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HomeMy WebLinkAbout18842-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22103 Date JANUARY t3~ 1993 THIS CERTIFIES that the building Location of Property 58775 MAIN ROAD House No. County Tax Map No. 1000 Section 56 Subdivision ADDITION SOUTHOLDr NEW YORK.. . Street Hamlet Block 2 Lot 3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 27, 1990 pursuant to which Building Permit No. I8842-Z dated MARCH 6r 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 TO EXISTING ONE FAMILY DW~TJ. ING WITH HOME OCCU?ATION AS APPLIED FOR. The certificate is issued to JEFFREY & MARY WILLIAMS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL , N/a UNDERWRITERS CERTIFICATE NO. N-190992-6/ll/91-N-207742-10/ll/91 PLUMBERS CERTIFICATION DATED MAY 23r ..1991-VICTORI_P~t. PLUM~ING Rev. 1/81 -- ~/ Buflding Inspector TOWN OF $OUTHOLD EUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERJ~/.IT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJ~PL~ION OF THE WORK AUTHORIZED) N9 18842 Z ,~_~_~... ~.~,.....~._~.~...~.......~...~~ ...... at premises I~ot~ ot .~.~.....~..~ ...................................................... Coun~ Tax Map No. 1000 Section ......... ~... Bilk ............. ~... ~ No ....... ~ ............. pu~uant ~o a~lication dat~ ......... ~.~ ............................., 19.~ and app~ by the Building Insp~er. Rev, 6/30/80 Form No. 6 TOWN OF SOUTHOLD 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 Compliance from archiuect or engineer responsible for the building. 6. Submi6 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. ]. 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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - R~sidential;$15.0~, Commercial $15.00 ~ew Construction ........... Old Or Pre-exi~ting Building,...., ........... ocation of Pro~ert~ A'- · ~z''~gg~g'~O'% ........ ''t' ...... Str'~g~ ........ ~ .... ~mie~''''' .... .... ~nwer or Owners of Property .... .~..~.~,.~. .... A.~. ....... ount Tax Ma No 1 0 "e- ~ "--~ ~'~ Y P 0 0, ~ crier .............. Bloc ubdivision .................................... Filed Map ........... Lot ..... ~.~] ...... ... ermit No...l.~.~..~..,~....Date Of Permit..~.~.~./,~-~ .... Applicant.~-~-. ............... .. ealth Dept. Approval .......................... Underwriters Approval ......................... lanning Board Approval ........................ equest for: Temporary Certificate ......... Final C~t~ate....~-----~.. ee Submitted: TOWN OF SOUTttOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 'TEL. 765-1802 CERTIFICATION Date (please( print )._x ' (please print ) I certify that the solder used in the water supply system contains less than 2/10 of 11 lead. Swor~t.o before me this .o a. ?lum~r "s signature) Notary Public CLAIRE I. GLEW Notar~ Public, Stere of New Yo~ No. 4879505 Qualified in Suffolk Count~ Commis~ion Explre~ December 8, 19,/.. TOWN, OF SOUTItOLD OFFICE OF BUILDING IN~'PECTOR P.O. BOX ?28 TOWN HALL SOUTItOLI), N.Y. 11971 August 20, ~990 TEL. 765-1802 MR. GREG mINT P.O. BOX 158 $oUTHoLB, ~ YORK 11971 RE: ffBFFRBY&MARY NILLIAI~S To Whom This:.May Co,cern, We are unable to complete your Certificate of Occupancy bccausc.o~ the following reasons. /.~/An application for Certificate of Occupancy ~/~$/ not on file. ' ~ /--/.No underwriters Certificate on file. /~The check is(outdated/not on file.) /~/ No llea~th Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this mat~er. Thank you for your cooperation'. Building Permit I~ ! 8~ 8 4 2 Buildinq Dept. ***/--_~No Plumber Solder Certificate on file. all permits in~lvin~ plumbing being issued after April 1,1984 TOWN OF SOUTItOLD OFFICE OF BUILDING IN~'PECI'OR P.O. BOX 728 TOWN tIALL SOUTt{OLQ, N.Y. 11971 July 23, 1991 TEL, 765-1802 Greg Hun~ Developmen~ Poe. Box 158 Southold, N.Y. 11971 To Whom This May Co,ncern, We are unable to complete your Certificate of Occupancy because .of the following reasons. An application for Certificate of Occupancy is not on file. /5/ NO Underwriters Certificate on file. /5/ The check is (outdatedTnot on file.) /5/ No llealth Dept. Approval on file. /Z/ No final inspection has been made. Please co~tact our Thank you for your cooperation. Building Permit If I 8 8 4 2 Buildin<l Dept. ***/~No Plumber solder Certificate on file. all permits involving plumbing being issued after April 1,1984 ) office on this matter. Z (JEFFREY WILLIAMS) FOUNDATIO.U FOU.'.~D A T I 0,'! 2. ROUGH FRAME & .PLUMBING INSULATION ?ER N. Y. STATE ENERGY CODE ADDtT]~ONA'L CO?.MEL'TS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND £ ] INSULATION FRAMING ~r ]FINAL DATE .INSPECTOR ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [~NSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE r~ / ,/ / 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 2ND L ] FOUNDATION 1ST [r~OUGH PLBG. ] INSULATION [ ] FINAL [ ] FRAMING REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ZST FOUNDATION [,~F~MING REMARKS: [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FINAL DATE 765-1802 BUILDING DEPT. INSPECTION [ ] ~UND/J.T~ON 1ST [ ] ROUGH PLBG. [ '~FOUNDATION ::)ND [ ] INSULATION FRAMING ~r ] FINAL REMARKS: ,/~.