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Home My WebLink About18778-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20572 Date MARCH 9~ 1992 THIS CERTIFIES that the buitdin~ Location of Property. 200 HICKORY ROAD House No. County Tax Map No. 1000 Section 54 Subdivision ADDITION SOUTHOLD~ N.Y. Street Hamlet Block 6 Lot 11 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 29~ 1990 pursuant to which Building Permit No. 18778-Z dated FEBRUARY 7~ 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 ADDITION & DECK ADDITION TO F2{ISTING ONE FAM7/,¥ DWelLING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARgIM~NT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A JEANNE O'BRIEN - // ildi Inspeotor Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRFJ~ISES UNTIL FULL CON[PLETION OF THE WORK AUTHORIZED) N9 18778 Z rote .... .~ ...................................... , ,9.~.~ Permission is hereb gran to: ~ / . ..................................................................... ........................................... ~o..~ ~ ~, ,o. ~000 ~.~,,on ....... ~.... ~ ........ ~. ......... ~,,o .......... /~. ......... pu~uont to oppltcotion d~t~ ..... ~ .................................. ~9~ ~nd opprov~ by the Building Inspector, FeeS.. Rev. 6/30/80 Form No. 6 TO~N OF SOUTIIOLD 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, industrial building, multiple residences and similar buildings and installations, a certificate of Code Complianca 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: 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 / ! ...... .................... .. New Construction ........... Old Or Pre-existing Building ................. Location of Property.. ,~.0. ~. ~. t' .~..~0 ,~ ~. /-~ t~../~.~ .~.~ .... House No. Street Hamlet Onwer or Owners of Property .................................... .. · .. . . t County Tax Map No 1000, Section .... ~ ...... Block ................ Lot.. Subdivision .................................. .. Filed Map ............ Lot ................... . .. Permit No J.~.~ ~ Date Of Permit . Applicant ..... Health Dept. Approval ........ Underwriters Approval Planning Board Approval ...................... .. Request for: Fee Submitted: $ ....... :..~.'. Temporary Certificate ........... Final Certicate ........... .... ,P~ APPLICANT INSPECTORS (516) 765-1802 VICTOR LESSARD, Principal CURTIS HORTON, Senior VINCENT R. WIECZOREK, Ordinance ROBERT FISHER, Assistant Fire Building Inspectors THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD March 2, 1992 SECOND NOTIFICATION SCOTT L HARRIS, Supervisor Southold Town Hall EO. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Joanne O'Brien 24-26 35th Street Astoria, New York 11103 To Whom This May Concern: BUILDING PERMIT Please contact our cooperation. We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is not on file. $25.00 No Health Departraent Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). 18778-Z (ADD & DECK) * office on this matter. Thank you for SOUTHOLD TOWN BUILDING DEPT. *THE ABOVE BUILDING PERMIT HAS EXPIRED & A CERTIFICATE OF OCCUPANCY HASNOT BR~ ISSUED. IT IS UNLAWFUL TOUSE OR OCCUPY SAID ADDITION UNTIL A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED. PLEASE SUBFLIT THE ENCLOSED APPLICATION & YOUR CHECK IN THE AMOUNT OF $25.00 SO THATTHE CERTIFICATE OF OCCUPANCY CAN BE ISSUED. TOWN OF SOUTIIOLD OF{:ICF. OF BUILDING INSPECTOR P.O, 13OX 728 TOWN IIALL sourlIO!.D, N.Y. 11971 Hax 4, 1990 TEL. 765-1802 JOHN LATSON 12425 SOUND AVE. HATTITUCK, N.Y. 11952 To ~,',~l~om This May Concern, ($OANNE O'BRIEN) I';'e are unable to complete your Certificate of Occupancy because .of the following reasons. /--//An anplication for Certificate of Occupancy is not on fil~. (ENCLOSED) /--/ :Io Underwriters Certificate on file. /_~_~'/'~"l'he check is(~X~<X~/not on file.) $25.00 /-/ ~:o !Iealth Dept. Approval on file. /~/ I:o final inspection hen been made. Please contact our office on this matter. Thank you for your cooperation, Buildinq Permit tt I 8 7 .7 8 Z Buildin(I Dept. ***/Z/ Plumber solder Certificate on file. all permits involving plumbing being is.qued after April 1,1984 ) YIELD FOUNDATION ( ~ S t FOU:.ID ATIO:! ( 2nd ROUGH FRAME & -PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIO~,:AL CO:-.~ME~ITS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ~]'~FRAMING [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FINAL REMARKS: / I :/ // DATE INSPECTOR 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ~JGH PLBG. FOUNDATION 2ND [~ INSULATION [ ] FRAMING FINAL DATE INSPECTOR~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE INSPECTOR FORM NO. Z TOWN OF SOUTHOLD BUILDING DEPARTMENT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ TOWN HALL · , ~OUTHOLD. N Y 11971 NO_T.