HomeMy WebLinkAbout18488-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218386 Date SEPTEMBER 19, 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 760 RAMBLER ROAD SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 88 Block OS Lot 20
Subdivision TERRY WATERS Filed Map No. 2901 Lot No. 33
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 18, 1988 pursuant to which
Building Permit No. 184882 dated SEPT. 15, 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 ACCESSORY SHED
The certificate is issued to GEORGE T. & PATRICIA A. HOLLOWAY
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
r~C
Building Inspector
Rev. 1/81
!'OEM NO.
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 18 4 8 8 Z Date I9.. g.~
Permission is hereby granted to: r"~
. . . . . . . . . . . . . . . . . . ~
. ,
. . ~ . ,
. Q . ....Q.
. . . . . . . . ~
. . . . . . . . . .
ct premises located of ~.~°..~...~p".^ -.....~f.:``.t.:.......:S~?.~:LN...:::^'4~
Caunty Tox Map Na. 1000 Section Block .......~.s..... gqLot No.. U
pursuant to application dated ......e~~...~..~ 19.~..{•, and approved by the
Building Inspector.
Fee $..°?S ~
/
....~,.~~:.:...:a-......~
wilding Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~i•~ to the Building Inspec-
torwith 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 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate 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. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate. ,
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory I0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 10.00
4. Vacant Land C.O. $ 20.00
S.Uodated C.O. $ 50.00 Date
NewConstruction, ~ ,Old orPre-existing Building Vacant Land
Location of Property ........7.~~.Q.... ~?!~x-~i-~!. ~d:~..........X',~~.~.-$'.~~ .
House No. Pp Street Ham/et
Owner or Owners of Property ~ ..r.~C~C,~.. .
p.
County Tax Map No. 1000 Section .......G Block ~ S~..... Lot aU .
Subdivision .................................Filed Map No. ..........Lot No. .
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval ........................Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ .
Construction on above described building and per ets all a le~ e~ 'egulations.
Applicant -
Rev. 10.70-78 /J ri~ G y Z ,~4~~~~~ -
co zi~~x~ 3 jig%y
..v:`ti1ENT~
o
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cOUtJDATI0f1 ~ (1st) I ~
FOUNDATI0IJ (2nd)
0
ROUGH FRAME &
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IIJSULATIDII PER N. Y.
STATE EIlERGY
CODE
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F Ii7 A L I
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ADDITIOtIAL COMMEtITS: x
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765-1802
BUILDING DEPT. `
tNSPECTIC~N ~
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL
REMARKS: ~
DATE ~ ~ INSPECTO
G.
f~` _
Y a-6-~ ~~L~~ - _
i OFFICE
TOWN $ALL, SOUTHOLD, N. Y. 11971
765.1802
July 25, ]988
Dear Mr. Holloway:
The inspection was done for the permit for
- an accessory shed for your property. Every-
thing was O.K. and the permit and C.0. can
be issued.
However on the C.O. for the pool we will need
j~ an.Underwritexs Certificate. Please provide
f our office with this so that your C.O.'s can
be issued.
Yours truly,~~//
A ~
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D ~ BOARD OE HEALTH
3 SETS OF PLe\NS
FORMN0.1 SURVEY
~~9$$ ~ ~S TOWN OF SOUTHOLD CHECK .
BUILDING DEPARTMENT SEPTIC FORM
(3LCr>""" ~ TOWN HALL
T0~'"' G` ;`~~''"~+TM ~ SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL ..........~.~n.n......~
Examined .~P•~~•'• • ~ ll 19~~. MAIL T0: ~ ~9 c.a{,vysrA a
/ ~ - u
Approved 19~ .Permit No. ~ !
Disapproved a/c
%1
(Building Inspector)
APPLICATION FOR BUILDING PERMIT r~~j
Date 15
INSTRUCTIONS
a. TIus application 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 showin; location of lot and of buildings on premises, relationship to adjoining premises or public stye
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap;
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 pen
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 construction of buildings, additions or alterations, or for removal or demolition, as herein describe
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on gremises and in building for necessary ins t' ns. ' ~
(Signs e of applicant, or name, i a c ~ porauon)
~~o....
