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HomeMy WebLinkAbout18875-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCC"JPANCY No Z~20878 Date JULY 21~ 1992 THIS CERTIFIES that the building Location of Property EAST END ROAD House No. County Tax Map No. 1000 Section 7 Subdivision ALTERATION FISHERS ISLAND~ N.Y. Street Block 2 Lot 1 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 9r 1990 pursuant to which Building Permit No. i8875-Z dated MARCH 15r 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 ENCLOSE EXISTING DECK INTO A SUNROOMAS APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION D~£ED ROBERT DANTE, T,~ JR. N-236984 - JUNE It 1992 N/A Building Inspector Rev. 1/81 FOw-'ae NO. · TOWN OF $0~11'10LD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- 18875 Z Permission is hereby granted to: ........ ~..&~......<~.~~,~.......~, £..~,...~. ....... ~...~_~-_~. ........................... .. . to ..... ~,~C;:~,¢.~t~-~... ,e~L .... ~f_~:?~ ....... ~ .................. at premises located at ...... .~..~~/~..~..~..~...~ ............................... County Tax Map No. 1000 Section ....... ~ ...........Block ....~ ............Lot No ......./. ................. pu~uont to opplicotion doted ............ ..'~ ....... .~. ............. ,9..~....~, ond approved by the Bui~ding Inspector. Building Inspector Rev. 6/30/80 l~O~ NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ...~. .......... Old or Pre-existing Building .....~. .......... Vacant Land .............. Subdivision ................................................. .rT. ............ Lot No....l ........ Block No.....~.. ...... House No ............. Health Dept. Approval ....................L ....................... Lobar Dept. Approval ................................................ Underwriters Approval ~....,~,,~...,~. ......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate ..... ~ ............................ Fee Submitted $ ..~....~'..;.~ ..................... Construction on above described building add ~it meets j~ll appl~c,~ble cedes and regulations, Applicant ........ .~. ~ .~..~..~.'.~...E....~).....'~.. ........ Sworn~efore me ~ --''~___J ~-/ /- ,~,, ~f ~,.J~ t~/~' ~.- (stamp Or d Notary Public , ..~.. NeaW No, 480555~ Quaint ea in SuHol~, County Ilst) FOUNDATION ROUGH FRAME & .PLUMBING iNSULATION PER N. STATE ENERGY CODE F~AL ADDITIONA'L COMMEUTS: 4 3 SETS OF PLANS ....... FORM NO.I SURVEY .......... TOWN OF SOuTHOLD CHECK .......... BUILD~NGDEPARIMENT SEPTIC FORM .' ..... , ...... : ", ,, , TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 CALL ................ TEL.: 765-1803 MAIL TO: Examined ................. 19... Disapproved a/c ................................... . . [i [J JI. ............................................. : ' ' ilJ%[---- (Building Inspector) ~-- ' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tttis applicati0n must be completely filled in by typewriter or in ink and submitted to the Building Inspector, witi' 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 stre, or areas, and giving a detailed description of laygut of property must be drawn on the diagram which is part of this apl; cation. , ' c. The work covered by this application may not be commenced before issqance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such peru 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the canstruction of buildings, additions or alterations, or for removal or demolition, as herein describ, The applicant agrees to comply with all applicable laws. ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or/Came, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ..................... ............. ..................................... (as on the tax roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer. ' (Namejarj(d title of corporate of~cer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Electrician's License No....~.flf..q.~/ .... ....... ' Other Trade's License No.. ¢7..~o~...--/¢. t~-. ......... 1. Location of lahd on which proposed work will be done ..... ,..~...,~ ........... ~...' ................. }louse Number Street Hamlet County Tax Map No. I000 Section ....... P ......... Block . ...: .... .~. ....... Lot ..... ~. .......... Subdivision Filed Map No Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · b. Intended use and a. Existing use and occupancy ........ occupancy ..... ~'~f.'. , 3. Nature of wot;.' (check which applicable): New Building .... ~,.;;. Additiori .......... Alteration ........ Repair Removal l)e~blifion ' ' Other Work ..... 4. Estimated Cdst ....... "7 "· ·" ....................... Fee ...................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelflng units on each floor ............... If garage, number of ears ..................................... ....:..; ............................. 6. If business, commercial or mixed occupancy, specify natu[e and extent of each type of use .................... 7. Dimensions 9f existing structures, if any: Front ............. '.. Rear ........ ' ...... Dep~ih .............. Height ............... Number of Stories . .............................................. ........ Dimensions qf~ ~rt/~e with alteration? Or additions: Front ................. Rear ................. Depth ..... :., '. :..."..'72 ......Height ................... i.. Number of Stories .................. 8. Dimensions of entire new construction: Front ................ Rear ............... Depth .............. Height ............... Nmnber of Stories .......... i... ........................................... 9. Size oflot: Front ...................... Rear ..... . ............. ' ..... Depth ..................... 10. Date of Purch iSe ............................. Name of Former Owner ............................ 11. Zone or use distziet in which premises are situated,...: ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ .............................. 13. Will lot be regraded ...................... ' ......Will excess fill be removed from premises: Yes 14. Name of Owner of premises .................... Address ~ .................. Phone No .............. · Name of ArchiDct ........................... Address ................... Phone No ............... Name of Contra, tot .......................... Address ................... Phone No ........ ....... 15. Is this' property located within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Scuthoid Town Trustees Permit maybe rem~ired. PLOT OIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and~indicate MI set-back dimensions from property lines. Giw. ~treet and block number or description according to deed, and show street names and indicate whethe, interior or corner lc t. STATE OF NEW YGI~K, S.S COUNTY OF ............. .................(~~ signing~contract) .... " ....... being duly sworn, deposes and says that he is the applic~nt above named. He is the (Coati'actor, agent, corporate officer, etc.) of said owner or o,>'ners, and is duly authorized to perform or have performed the said work and to make and file thh application; that all statements contained in this applicati?n are true to the best of his knowledge and belief; and that the work will be perfow~ed in the manner set forth in the application filed therewith: Sworn to before me ............... .05, ...... day of ........... ;19 .... .....