HomeMy WebLinkAbout18696-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hail
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218775 Date FEBRUARY 9, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 1405 NARROW RIVER ROAD ORIENT
House No. Street Hamlet
County Tax Map No. 1000 Section 027 Block D3 Lot 06.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 7, 1989 pursuant to which
Building Permit No. 186962 dated DECEMBER 13, 1989
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 DECK ADDITION TO EXISTING DWELLING.
The certificate is issued to BERIT LALLI
(owner, xxxxxxxxxxxxxxxx)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
,
Building Inspector
Rev. 1/81
Fosai xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
a .
N 18 6 9 6 2 Date .~/3
.............a..,...... 1
Permission is hereb~y,egrante~d
to~~ ~ ~ ~
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ct premises located at ........~y. ..r.........~.y~~ ~"'.(/.~.4c~r`.-.
Caunty Tax Map No. 1000 Section ..........P~.Z...~... Block Lot No.......~.~.~..-~
pursuant to application dated ......1.2~ 19...~~., and approved by the
Building Inspector.
O~
Fee
uildin~~~ nsgaectur
Rev. 6/80/80
rD ~ 1 TOS7N OP SOUTIIOLD `
FHB ~Ry~ BUILDING DEPART:IENT
f P TOIIN HALL
TOWNUFSOUTliOID SOUTIIOLD, NEN YOCCK lI97i
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APPLICATION FOR CERTIFICATE OF OCCIIPALICY
DATE.
NEST CONSTRUCTION ._...../O/LD OR PRE-E%ISTI27G IIUI//LDZNC,QQ.....VACAtiT LAND....._..
Location cif Property.. ~TUJ~....:....._/l/rin~c.d~ /~~u~!~~:_.... ~~~Gn17-
UOUSE NO_ ~ .STREET UAMLET•••
Ovner or Ovncrs of Property...~~~~..:`:'.L~'.~
County Tax Map No. 1000 Section Q~7. IIlock .U'~... Lot' .DO (O"3...
Subdivision Fill/e~7d Ma pry .._.....Lot..........
PcrraiC No. ./~~~SO_..Date of Permit .`.°~//~~a.~Applicant .~~C~~'.e.'~ D~--~...
Health Dep[. Approval Undcrvritcrs Approval..............
Planning IIoard Approval
RequesC for Temporary Certificate Final Certificate
Fee Submitted:
APPLICANT . ~~s-C`~...t.. }i . .
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~ FORM N0. 6
TOWN OF SOUTIIOLD
BDILDING DEPARTMENT ~ .
TOWN ITAL.
765 - 1II02 '
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APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
,'i '
A. This application must 1b1e filed in typewriter OR ink and submitted Co the Building
Inspector with the following; for new buildings or ?ew use:
i. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features. '
2. Final approval of D~al[h Dept. of eater supply and sewerage-disposal(S-9 form),
3. Approval of clectrir~al installation from Board of Firc Underwriters.
4. Sworn statement fro~p plumber certifying that solder used in system contains less'
• than 2/10 of IZ lead. .
5. Commercial buildings, industrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer reapons}ble for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B, For eaisting buildings',(Prior to April 9, 1957] non-conforming uses, or buildings
and "pre-existing" land uses:
1. Accurate survey of 'roperty showing all property lines, streets, buildings and
_ unusual natural or topographic features.
2. A properly completed application, a consent Co inspect signed by the applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate ofOccupancy is denied, the Building Inspector shall state the
reasons therefor inlvriting Co the applicant.
3. Date of any housing'~,.code or safety inspection of buildings or premises, or ocher
' pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. An application for gacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of~the entire lot prior to April 9, 1957 shall also accompany
the application. I€ a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF QCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 -'Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Cer ificate of Occupancy - $20.00
5. Dpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $15.0.0 Residential
Commercial
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BOARD OF HEALTH ,
3 SETS 0$ PLANS
~FORMN0.1 SURVEY?
TOWV OF SOUTHOLD CHECK'-
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BUIL'D.INGDEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL
TEL.: 7G5-1802 MAIL TO:.. • • D ~
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Examined l~G./. ; 19
rlpprovcd . 19~Pctmit No.~~
Disapprosed a/c i ~ ' '
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( ildin Spector) BLDO. UlP7.
