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HomeMy WebLinkAbout18791-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19110 Date JUNE 5r 1990 THIS CERTIFIES that the building Location of Property 1380 TRUMAN'S PATH EAST MARIONr N.Y. House No. Street County Tax Map No. 1000 Section 31 Block 12 Lot 10 Subdivision Filed Map No. Lot No. ADDITION Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated ,F~BRUARY 7r 1990 pursuant to which Building Permit No. I8791-Z dated FEBRUARY 14r 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 SOLID FUEL BURNING APPLIANCE IN EXISTING SEASONAL DWELLING The certificate is issued to (owners) 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 GEORGE F. & MARGARET M. REINHARDT ' // Bui~lding Inspector l~OR~ NO. B TOWN OF $OUTHOLD BUILDING DEPARTS, RENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ,AUTHORIZED) 18791 / N*_ Z Dote ..... ~../..../.~ .................................. / Permission is hereby granted to: .....................~~~__ ~_ ~~"~; ......................... ~~.....~~~A...~....~~_~ ............ ;t premises l~*ted at ,,~.~; ....... ~.~....~ ....................................... ............................................ ~~..' ~~ ..................................................................... Coun~ Tax Mop No. I000 Section pu~uant to application dated .......... ~ .................................. , 19~., and approv~ by the Building Insp~tor. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 Ai~PLICATION FOR CERTIFICATE OF OCCUPANCY mo 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 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. ~. 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 ever 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 , ~-~ OO~I~ ~-J~ Date .... .~?~.~ ~ .~ ] .~ ........ 2 ................ New Construction ........... Old Or Pre-existing Bui~.ding ...... . ......... Location of Property..,..~.. -~'~(-~.) ..... % ~.~ ~ ~ ~...%~ .~K-.-~..~-~ .......... ~ L ~ ~2~p_,,.~ ~ ~ ...... House No. Street Hamlet Onwer or Owners of Proper ty.~Q.~...~i7...~. ~~-....~ ~.~.~.. ........... County Tax Map No 1000, Section....~.J~' ........ Block.. l~ .... Lot Subdivision .................................... Filed Map ............ Lot ..... ~.~ .............. Permit No./~.2 .~-I ...... Date Of Permit.. ~t~ .Z~. (.~..mpplican~~...~'--" ~..~ Health Dept. Approval ...................... ... . Underwriters Approval ....................... .. Planning Board Approval ..................... ... Request for: Temporary Certificate ........... Final Certicate....~...... Fee Submitted: $...~. ~ .OUND~TIOJ (1st) FOU:;DATIO~'! (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~INAL REMARKS: DATE INSPECTOR iUiL765'1802 DING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.; 7G5-1802 BOARD OF ~EALT~ ........... 3 SETS oF PLANS .~;.i%', ...... SURVEY CUECK ...... ~. &~Z¥. ........ SEPTIC FORH ...... ~ ...... Disapproved a/c ................................. . ... APPLICATION [:OR BUILDING PERMIT NOTIFY~ INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Ifixpector, with s~ts of plans, accurate plot plan to scale. Fe~ according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubIin stree or areas, and giv/ng a detailed description of layout of property must be drawn on the diagram which is part of th/s app] 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 perm 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 aoy purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build/ng Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances c Regulations, for the construct/on of bu/ld/ngs, additions or alterations, or for ~emoval or demolition, as hem/n describe, The applicant agrees to comply with ~It applica~e laws, ordinances, building code, housing code, and rcgmtnfions, and t. admit author/zed inspcct~l~r*ern~f ~h'd in building for necessary inspections. __ ~ ;',~( "7" ' .