o~ .
.
11. Zone or use district in which premises are situated .........,/{FS~.~+~ T.-!4-~ . . .
12. Does proposed construction violate any zoning law, ordinance or regulation:
] 3. Will lot be regraded .....~'!'.a . Wiil excess fill be removed from premise • N
14.; Name of Owner of premises efiagrc:~... MaB~Yyti:~Address ~rGuciav~ , ~esf"Ps phone N~9!Y~ ,9e y y,> o?,
Name of Architect . ...........Address , , , , ...Phone No............... .
Name of Contractor ......6
If es So thold Town~~A "Address ...................PhoneNo.......
15.Is this ro ert loca';ted withiu 300 feet of a tidal wetland? * ..,jlsa
* y ' Trustees Permit may be 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 corner lot.
STATE OF NEWY~RK, ~ g- vz -b~G~
COUNTY OF ...//,~S a°vri.,f.'. , , , , S.S
..:...~~4! I?.~.Gy`i.'....~'/s,R, kN~.re-~, , , , , , , , , , , , , , being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the....... w.!".~ I
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained 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
f. ~ ..day of 19 . J
Notary Public, ~ , , , County
City of Plow 1'Orlc - No. J 4018 ~~~~~--aa
cortiuo:~ta °I!,~,I iu Crr:rix caumy ~ - (Signature of applicant)
' Commission Expires ~
U 'i~ ~
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