~',~~ ~)r~ _ //.v/ INSPECTO~ DATE 765-1802 BUILDING DEPT. INSPECTION [~FOUNDATION 1ST (- ] ROUGH PLBG. [ ] FRAMING REMARKS: FOUNDATION ;ZND [ ] INSULATION [ ] FINAL DATE 765-1802 BUILDING DEPT. INSPECTION j~FOUNDATION 1ST [ ] J FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION FINAL DATE BLDG. DEPT. i TOWN OI-/SOUTHOLD ~ Examined ............... , 19 .~?. Approved..~/~ .......... 19 .~.. Permit No...~......~. ~...~.~. ~ Disapproved a/c ..................................... BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : Town RALL 7 /f f5' ? $OUTHOLD, N.Y. 11971 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ................. 24/ , a. This application must be completely filled in by typewriter or in ink and submitted to the Building I~spector, wi '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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this a 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 pe 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 any purpose whatever until a Certificate of Occup, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant t, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinanc, Regulations, for the construction of buildings, additions or alterations, orrTo~,remova[ or d/:molitim3, as herein descri The applicant agrees to comply with all applicable laws, ordinances~i~d~/code, hoFs~~ regulations, an admit authorized inspectom on premises and in building for neces.~r~ ins/~f56ns. k ,_.x(Sign~Sture ~ applicant, or na' ' me, if a corporation) ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engzneer, general contractor, electrician, plumber or buff Name of owner of premises..~.' .~ ?.~. . .I .l .l .l .l .l .l .l .l~l . .~. .. . ~ l ..%~ ~(.a~s ~o n~ ~l~e. t~a.x. ~o~it .e ~ t~ } e~d~ 1.~ ~ ............... Ifa acorporat n, i- atureo%duly authorized o ricer. [.'"'-"- (Na~Se and title of corporate officer) · ",-ALL CONT/RACTOR'S MU~TBE SUEFOLK COUNTY LICENSED Builder'~ License No../.~. ,1. 7~.~ . ./"/-..~T ......... I1~ ,~ Plumber's License No...~/'~/. ~... , [ ElectriciansLicenseNo...~..~5.~..~. Other Trade's License No ...................... I. Location of land on which proposed work will be done~ .............................................. ...... ............................ ..... House Number [ Street Hamlet County Tax Map No. 1000 Section ..... ~,~ .'"~ ....... Block .....~ ............ Lot ................ Subdivision ..................................... Filed Map No ............... Lot ............. (Name) State existing use and occupancy of premises and intended use and occupancy of pronosed construction: a. Existing use and occupancy ,-~-'~.~ ~ ..~ .¢~...~-. ...... b. Intended use and occupancy · ·. ~}.~k)~-~. ......................... '. '. ,,- ....................... Repair .............. Removal .............. D e m o lit ion/~ .'~.'-/~,",'~', ...... Other Work ..... · 6dO .__.(Descrip.tic 4. Estimated Cost ......... ,~.9.t.~.(~.~ ..................... Fee,. e~- '-"~ *' (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 nature and extent of each.type of use ................. 7. Dimensions of ]xisting structures, if any: Front... ?--..~ ........ Rear ...";~.~ .... Depth...E..7 ....... Height ..~ .......... Number of Stories ...... ~ .................................. ~ ....... Dimensions of s_ame structure with alterations or additions: Front .. :~..~., .......... Rear . .~ .......... Depth ..... ,,~. ,Z~,. ........... Height ..... ,'~..~ ............. Number of Stories .... I ............... 8. Dimensions of entire new construction: Front.. '"~-"7' '" ..... Rear.,, .~--:.~ ........ Depth . ?-,~{~ ....... Height ....~.~ ........ Nmnber of Stories ...I ....................... ( ............. ~ ............ 9. Size of lot: Front ..... /.7~ ............. Rear ....... ]. ~0 ........... Depth .. h~ ............. 10. Date of Purchase ............................. Name of Former Owner .......................... I 1. Zone or use district in which premises are situated .......................... ~ ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....t~.!.l~. 13. Will lot be regraded ...... .,~_~ ~ ................ ~.. Will excess fill be removed from premises: Yes 14. ~e of Owner of premises .~ q~..~*-~ .~. ¢ t4 0e-~. ~t~ ................... Phone No.. 7.~: !,'+.9). No. me of Architect .... . .~ .......,,,. ........ ~ ./. ~,. Address ................. Phone No.~.7, ~ .~.-. Name of Contractor...~-_-_-_-_~4~.i-.. ,'~t~..~..qX~..af~U~,Aaddress ...b~'~,..k~.~. I.~.~.. Phone No..Z. I5. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Tow~ Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate wheth interior or corner lot. STATE OF NE',',' YORK, S.S COUN~f Y OF ................. ................................................. being duly sworn, deposes and says that he is the applican (Name of individual signing contract) above named. /r~ (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 at~plication: that all statements contained in this application are true to the best of his knowledge and belief; and that th work will be performed in the manner set forth in the application fileda, herewith. Sworn to before me this .............. ...... dayof .... ....... I ......