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Home My WebLink About18894-zFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19182 Date JULY 5~ 1990 THIS CERTIFIES that the buildin~ ADDITION Location of Property 37470 COUNTY ROAD #48 House No. Street County Tax Map No. 1000 Section 69 Block 4 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 10.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 6, 1990 pursuant to which Building Permit No. 18894~Z dated MARCH 20, 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 PORCH ADDITION TO EXISTING ONE FAMILY DWELLING 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 ROBERT D. BURNS Rev. 1/81 //Buil{~ing InSpector TOWN OF SOOTHOLD BUILDING Ds:PARTMEN? TOWN HALL SOUTHOLD, N. ¥. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18894 Z Dote ..~,A, ~ ............................................ ~9.~..'f Permission is hereby grant,ed toj ................................................ . . ...~~,..~...r,,_..z./.~ ......... ,o ~ premises IC/ocoted at .....~.....~....~..Z.~........~~~_..._.~../~........~.~...~....~/ ~ .................................... County Tax Mop No. 1000 Section ....... ~..~... ......... Block ............ . .~....... Lot No...../....~.~./... ...... pursuant to application dated Building Inspector. Fee $.. ~.~'....~.~.. 19.?....~.., and approved by the Rev, 6/30/80 · ~'~' ~ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 CATION 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 contm~ms 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: 1. Accurate survey of property showing all property lines, streets, building amd 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 I. 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 - $i0.00 4.Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction.~. ....... Old Or Pre-existing Buildzn~ ................. House No. Street Hamlet 0uwer or O.ners of Froperty...£ ...................................... County Tax Map No 1000, Section ........ Block .......... Lot. · u ' ~ ............................. Filed Map ............ Lot ...................... Permit No .......... Date Of Permit ...... Applicant. Realth Dept Approval Underwriters Approval ,, Planning Board Approval :~ '" Request for: .Temporary Certificate ........... Final Certicate..~, ....... Fee Submitted: $.~.~. ........................ TOWN OF $OUTLIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWN IIALL SOUTIlOLD, N.Y. 11971 June 28, 1990 ROBERT D. BURNS BOX 155 PECONIC, N.Y. 11958 TEL. 765-1802 To Whom This Ma~ Concern, 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) /~_~ Underwriters Certificate on file. /~'/ '['lie chock i';(xx~*xl~xix~l/not on '' ..... f~le.) .$25.00 /~/ No Health Dept. Approval on file. /~/ No final inspection has beeu made. PJease contact (>ur office on this matter. Thank you for your cooperation. lhiild~ng Permkt t! I 8 8 9 4 Building Dept. i'Io Plumber :3older Certificate on file. ( all )ermits involving plumbing being issued after April 1,1984 ) FOUNDATION {1st} FOU:;DATIO:! (2nd) 2. ROUGH FRAME & ~PLUMBING INSULATION FER N. STATE E~';ERG Y CODE Fii:AL ADDITIO~.~A'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK SEPTIC FORM ............... NOTIFY~ C^LL Y..;..¢q. MAIL TO: APPLICATION FOR BUILDING PERM IT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Ihspector, 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 lhyout of property must be drawn on the diagram which is part of tiffs apph- cation. e. 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 be kept on the premises available for inspection throuo~hout the work. e. No building shall be occupied or used in whole or ~n 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Reg~l=tions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The_.applicant agrees to comply w!th all applicable laws, ordinances, building code, housing code, and regulations, and to adr/li't authorized inspectors On p,[em~ses and hq building for necessary inspections. ¢-, .~' ' ,,~ : t (Signature of applicant, or name, if a corporanon) · ... ;. . ......... , ....... .:. (Mailing address of applicant) State whether applicant,is ov3ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................ .-.jy~;Y~ ,.~O~'~)~'.~i:i';¢,).', 2~;) ~,:.,:~.,,'; ' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ...... ~a~e ;nd title of corp;rati ~>~ir') ......... Builder's License No.. ~.F.~. ,/~.~. ,//~. ............ Plumber's License No ......................... Electrician's License No ....................... Ott T d 'sL'~er seNo ra e lcen .................. Location of land on which proposed work will be done; ..... . ....... a tlouse Number ...... ' Street, ' .............. · Hamlet '" Cou,,yso. o0o s,o,o, ..OO.? ..... ' ....... .............. Subdivision .~... ~/ ...... ~.q~.~ ...... Eiled Map No. ...... (Name) .............. Lot ............. State e -' x sting use and occupancy of premises and intended use and occupancy ofproposed construction: a. Existing use and occupancy . ~< .~9./~;/. ~.~.¢{~. b. Intended Use and occupancy . .~/~]~( ~. ~4~.. 3. Nature of work (check which applicable): New Building .......... Addition/~. · · ?~g¢ff. ,Alteration - R,,mov- ., ........ ,~,,,o ,]on ........... l/epalr .............. P - .... . . ' . Tennis Court ......... Aqeessory Bu:L:l.d~_ng .......... Fence ........ .~ ....... 'o Fee .: " 4 Estimated Cost ........................................................... · ' ' ,' (to be paid:on filing this application} 5. If dwelling, numbar of dwelling ur~its ............... Nnmber of dwelling units on eac ocr ................. If garaee,, number of cars ......+ ............................................................ ' commercial or mixed Occupancy specify nature and extent of each type of use .................... 6. If business, ' 7. Dimensions of existing structures,,if any: Front:~..~c~ ....... Rear ....~.q ......... Iteig ~t .............. Number of Stories ............................ with alterations or additions: Front Rear . · Dimensions of same structure ................................. ~ Height Number of Stories ................. · · · Depth ............................................ Dimensions of entire new constm6tion: Front Rear Depth . . Number of Stories ' Height ............... · ..................................................... · Rear Depth 9 Size of lot: Front ................................... Date of Purchase . . Name of Former Owner ........................... 12. Does proposed construction v.,iola[e any zoning law, ordinance or regulation: ..tvv ........................ ,, · 0 .! ......... Will excess fill be removed from premises: Yes .... 13. WilI lot be re~,raded .... ~.... ........ : · ,- .~3- 14. Name of Owner of premises fqe~T..A .ELt~ 6/..5 .... Address ~/la~,. ~Cg~llC~.lql/. #.~..~Phone No.7.(oX'.. ~.~?(,o.q.,. I Address Phone No · · · Name of Architect ............................................................. · Name of Contractor .......... : ....... ~ ........ Address ................... Phone No ..... ,~ · · .~ ...... 15.Is this property located within 100 feet of a tidal wetland*. *YES .... ~If yes, $outhold TownlTrustees Permit may be required. i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from pr~y lines. Give street and block 'umber or description according to deed, and show street names and indicate whether or comer lot. ~ ' , 766-1802 9 ~ ~. PM FOR FOLLOWING INSPECTIONS: 1. FOUNDATION TWO FOR POURED CONCR~(TE 2. ROUGH - ~RAMING & PLUMB: 3. INSULATION 4, FINAL . C(~,~TRUCTION Mt BE COMPLETE ~ C.O. ALL CONSTRUCTION SHALL MI THE REQUIREMENTS OF THE STATE CONSTRUCTION & CODES, NOT DESIGN I being duly sworn, deposes and says that he is the applicant Notary Public, ST^?E OF COUNTY OF .... ffJ~5~/.< ...... , (Name of individual si=nih,, contract) named. above ' He is the ..................... ! .................................................................... ! (Contractor, agent, corporate officer, etc.) of sa d owner or owners, and is d~ly a~thorized to pe,rform 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 thc application filed therewith. ... Sworn to before me this ! ; day qf / '//