HomeMy WebLinkAbout18641-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219064 Date MAY 21, 1990
THIS CERTIFIES that the building ALTERATION
Location of Property 1295 ROBINSON LANE PECONIC
House No. Street Hamlet
County Tax Map No. 1000 Section 98 Block OS Lot 02
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOV. 2, 1989 pursuant to which
Building Permit No. 186412 dated NOV. 14, 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 CLOSE IN EXISTING SCREENED PORCH-AMEND TO INCLUDE DECK.
The certificate is issued to CHARLES & CONNIE BOOKLET
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING SLIP MAY 16, 1990
PLUMBERS CERTIFICATION DATED N/A
uilding Inspector
Rev. 1/81
posa~ 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)
N 0 ~ 8 ~ 4 Z Date ...//~7 19f.~
Permission is hereby grante toD' 1
~~..y...~-
ta ..<~&.a..'~......~it,2.....~~~i.R/.rna~ .~r~'';rrl.~f..~.:G:.~,J.R~. .....~-!~j
at premises located at ......1..~.~~...7~ t~Q!/.1..~
............................................................................pp....................................................................................
County Tox Map No. 1000 Section ..........{..St........ Block ~ Lot No.....~..
pursuant to application doted ........1,(.?.7.r 19..f~, and approved by the
Building Inspector.
04
Fee
~Buil g I or
1 Rev. 6/30/80
\p\~ Form No. 6 , ,
„ems ,.,.~...-~i.~_ c C.\t
,,1, TOWN OF SOUTHOLD ~ ~ [=~~~I \.',/~,~~z'A~~ ~ i~
~~~7 BUILDING DEPARTMENT t S
~n .7'' TOWN HALL ~ a,~>_: 1 ~
lY 765-1802 MAY 171990 4,:
pry 1
g2I~V lJ. V~I~Y"iTanm
APPLICATION FOR CERTIFICATE OF OC UPAI$gSTJ!q OF ~t!7h46f_!7 „ ~
M~~ .
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 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 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 $15.00
~j~~J~ ~ Date . ~~~~j~ .
New Construction. ~~~~5~/ 0
d /OJr /Preexisting B~u/~,l~ding........:~~-'~''w`~
Location of Pro~percy..,/.~~i.6...i:°~5:b`.~:?:-:'..lr='::`~~.......
House No.?~~~ Street Hamlet
Onwer or Owners of Property.,.~:-!'':`:.`~~~-}}:`.°.•;(s;~.':~:~.•.•...•.
County Tax Map No 1000, Section...~.3.......Block....~.........Lot.....
Subdivision..//.~~.//.....77
......................'.l..~./,.Fiplced Map............Lot......................
Permit No~..(OS~~~ f~...Date Of Permit..~'/.~1/ D.l....Applican[
Health Dept. Approval ...................../.....Underwriters Approval......................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate,:~......
Fee Submitted: , pt-~~`cnf . C~P~ . .
~ ~ 9532/ ` . .
C x/ %O~ l APPLICANT J
r'lELD I;:S:'~C:iU;J ~~llAiE ~ %OMMENT° ~
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FOUtdDATION (1st)
c
FOUNDATIOtJ ~
(2nd) _ ~
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o \
P,OUGH FRAME &
PLUMBING vL
H
3
3. ~
rn
INSULATION PER N. Y.
STATE ENERGY
CODE
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ADDITIONAL CO ENTS: x
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l~rytl ~~:~~i..+1ti Orf'iCii Ol' f3I11LI)ING I2JSPF•.CTOR
J, ~i~ . ~jy~`z1.:,~~' P.o, rzox 728
e',~~ ..P.t~~~.c:r SOUI'1IOLD,N.Y.11971
^''~r'l."'~ May 8, 1990
Charles 6 Connie Booklet
Box 1010
Cutchogue, N.Y. 11935
To 4I},om This t4ay Concern,
hie arc unable r_o complete your Certificate
of Occu[~ancy becau~c,of the following reasons.
~~An application £or Certificate of Occupancy
~is not nn file. ENCLOSED)
/~?///.`lo Under':rritcrs Cert-ificatc on file.
'1'hc check i:; (~~{%YgR~N$not on file.l $25.00
t:n health Dcpt. Approval on file.
tJo final inspection has been made.
Plear;e contact- our office on this matter.
Thank yoi.r for your cooperation.'
Buildi.n, Permit 1E ~ 8 h .4 ~ Z
Buildir.c[ [)ept-. .
*k"/-/ tfo ['lumber Solder Certificate on file.
( all pnrmitu involving plumbing being
i:,:;ucd after April 1,1909 )
NOTE: CO CANNOT BE ISSUED UNTIL AMENDED PLAN IS
SUBMITTED TO THE BUIr.DING DEPT.POR DECR. ~
it
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1 ~l 765-1802 .
BUILDING DEPT.
INSPECTION
(]FOUNDATION iST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSULA ON
[ ]FRAMING NAL
REMARKS: C.~
DATE ~ ~ INSPECTOR
Q~ 765-1802
00 BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T ( ) R H PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ]FRAMING [ ]FINAL
REMARKS:
<-,~°N~~G~~a
DATE ~ O INSPECTO
Y
6S-isoz
BUILDING DEPT.
INSPECTI®N
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ l FRAMING [ FINIA/L~
REMARKS: ~-~~.~-~-C_ v
~-r~ ,
r
~ i /f _
DATE ~ ~ INSPECTOR
` BOARD OF HEALTH
3 SETS OF PLANS
~FORMN0.1 SURVEY
TOWV OF SOUTHOLD CHECK ~loSFQ
6UIL"D.INGDEPARTMENT SEPTIC FORiI
TOWN HALL l
EOUTHOLD, N.Y. 11971 NOCALL J:
TEL.:7G5~1802 MAIL 0 4
Examined .l~ ~j:'........., 19 ~ ~ ' 7J~ ' ~d
Approved . 1~~......., 1~~ Permit No. f~6.5°~~
Disapproveda~/c ~ " ~ ~ f
BLDG.DEP7.
