HomeMy WebLinkAbout18597-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20249 Date SEPTEMBER 26, 1991
THIS CERTIFIES that the building ALTERATION & REPAIR
Location of Property 300 PACIFIC STREET NATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 141 Block 4 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 20, 1989 pursuant to which
Building Permit No. 18597-Z dated OCTOBER 25 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 ALTERATION & REPAIRS TO UNHEATED PORCH OF EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to THOMAS & HELEN KOCH
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLtTMBERS CERTIFICATION DATED N/A
~S~
B ilding Inspector
Rev. 1/81
roast xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CgOMPLETION OF THE WORK AUTHORIZED)
.J.gJJ~ C~
N~ Z Date .....1~/...~::~'..~ 19..1.
Permission is hereby granted t s
~~/1~,''~.,...~1....~..~'~.
r
to .Geis i2,~.,~~£ayfid'i.~!t„.~rr.~d.~....&k~t~1~.,4-
s
of premises located at ~.f~....... 1 .r!~?~r.~....................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .l. . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No. 1000 Section .......r7///"''',1....... Block .......~,7~ Lot No.........~.1..........
pursuant to application dated .........~~'.,1..~ 19.v.,e..., and approved by the
Building Inspector. /
Fee ~~r
9 G'. .
uildi I or
Rev. 6/30/80
Form No. 6 - ,
fP°"g1~,tr~.'~
TOWN OF SOUTIIOLD ~ ~@~ ~
BUILDING DEPARTMENT ~ ~
TOWN HALL C ~ ~ t C
765-1802 41
J
mvmm ~ K , t
APPLICATION POR CERTIFICATE OF OCCUPANCY"'~"°"""'' ~
1. This application muse be filled in by typewriter OF, 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 17 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 bu~.lding.
6. Submit Planning Board Approval of r.ompleted 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 - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ......Q
ew Construction.... Old Or Pre-existing Building../.
ocation of Property.~C~O ~~~l~F~~..~7............::1~~'T.
~:~7~........
House No. Street ~ HamleC
nwer or Owners of Property..~f~~~1~/~..~~~?.../, /~~~/?.,,/y,1~~C~~ .............q.....~.........
ounty Tax Map No 1000, Section..~-!.~.......Block........J.......Lot......./
abdivision ...Filed Map.........~..Lot..
>rmit No. ,/.0.~./.......Date Of Permit.~{JIP~c~.~C~~...Applicant).r7':'!~.~J..~~'T.7.°~.. ~F.,,
~alth Dept. Approval ....................../....Underwriters Approval.........................
anning Board Approval
quest for: Temporary Certificate.........,. Final Certicate.. Y,.,.,.,
. Submitted: $ "2S'O
c~® ~.ao~2y~- - ..APPLICANT
T
a 375003 THE NEW YORK BOARD OF <~tRE UNDERWRITERS PncS: ' r
~ au~uw ot< etcrrr 3,
EE JOHN ST?~tT. NEW YOtlK. IE~'1N YOMtK.fOO33
OC.7'OB'k;N 27,1!391 7388979T/91 N 3()8+97
Date Applicetbn No. on fl&
w~
THi3 CERTIFIES THAT
1 Doty tfia aleeMw/ equipment r dreriked 6alo[o and InenodreaJ by tM gyrlieartt awuttfad eTt tke dGoer appgatian naasbp la tMpvatLn of ~
'COM KOCN, .300 PAC3:k"IC S`C'RN;kI1'; MA'P'i;.'~ttCK, N. Y.
in the Bain Iota ' r~ - A"i"
1'Ti'
fol R ~iA,? ~ret~ l~_J /At FY. ? Ynd F!. .Section Block Lot
aat esamined on aK v ~ , and found to 6r in rnmpliance ai[h the reyuirementr of tku Ioo[d.