~ (Mailingaddressofapplicant) k),'~, I I'"/~ State whether applicant is~*pj4~.~r.; lessee, ,a~nt, ~chitect, engineer, general contractor, electrician, plumber or buildex ............... ....................................... Name of owner or mises . ,'~-.. .~j .j .j .j .j .j .j .j .j .J2~.~-'T'.. 0~L ~ .......................... .~ ./~..'-~.., T~Jt,M .;.~- 5 ¢~..3:' "''~ (as on the tax roll or latest deed) Ir applicant is a cq,l'~n.'sYg,~,'~¢~q.i~r'~tqlT, authorized officer. ~lName ano title pi corporate OZllCer) Builder's License No Plumber's License No ...... ............. Electrician's License No Other;Trade's License No ..... . .~FtA~....'~°'Z~..... ~ ..... I. Location of land on which proposed work will be done; }louse Number Street ' ' Hamlet D. 1 .... ( .0,. LO. County Tax Map No. I000 Section ............ ck ....... Lot z, Subdivision ..................................... Eilcd Map No. .... .... . ..... Lot ............. . - (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: oc=,=c,. ....... b.l ~ ' ~-- .- ~-~- ' ntended use an .'. v. ~q ~ t' k( h hi h ppti bi } Iq Additi .... 3. Nature o wot c eck w c a ca e: ew Building .......... cn .......... Altcration ...... Repair .............. R~moval .............. DemoLition ........ 8wimmirm ~o~1... i-.7 ........ Tennis Court ......... Accessory Building .......... FJnce ....... ..... Other~*~Work ~ '~.~ i ~.~.q~>.~: 4. Estimated Cost .... -' ...................... ee ..................................... (to be paid on filing this application) 5. It' dwelling, number of dwelling units ............... Number of dwelling units on each Hoor ................ 6. If Business. commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front.., ............ Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Height ..................... '. Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ................ hiumber of Stories ..... ' 9. siecor'lot: Fro , ..... .......... Rea: ...... ............ i I. Zone or use district in which prefnises are situated ....... ~2. Does proposed Construction violate any zoning law, ordinance or regulation: ...... ~ ..................... " 13. WHllotbere~ded .~.~ ...... ~ ............ ~ .... Willexcem~fillbercmovedfrcmpre~ises: t4. Nme o~ Owner of pr~T~. ~~ss N~e of Architect .... ;.. ~ .... : ............. Address ................... Phone No ................ N~e of Contractor ... ~ ....... ... j ........ Address ................... Phone No ..... 15.Is this property 1;c~;d within I00 feet of a tidal wetlaad~ *~S..~..- mil yes, Southold Town Trustees Permit may be required. PLOT DIAG~M Locate cle~ly ~d ~st~ctly M1 bulldogs, whether existing or proposed, ~d. indicate ~1 set-back d~cnsions from property Hnes. Give street ~d block number or description accord~g to deed, ~d show street nines and ~dicate whether interior or corner lo~ AP RI)V£D AS NOTED N~ B~I~ING 765-1~2 9 AM ~ 4 ~ F~ FOLL~ING INSPE~ONS: 1. FOUNDATION ~ R~UIR~ FOR P~RED CONCR~ 2. ROUGH - ~AMING & P~MB[NG 3, INSU~TION 4, FINAL CONS~UC~ON MUST BE COMPL~ FOR ~O, ALL CONSTRUC~ON S~ ME~ THE REQUlREMEN~ ~ ~E N.~ STATE CONSTRU~ON ~ ~GY CODES. N~ RES~NffiB~ DESIGN OR CON~U~ON ~RORS STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applican (No,ne of individual signing contract) above named. He is the ........................................... : ......................................... ; .'. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file thi application; that all statements contained in this application are trne to the best of his knowledge and belief; and that th work will be performed iu tim manner set forth in the application filed therewith. ' Sworn to before me this .................. t-/ ..... day of ..... :... fl/..~. ....... 19 .~..d. H~E'N IL D~ V~ NOTARY PUBLIC, ~at~ of New Ym~ . Pax 4707878, Su~lk County ~... imm [xl~res M~mh 30, l.q '7 / (Si,nature of applicon.