~ '
• i • ddress ofof applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contracYO~ec
titian, plumber or build:
1
r
Name of owner of premises `.....~f .
~ ~ (as on the tar ~Il q~r~,~t~,st~leed)'
If applicant is a cor~o~ati$rr; "sig~~fure -f duly authorized officer. ti ~;`T z ~
I"
(Name
a,~ndjt~tly corporate officer) t<''~i3 ~,G' l:"' _ `g'- "
Builder's License No~~?-Z~:. ~4C'9~. /4~~:~~'"~O
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. ~ .
~ J
. n-U''G?t it`d! ~ _ - /t-~
.,I.f
House Number S~t3reet Hamlet
. ~ c.~;
County Tax hfap No. 1000 Section • . BI'pck ~....9.......... Lot .
lam-
Subdivision • • • • • • • • • • • • • Filed Dlap No. ~G" Lot _3...... .
(Name)
State existing use and ccupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy ....r • • • • • • • / .........~~:5-C .
1/ • ,~1~~
3. Nature of work (check which applicable): New Building Addition Alter n .
Repair Removal Demolition Other ~o~k .....RVi,!
(Descript
4. Estimated Cost ....yfc5'~.' Fee .
(to be paid on II1ing this application
5. If dwelling, number of dwelling units Number of dwelling units on each floor , • • , , , . • ,
If garage,numbcrofcars
6. If husiness, commercial or mixed occupancy, specify nature and extent of each type of use . .
7. Dimensions of existing structures, if any: Front Rear Depth ,
Height ...............NumberofStorics....................................................
Dimensions of same structure with alterations or additions: Front Rear . , .
Depth IIcight Nucnbcr of Stories .
8. Dimensions of entire ne~v constntction: Front Rear Depth .
Hei~itt ...............NumherofStoriel....................................................
9. Size of lot: Front Rear...................... Depth
16. Date of Purchase ame o(Fo er caner .
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: . ~ .
13. 1VIl1 lot be regraded ......;~'~a... lVil! excess Fill bee ove from premises: Yes
14. Name of Owner of premises _ Address ..~~~':-C-,t-~.~al• .....Phone Na .
Name of Architect ~ , Address ...................Phone No............ .
Name of Contractor ~ ..Phone No. .
,.~~ozt~~~s ......Address .
IS.Is this property located within 0 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAh1
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fr
property lines. Give street and block number or description according to decd, and show street names and indicate whet
interior or corner lat.
c~?Oi~1z~C9~
APPR YED AS H01'ED , $ ~
DATE: 9/ B.P H
NOTIFY t3t.11LDtNG DEPARTMENT 'AT
785-T802 8 AM Tp A PM FOR 7HE •
FOLLOWING INSPECTIONS.
I. fOUNDATtON - TWO REQUIRED
fOR POL'.^.Cv LuNCRETE
2. ROUGH • FRAMING & PLUMEIING
3. tNSUtATION
4. FINAL - CONSTRUCTION MU51'
BE COMPLETE FOR C.C /a
ALL CONSTRUCTION SHALL MEET OCCUPANCY ~R
THE REQUIREMENTS ~ THE N.V. ~SE ~S UN~.AWFt1L
STATE CONSTRUCTION ~ ENERGY
txloES. NOT RESr+ONSt~.E FOR WiTOE OCCi~PANCYATE
DESIGN OR CONSTRUCTION ERRORS
STATE OF NE1V YORK, S.S
COUNTY OF .
• • • • • • • • • • • • being duly sworn, deposes and says that he is the applica:
(Name of individual signing contract)
above named.
1{e is the
(Contractor, agent, corporate officer, etc.)
of said owner or atvncrs, and is duly authorized to perform or have performed [he said work and to make and file tY
application; that aJl statements contained in this application are true to the best of his knowledge and belief; and that tl
work will be performed in the manner set forth in the application ffled therewitlt.
Swom [o before me this
..........day of 19.x'
Notary Public, . .7L...~J~. County - ~ ' ,
HELEN K QE VOE / , - .
~N
~d76)878 S~oiN
t
au~ ~ • .
Term ExpiresM:rch30,1 -_°~r (Si~natur fapplicar.