rn
/k
tt~f ~ NCANOdC[NT MUOt9CYNT OTNiR AMT. R. W. AMT. t. W. M1i. LW. AA1i. K. W ~ AMT. N. 1. ~
3
V DRYRRR 1U~111O1 ItIDTOK lUTIIRR AIRIAIICR ISM[ ttl{kR NMRGEiGtf. il~U tNiIC.tRktMR' OtANARRf
AMT. N. W, pl N. I. OA7 N, t. AMT. NO. A. W.O. AMT. AMI. AMT. AAM'i. fRANf.. AMT. M. R AMT. WAM
SHVIp YMWIINRCT NR F1 _ S R V _~1 t 1 _
AMT. AMr. Trrt t~ i w xw i w ow t i tw of ~w No: . c[»a. Atw. No. a N4itc No. a Ntv~uts of r
eu~iw
f)TNp AMARAflIfr
E1~
Q.C. F:I,MCTkLC TNC„ [,t.C.~3$?,3-k;
P.t).130R 518
LAt1Rf]fr, NY, 1'1948 0~lIIl gMIAARIt
M1 1
,J :%g
Prr
T1~. raott opt ~ Mend is a^Y T0t11NN[: return to !iN tt(iip of IAe ~ iRLaetaCl. [ be tdantlfed ~ r:
fat tt}1410~IM6 Ol TFMS ~ as Mt;IST Npi 6E ALTtJFEJ? tN AST MkNIIItR• '
E
~~r.
~a. ~ u..
r~z TEL.;~7G5-180'
c~~FF.OtX~
o~p^a , OGy T'OWIV OF SOUTIIOLi~ ,
ta, ~ ~c OFFICE O[' BUILDING INSPECTOR
o ~ z ~ P.O. BOX 728
rn ;J';: '4 rn
~ ~9s~~1i' ~ TONN FIALL
O~O~ ~ ~a~c SOUTHOLp, N.Y. 11971
May 31, 1991
THOMAS ROCH
BO% 191
MATTITUCR, N.Y. 11952
" To v7hom This May Concern,
We are unable to complete your Certificate
of Occupancy because of the following reasons.
An application for Certificate of Occupancy
is not on file. (ENCLOSED)
/ / No IJnderwriter~ Certificate on file.
The check isel/not on file.) $25,00
/Y/ No Health Dept. T:pproval on file.
No tinal ins.pccCion has been made.
Please contact our office on this matter.
'T'han!: you f-or your cooperation.
Bui]di.nq Permit it 1 8 5 9 7 Z
Buildi.nq Dept.
No Plumber So].cler Certificate on file.
( all permits involving plumbing being
issued after npril 1,19II8 }
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OUGH FRAME & ~ ~y
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STATE ENERGY
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INSPECTI®N
[ ) F N ATION 1ST ( R GH PLBG.
( ] F DATION 2ND ( SULATION
[ ] F MIN ( FIN
REMARKS: ~j r~
~ ~_~~y~~ ~
Q U t_ (z.~2~
_.~Q I~ 0 1 Ceo tiP i l
/D; ~31~ w.t.
DATE ® ~ INSPECTOR
~A
/ g~~?
ass-iso2
BUILDING DEPT.
INSPECTION
[ J FOUNDATION 1ST [ ] ROUGH PLBG.
[ J FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
REMARKS: ~ o~r~'-~
DATE ~ ~ INSPECTOR ~
~F~ ~ 765-1842
BUILDING DEPT.
~NSPECr'oN
[ FOUNDATION i5T ( ] ROUGH PLBG.
[FOUNDATION 2ND [ ] fNSULATION
[ ~ FRAMING [ ]FINAL
REMARKS: ~e~~
DATE ~l~ I INSPECTOR fin,
BOARD OF HEALTH
3 SETS OF PLANS .
~FORMNO.t SURVEY
TOWw OFSOUTHOLD CHECK •
BUICD.INGDEPARTMENT SEPTIC FORM
TOWN HALL NOTIrY p
„OUTHOLD, N.Y. 11971 CALL ~ ~ •
. o TEL.: 7G5.1802 L TO : ~ ~
Examined 19 C
APProved r~~a.s'....., 19 Permit No. ~ ~ ~ ~ ~ t?
Disapproved a/c ~ f5 D
„Build' o Inspector)
APPLICATION FOR BUILDING PERMIT pp
Date IO j~o 19 0;~
INSTRUCTIONS
a. Tltis 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 azeas, 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 MADE to the Building Department for the issuance of a Building Petmit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, 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 inspections.
y-~ ~~z~ .
