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HomeMy WebLinkAbout18610-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY ' No 219070 Date MAY 22, 1990 THIS CERTIFIES that the building ALTERATION Location of Property 465 OLD HARBOR RD. NEW SUFFOLK House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 003 Lot 11.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 25, 1989 pursuant to which Building Permit No. 186102 dated OCTOBER 31, 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 WORK TO AN EXISTING KITCHEN. The certificate is issued to MRS. C. F. BENBOW (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A /JY,../ Budding Inspecto~ Rev. 1/81 z Fosa~ xo. a 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) N ~ s ~ ~ Z Date ..Gl.../.N.........:3...f 19...P~... Permission is hereby granted to: ~y ~ of premises located at ;,•~•••..~~~..~~0~/.72...../1.. ........L........... ...................................................?'1.. ..r~.~.~ County Tax Map No. 1000 Section ..4.~.~.......... Block Lot No. pursuant to application dated 19...~~...~nd approved by the Building Inspector. Fee ~~d.~. Building Inspector Rev. 6/30/80 Form No. 6 D ~ (~l R ~ TOWN OF SOUTHOLD lVJ IS BUILDING DEPARTMENT ~ 3 0 TOWN HALL 765-1802 BLDG. DEPT. TOWN pp gpU7H0LD APPLICATION POR CERTIFICATE OF OCCUPANCY A. 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. B. 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. 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 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..,~~r,.~. Q ~ ~ . New Construction........... Old Or Pr~~e^^'-IIexist/i/n//g Buildings ~ , Location of Property... ~'~-~.-........V1.~...7~~: House No. Street Hamlet Onwer or Owners of Property..~M,l;$„~, /~,y,~,,,~ ~ y'.~.gyg/ County Tax Map No 1000, Section....~.l.J.....Block.....~.........Lot...[I..3 Subdivision ....................................Filed Map............Lot...................... Permit No. ~.d.Aq ~,~,,,,,,Date Of Permit. U.C~..~ ~~f.~~~i:.Applicant Health Dept. Approval ..........................Underwriters Approval Planning Board Approval Request for: Temporary Certificate........... Final Certicate...~~. Fee Submitted: n J~/L Y/yo APPLICANT 1Gt J 1...C.. ~VSn ~1 II~h..~.. I ~ ~v.Y;1CNT.^. ~ 1 ~ =OUtID;TI0.1 (1st) I _ _ y~ ?OUIJDATI0IJ (2nd) I c - v, ~ - m .',OUGH FRAh1E & I o ~ i •PLUMBT;JG S ~ 3. H IJSULATIOIf PER N, y, I m H~ STATE EPJERCY CODE y ~ I ~ © ` _.._.J y ~ F I; f A L I • ~ • ADDTTIOPIAL COMhfE1JT5: m m x . .9 N ` • ~ W • ? `l I m • ~ . - r ' ~ H b m v FORM N0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 q / ~,y ~f TEL.: 765-1802 Examined 19 / Application No . Approved 19~~ermit No. ~~~~OZ Disapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERMIT , Date .S..f. C_..I.~... 19~~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 descripTioh 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 issue 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 Permit 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 buildings for nec~esjs~ary insp~ecyt~iions~i ~j~ ~ ~ Q (Signature of applicant, or name, if a corporation) (Maili g addre of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~}-5,..~..~....(J•~'.~J.~.C1.W (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ . Plumber's License No . . Electrician's License No . . Other Trade's License No . . . 1. Locatio//,,n//r.,,~ofyy~~la--n^^d on which //p//)roposed work will be done. 543-/'A~. SG4,'~...d..T. , 0((~5~ ~-{/~?~tGf' /p/® d- K-}da~,/(a~~. . ..j..l%..I............1,/./~...~a•1; .Y 1T. ~....~o.U AX~......~E~/e! ~/~~JG. 1/.M-.l.~r~: `.f:'a.~. House Number Street Hamlet County Tax Map No. 1000 Section l..~......... Block Lot . Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy S~~ .e~S~..,'~€~'.p1? . b. Intended use and occupancy f'~:~:".!!`"1._ . p ' ~ Remov icable): New Building Addition Alteration . 3. NRetuarr of work (c ck which applRl Demolition . ..............Other Work . (Description) O~v-o ~ 4. Estimated Cost...~..~......r0??•••••••••••••••••••Fee...~:r~.~~•'U. (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 existing stmctures if any: Front .MO..G~tcc h.~>Qf• 1?~ear jh • • ~•`tT-,~. v:~ De;3th • ~ 4.?1't • • • ' ' Height .............Number of Stories........................................................ Dimensions of same structure with alterations or additions: Front Rear . Depth........... 8. Dimensions of entire new constml• Height ......................Number of Stories . ction:Front Rear............... Depth Height er of Stories . um 9. Size of lot: Front Rear Depth . ' 10. Date of Purchase L ................Name of Former Owner . ' 11. Zone or use district in which premises are situated . . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Will lot be regraded 14. Name of Owner of remises , ' ' ' ' ' ' ' • • • Will excess fill be removed from premises: Yes No p • .................Address...................Phone No. Name of Architect ~r...~ Address .........Phone No............... . !l?e~i•e.~-ir~~el~t•:Y.~Acldress . L'.vl~c.lloq•ce.'Q.... Phone No. ~.~.Y-~ ~ . Name of Contractor (~Jr~• ~ r3 J PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from ' property lines. Give street and block nLtmber or description according to deed, and show street names and indicate whether interior or corner lot. ~e~~ac-e {^o~I~~ S~~ls APPROVED SNOTED ~e~~ar`~ ho ~e~l ',S~ugS DATE ~ _ B.P•# ~ f a ~ ~ -~-'ti_ I n ~ ~ , t r S YL ~e ct NOTIFY BUILDING DEPARTMENT A I I 786-9802 8 AM TO 4 PM FOR THE I t ~ G u d S r~ CJ /'e.$ FOLLOWING INSPECTIONS: / 1. FOUNDATION - TWO REQUIRED ~h S l d~ L N'~ W W~ h~ a ~`S FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING Ir ~ ~ p 6 J I~ 3. INSULATION 4. FINAL - CONSTRUCTION MUST ~ BE COMPLETE FOR C.O. `e j~ I0. ~ ~2 C'C' 1 ~ (h', ~ ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. ~ ~ ~CC C.,L' C q I^ Vl'l S ~ STATE CONSTRUCTION & ~NERGY CODES. NOT RESPONSIB FOR 1 1 ~ 1-l~'~ ~'~S L'e0.~(`~ ~"S DESIGN OR CONSTRUCTION ERRORS .ALL wv~ K ~a!,s ~v ~ e clQ?~~e-- 11 °e ~ ~ ~t~ ~ STATE OF NEW YORK, S.S ~~PA~iCY COUNTY OF • • • , , , • • , , , , • , , • b~ ~i s and says that he is the applicant (Name of individual signing contract) ® i•~ above named. IP~~G ~ Y ~ f ~~I'"A 1 l~ 1. ~.A.1...................... He is the qq°° (Contract~ge , r cJ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contiiined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannei set forth in the application filed therewith. Swom to before me this Y I .......da of...~~...............>19~y. Notary Public, • U~L~; • • • • • • • • County NOTARY PU~i1CKSt0atEeYo New Yark (Signature of applicant) No. A70 97R, SutNlk County Term Expirgs March 30,19 I