TOWN OF SOUTHOLD
(B 'ding Inspector)
APPLICATION FOR BUILDING PERMIT f
Date ~~./...t~..... 191.
INSTRUCTIONS
a. T}us 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-
6atian.
e. 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
!hall 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 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
Re=4ilations, 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.
M as (Signatupre of a cant, or name, if rporation)
t at, a tt.; t, ~~p ~ ~ (bfailing address of applicant)
State whether a,~4~Jkca~c gs. owner;•les"see, agent, architect, engineer, general contractor, electrician, plumber or builder,
, fi. ;
\ame of oe•ner.q( r r1+~.': s ~c.~~ . 9C.J"~
~,~:.~nR 5~~~
p„0 HC)'t;~~l ~l'"r~`~{°~ (as on the tax roll or latest deed)
If applicant is a'fi~o~i s ~ ~I~T~15' authorized officer.
(Nat'Hi~n ,pt~#;q{f~ccs)^ .
ALL COtiTfpd~{~~ BIi SUFFOLK COUNTY LICENSED
Builder's License No. !»>:~-?-n--~.......... .
Plumber's Liccnsc No . .
Electrician's Lirensr. No . .
Ot14cr Trade's License No . .
1. Location of land on which proposed work will be done . .
~CJ/CJ/
House Number Street Hantlet
County TaxAtapNo.l000Sectibn ..7~............ Block Lot..,
Subdivision Filed \fap No. Lot .
~(Namc)
State existing use and occupancy of premises and inten(d~e~d use attd occupancy of proposed construction:
a. Existing use and occu anc ~ z~b~r a;'~~~r't- ,u?crs°
..~l ~f,Y .J... ! Y.:: S-if'.. "^7fS}SFwY ~r{hFE s2` L£3MtCS4{tc~',
b. Intended use and occupancy ia..............:^,-::-.':,........
3. Nature otwork (check which applicable): New Auilding , , Addition Alteration , ,
Repair . Removal , Demolition , Other Rork ,
4. Estimated Cost......... lt7.6. ' Fee.............,.........,..............
5. If dwcllin^ number of dwcllin 'units . . . . . . . Number tto be paid on Tiling this application)
g ~ of dwelling units on each floor .
If garage, number of cars . . .
6. IC business, commercial or mixed occupancy, specify natur5 and extent of cacti tyyp~c of use ~ .
7. Dimensions of existing structutcis, if any: Front . ~ Rear . , fol........ Depth ..e~:~ .
Height ...g: Nuh~bbr of Stories
~
Dimensions of s me structure w tli alterations or additions: Front 1a1........... Re ~.c+~........... •
Depth ...gyp.: Height ....g.~ . Number of Stories . .
8. Dimensions ~t~e
ne~4~onstrNction: Front . ~ , , Rear Depth
Height ~ Nmuber of Stories ~
9. Size oC7br. Front . , Rear Depth
0, Date pf Purchase . . . Name oC Former Owner .
1. Zorte or use district in which prcll'mises are situated /Q~`. /~~;U~~;~-:.... .
2. Does proposed construction viol'~te any zoning law, ordinance or regulation: , ,.1.~6 .
3. 1Yi11 lot be regraded Nb . \Vill excess fill be removed from premises: Yes ~
d. A'ame oC Owner oC,premises ...............Address ...................Phone No................
Name of Architect I'` ...............Address ...................Phone No..
Name of Contractor .................Address .......Phone No... .
5. Is this property located within 300 feet of a tidal wetland? *Yes No v
*If yes, Southold Town Tru$tees Permit may he required. "
PLOT DIAGRAM
Locate clearly and distinctly all ;buildings, whether existing or proposed, and. indicate all set-back dimensions from
:operty lines. Give street and block dumber or description according to deed, and show street names and indicate whether
aerior or corner lot.
I '
k
j ~-~~~~~y~ ~ ~ .
C/
I
APP O AS NOTED
i DATE: ~ B.P. K
• FEE: b' -
NOTIFY 8U1 EPj
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION TWO REQLlIREb
• FOR POURED CONCRETE
2. ROUGN - FRAMING ~ PLUMBING
3. INSULATION
4. FINAL CONSTRUCTION MU8T
ALL CONSTRUCTION C~ .MEET
i THE REMNREMENT3 QP 1MIE py,
STATE CONSIRUCPIpN ~
. ~w CODES, NOT R~MONAIpI~ Npp
pESIGN OR OORISTR1It:f101i1O11IMR8
1~, .
"ATE OF \Et Jq)(!1... S~'S .
~G 1TY Of• (+l
Q~~~q~~~~.-~-:
fir. being duly sworn. deposes and says that he is the applicant
• ~ • ~ ~ (tiamc • • dividual si^nins co ct) ' •
ovc named.
~
: is the ~~!!.t-rG~`.'~!C7:`:. . " ~ . .
I (Contracto agcn 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 contained in this application are true to the best oChis knowledge and belief; and that the
rk will be performed in the manner sc[ forth in the application filed therewith.
orn to bc(orc me this
...........~f~ ..day of ~ 19 .p.l
tar}• Public, ~/~~~~`r•'", , County
CttelNlsdlnStlHolkCo~MY (Srgnatureofapplicanq
Commiseion Explre9 December 8,1
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