-I.F-~: .-, -r~,. -,~.~ '~;f~ /,~'i, ~, .o,./.d. ~_?./. (. / i '~'/~" i.,~ ..... " ' '9 c:2019'~ -"'* ..... ' .... ~,tA I I. .............. TO: ii ...................... , ........ ..................... ') L TOWN OF SOUTHOLD APPLICATION F~ BUILDING PERMIT Date .. INSTRUCTIONS · a. Tiffs appiicafion must be completely filled in by typewriter or in ink and submitted to the Building lhspector, 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 street~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli 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 shalI 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 apy purpose whatever until a Certificate of Occupanc) 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, Ordinmnces Regulations, for the construction of buildings, additions or alterations, or for/-emoval or demolition, as herein described. Th~ applicant a~rces to comply with ail applicable laws, ordinances, building cod%,housin~ cod~, and regulations, and to · . ~fl ~. ~ "r p ~on) ,. · .~, (Mailing address of applicant) ~ame of owner of premises ......... Q ............................................. (as on the tax roll or latest deed) Il' applicant is a corporation, signature of duly authorized officer. ...... (Name and 't[t{~ ~ ~g~or~ie ~fficer) ...... ,uilder's License ,o .... 4 .... . . . Plumber's License No ' Elcctrtcmn s License No ............ Other Trade's License No ...................... I. Location ofland on which proposed ~.vork will be 0~one~ . j. f,~,; 1~// .. ..... ,,,., tlouse Number ' 7 Street ' ' Halnlet , ' ' County Tax Map No. 1000 Section . · Block .. Lot .... Subdivision ..................................... Eilcd Map No ............... Lot ............... (Name) '.. State existing usc and occupancy of premises and i3?tcnded use and occupancy of proposed construction: . a. Existing usc and occupancy ....... ~ ,~.~ · · · q~ ............................ b Intended · u~e and occupancy' ............. 3. Nature of work (check which applicable): New Building .......... Addition ...Y- · · · .... AJtcration ......... Repair ............ ~. R~moval .............. Demolition .............. S~imming pool. Tennis Court ........ A~ccessory Building .......... Fence ....... Other Work; .......... ~. Estimated Cost.....l.%. · '- · ................................... ..........- . . . (to be paid on filing this application) S. Ifdwclling. numbcrofdwcllingunits... ~ Numb~rofdwcllingunitsoncachfloor .. ~ If garage, number of ca~ .............................................................. 5. If business, commercial or mixed occupancy, specify nature and extent ofcnch type of use ..................... 7. Dimensions of~x~gtin~ s~mcturcs: if~pz,:, Fr0nt..~. ~, ...... Rear . ..~.~ ........ Depth .. ~ ........ H~i~ht ..... ~ g ~. ...... ~um~cr .of ~f~as ......... t .............................................. Dimensions of ~mc structure With ~ltcr~fis or ad.dit'ons: Front ..... ~.~ ......... Rear ... ~ ......... ; . Dcpt~ ........ ~ S .......... Hei~g ~ :...~ 6 .............. '. Number of Sto~es ....... l .............. 8. Dimensions orentire ~~: ~0Et ...... ,/. ~. .... Rear ..... ~ 6. ....... Depth ... ~ .......... Height ..... ff.~ ....... ~umber of StO~s ...... { ....... : ......................................... % ..... ... .................. ). Zone o~ u.::. district in xvhich premises arc situated ...... d~.e.~,c~./t ~.1 ......... ~ ....... ' ....... ; ......... ~ Does proposed construction v~olate any zoning law, ordinance or regubtion: .... ~.~ ........................ '. 3. W~I1 lot be reg~ded ..... ~.~ ........... ~. .... Will excess fill be removed fr~m premises: . Yes 4. N~e of Owner of premises .. ~,~ ~.~. ~ .[~tl}~ Addrc~ L ~,. ~ ~.'~. ~ Jq~. Phon~ No. ,~7.L~g... N~e of Architect ............. . .. Address . - .. Phon~ No., ............ {5.Is this property located ~ithin 100 feet of a tidal w~tland? PLOT DIAG ~M 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 ~dicat= whether nterior or comer lot. STATE OF NEW YORK, COUNTY OF ........... ...... S.S ..........................................· . ·... · being duly sworn, deposes and says that he i~ the applicant (Name of individual signing contract) above nar~cd. , t-~ is the ........................................... : ....................... ; ................. ~ ;i. (Contractor, agent, corporate officer, crc,) of said owner or owners, :md is duly authorized to pesform or have performed the said work and to make and file this application: that alt statements contaiacd in this application are tree 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 tiffs ............... ...... dgy Of ..... ~ (Signature of applicmat)