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State w}rether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
t?W/?~2
..................,..................j~...........................................................
Name of owner of premises ~~.°!x!1.5.. Kl7G/~ . . ~~F~
(as on the tax roll or latest deed)
!f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUS~~JSE SUFFOLK COUNTY LICENSED
Buildei s License No. J~1ll .
Plumber's License No. ...~/f}
Electrician's License No. . .
Otltcr Trade's License No. ..~f
~ .
1. Location of land on which proposed work will be done . .
.ion . . P~ci~~~ <S~1,e~~"............~.~.~if~~:v~K............... .
House Number Street Hanilet
County Tax Map No. 1000 Section . Block ~~O®........ Lot ~/yO~G~ , , '
Subdivision Filed \1ap No. Lot...............
(Name)
State existing use and occupancy of premis~e-s and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..7~F /!~I?JI,Gy .tJUJU//,t06....C~~~t;;rp'?~'fi-f-1>
b. Intended use and occupancy ...l. K:C.~.'~... ~bf'GJ~.... ~1P~1{C~iTI~ . .
1
3. Nature of work (check which applicable): Nett' B~ .Iding Addition Alteration , , ,
- Repair 1~........ Removal Demolition Other Work , .
' (Description)
/SOO, Q ~ ~I
4. Estimated Cost Fee......................................
I (to be paid on filing this application)
5. If dwelling, number of dwelling u ;ts Number of dwelling units on each floor ...Nf
g........ .
If garace, number of cars (`1~~ . . h
_ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ly~,?........... .
7. Dimensions of existing structures, if any: Front ../.q ....Rear Depth , , .
Heig~tt " :;::;~`1` nip'e of Stories ( .
DintCnsions of aptfte S.ttiictutey i1vi~(Y'alterations or additions: Front Rear .
Depth t ~1. ~IHcight Number of Stories .
8. Dim¢p~i'ons ~t~n7~o ~ti ;ion: Front Rear ...............Depth .
Heigii,.~-^!~. N mb~ofStories..... '7,, •F ,
9. Size f lostj~t-, - ....9'. , Rear~..~~s.T. /.......Depth ~-~~•~rO. r/Y.~b~~
0. Date of Pttirl~(a~,~ j~T , ~ yea ............Name of Former Owner l7'Eo,~6E ~ Yf;e6(hlff~ , CE-(, , ,
1, Zone 3e tstnct m which premises are situated .
2. Does proposed construction violate) any zoning law, ordinance or regulation: . ,/gyp .
3. 11 ill lot be regraded , , ,
~ /rl ~ ....will excess fill be removed from premises: Yes No
4. Name of Owner of.pre~m~~es7Ef°..!~s..f.<9~f4...... ,Address P~(F~C:.~:...... Phone No. ~9~-~00~
Name of Architect :Cf~ ' ....Address ...................Phone No............... .
Name of Contractor .
-5. Irs this property 1 ~ ated wi ~ ~ ~ ~ ' ' ' ' • • Address ....:..............Phone No.............:. .
~hin 300 feet of a tidal wetland? *Yes No ..Il.`~
*If yes, Southold Town Trustdes Permit may be reqgu~ired. „
PLOT DIAGRAM
Locate clearly and distinctly all btSildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
tenor or corner lot.
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T'ATE OF NE1V YORE, S. S'
OGATY Of
(tiatne of individual si~nin~ . being duly sworn, deposes and says that he is the applicant
o,contract)
~ovc named.
:isthc ........................i..
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly a}rthorized to perform or have performed the said work and to make and file this
plication: that all statements contained in this application are true to the best of ltis knowledge and belief; and that the
irk will be performed in the manner suit forth in the application filed therewith.
~•om to before me this
narylPublic, l:r:~;n; ; , I~~-. Y.~.. , . County (/J ~~}/7
NELEN K DE VOE ' ~eK.`~`.-~n~ „ ` ../.~f'e.~ .
. .
(Signature of,applicant)
~A~ ~18J8, Su9tolk
C~aYatY . .
Term Expires Mtroh 30,19}.~~
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