APPLICATION FOR BUILDING PERMIT T®WNOFSOUTPiOLi~
Date 19 .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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 layout of property must be drawn on the diagram which is part of this appli-
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 permit
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 Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY h1ADE to the Building Depaztment 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
Re_ulations, for the construction of buildings, additions or alterations, or for removal, or dernolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary ins~,ecti s.
~y.-K--~ .
(Signature of applicant, or name, if a'c//orporation)
37$0 Q~CH~}Rt'J. ~t:.i.~:rEntT ~r. l(`t~ 7.....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.
\ame of owner of premises . 4J~1T• • `~7`~-.~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALL COtITRACTOR'S MUST BE UrPOLK COUNTY LICENSED
Builder's License No. ~`~-`tr~.7•
Plunabcr's Liccnsc No . .
Electrician's License No . .
OtltcrTrades License No .
1. Location of land on which proposed work will bedqne. . . .
nl/{:CKot3 P.IJE~ I:~.
House Number Street Hamlet
County Tax Atap No. 1000 Section 0 , Block ~ Lot 3, , , • , , , , , , ; , ,
Subdivision Filed ~1ap No. Lot .
• •(Namc)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
~1NG~ F~n1~.Y ~w~,~U~~
a. Existing use and occupancy ,
b. lntended use and occupancy • •~(+V~~ ~~`llL~ ~tilr~("G(~J~• • • • • •
3, Nature of work (check which applicable): New Building Addition . ~ • • • • • • Alteration , ,
.Repair . . . . Removal Demolition . , , , Other Work ,
_ (Description)
4. Estimated Cost....~°?t~~ ~I Fee
ito be paid on filing this application)
5. If dwelling, number of dwelling Nnits , . , Number of dwelling units on each ffoot ,
If garage, number of cars ....f?,nd,~
6. 1f business, commercial or mixecj occupancy, specif~npture and extent of each tyypy of use .
7. Dimensions of, existing structurc5, if any: Front . ~ Rear ,•2.:f:....... Depth , . ,
Height . r~`l5........... Number of Stories c~ . ...................d~ r .
Dimensions of same structure wiirh alterations or add%tions: Front ,~8............ Rear .
Depth ....C, Via ~ .Height c~$~............. , Number of Stories .
Dimensions 4f entire new construction: Front . , 1 Rear ...I Depth ..~Q.......... .
Height a:. . JaVumger of Stories . , 1, , p~ , , , , . , , , , ,
9. Size of loz4,?~rt~nt g o d i Rear ~~~0:7~ Depth .9. L c .
0. Date of Purchase , , 1 Name of Former Owner ..~.11G~... .
Zane or use district in which premises are situated . ,IS,~~.i~e~Tt!q.4.......
2. Does proposed construc~t~~~ppn viol~te any zoning law, ordinance or regulation: .
3. Will lot be regraded ..,1V4~. ~ , Nill excess fill be removed fro ~PPremises: Yes No
4, Name of Owner of.premises . ~CPitT.G.1)~l ........Address ~0l'f~rjRR:Sc~rl ~i!~nnEP'~!"k~ttone No . .
Name of Architect ...............Address ...................Phone No.. .
Name of Contractor , . ' ......Address .......Phone No. ,
5. Is this property located t3ithin 300 feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit may be reqgu~ired.
PLOT DIAG1tAM
Locate clearly and distinctly all puitdings, whether existing or proposed, and indicate all set-back dimensions from
roperty lines. Give street and block nltmber or description actor g~to deed, and show street names and indicate whether
uezior or corner lot. C^~.
,`/7 p
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SATE OF KEt~Y,OR '
V, S.
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R being duly sworn, deposes and says that he is the applicant
(tiamc of indieidua] signin; contract)
ovc named. j'~,,
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
alication: that all statements contain';ed in this application are true to the best of his knowledge and belief; and that the
;rk will be performed in the manner s~t forth in the application filed therewith.
orn to bclorc me t~h~i`s~~,
./1.~: , : ..day of 19~
tart' Public,~~-Y~c-~c^ti,~`-~.... County / ,
~ ~ V
Notary Public, State of New York (Signature of applicant)
No, 4S79b1)6
4uaiified In Suffolk County /~h
Commission Expires Decemiier S,1