HomeMy WebLinkAbout18106-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218070 Date JUNE 1, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 465 TARPON DRIVE GREENPORT
House No. Street Hamlet
County Tax Map No. 1000 Section 53 Block 05 Lot 05
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 4, 1989 pursuant to which
Building Permit No. 181062 dated MAY 10, 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 ONE FAMILY DWELLING.
The certificate is issued to WILLARD BARRY
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
Building 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
COMPLETION OF THE WORK AUTHORIZED)
N O ~ g ~ ~ Z Date 19
Permission is hereby granted to•
~ ~~:7............
.~~'~ai,~~; ilk ~ ~
.
at premises located at ~~ir~l!:~
.............................................1~.~.e~..~i.ZA y~~=~2..............................................................................
County Tox Map No. 1000 Section Block Lot Na
pursuant to application doted 19!!.x..., and approved by the
Building Inspector.
Fee $..~:d,,../,~
B ildin nspector
Rev. 6/30/80
_ ~
TOWN OF SOUTIIOLD 5~- 3
'""°""~p"~~~ ~ ' BUILDING DEPARTMENT
~(5 ~
TOWN HALL
}
AY 3 ~ SOUTHOLD, NEW YORK 11971
hI~ ~ 765 - 1802
SLUG.O~?T
TOWN OP SOUS HE7f_q
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
DATE.
NEW CONSTRUCTION .......OLD OR PRE-E%ISTING BUILDING..~NT LAND....._..
Location of Property... ~C~.J
IIOU5E N0. TREET H LET
Ovner or Owners of Property,..-~.~y"KK..
~
County Taa Map No. 1000 Section ,5 Block Lot
Subdivision Filed Map ........Lot.
,,ss~~
q/ 99
Permit No./~~v~'•~:"„Date of Permit ®/,~,/y:~~,A Lica g~~,
Health Dept. Approval Underwrite Approval..............
Planning Board Approval
Request for Temporary Certificate V
Final Certificate
Fee Submitted: $~~..i_
,,l~ APPLICAN
~I~I ~ ~
C
rev. 10/14/88
f ~F•
FORM N0. 6
'i TOWN OF SOUTHOLD
BIIILDING DEPARTMENT
TOWN HALL
765 - 1802 i
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
' A. 'This application must be filed in typewriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
~ 1. Final surve of
y 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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from ,plumber certifying that solder used in system contains less
than 2/10 of 1Z lead:
h 5. Commercial buildings; industrial buildings, multiple residences and similar,
buildings and installations, a certificate of code compliance from the 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:
I. Accurate survey of property showing all property lines, streets, buildings and ~
unusual natural or topographic features.
2. A properly completed 'application, a consent to 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 of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant. '
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
I. An application For vacant 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. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF OC~IIPANCY - 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 Certificate of Occupancy - $20.00
5. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
APPLICATION ON BACK
rev. 10/14/$$
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BUILDING DEPT.
INSPECTION
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REMARKS: Cam/
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BOARD OF HEALTH ,
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3 SETS OF PLANS
;3 FORM NO. 1 Sl1RVEY , , , , , ,
.Q.~/
-TOWN OF SOUTHOLD CHECK ~~ST`f'• .
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
• SOUTHOLD, N.Y. 11971 NOTIFY t'"
' TEL.: 765-1602 CALL , . , , , ,
Examined 19 ~l. MAIL T0: .
Approved 19~ Pctmit NO ~t?~?.~ ~ r" ~~,'h-~~!
Disapproved a/c
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9LOG.OEP'T.
uil g Inspector) TOWN OF ^sOUTHOLO
APPLICATION FOR BUILDING PERMIT
Date . ~,/.s~.........., 15
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 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
hall 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
Re;ulations, 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 inspectio ~~y,/~'-
.0.4~..........
g re of"applicant, or name, if a corporation)
' fling ad ress of appl. ant)
State whether applicant is owner,~~eLle~~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................~~Qa~%~'.~eG~'L.-.............
Name of owner of premises O.-4%~~~'~!~r. .
(as the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporaQte~o/fficUer)
Builder's License No. 77 P.../f?Z.'...... .
Plumber's License No .
Electrician's License No . .
Outer Track's License No . .
1. Location of land on which proposed work will be done. ~6~,, y , i'~~- .
v~
.~~~1~~
House Number Street. Hamlet
County Tax Map No. 1000 Section ..S'3........... Block ~ ...Lot , , _ , , , , .
CC /r-
Subdivision .S„_.l~ ..p....... Filed llap No. Lot .
(N:une)
State existing use and occupancy of miles and intended u e and~o/cc~u~pancy of proposed construction:
a. Existing use and occupancy
.
b. Intended use and occupancy Y,3AW ~ ~ ~ ~ ~ " "
aif -,tE ~
i~~ .
P , . • . • . R`lapplicable): New Building Addition rUterati
ature of worl~check which , . • , , , Other 1Vork . f~G~iC„_, .
• Re air moval Demolition
4. Estimated Cos"t'. C~~'b ~ ~ ~ (Description)
Fee.
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwcllin units on each floor .
If garage, number of cars g • .
6. If business, commercial or mined occupancy, specify nature and extent of each type of use .
7. H`m}>~sions of existing stru N~res, if any: Front ~ , , , , , , , ,Rear Depth .
" m ber of Stories . ~ • • ~ • " " " " '
Dimensions of same structure ,with alterations or additions: Front ~ ~ ' ' ' ' ' ' ' ' '
Depth . ' . Ilcight . Rear .
8. Dimensions o enure new construction: Front • • • Number of S[orics , . , , , , , ,
Height ~,~~~~.•~Rear Depth
Number of Stories . , , ,
9. Size of lot: Front. "
10. Date of Purchase ,/G~ZO; " • • Rear ...,iv7d..'........... • Depth , . , .
•••••••••••••••....NameofPormcrOwner
1 1. Zone or use district in which premises are situated ' ~ ' ' • ' ' ' ' ' ' ' '
1... Does proposed construction vi
~ plate any zomn law ordmancc or re ulation; ~}¢,p. , , , , • • ,
13. Will lot be re"raded • • • • • • • , .
° ' ' ' ' • • s.... Nill excess fill be rerr.~ oved from premises:
14. Name of Owner of premise !/~i~~,~lQiQ/1,G/` rr~ Yes N
Name of Architect / ' • Addressf~~~.~j~~o,f!(~iQ , , ,Phone No. SG~~'/,~
_ Name of Contractoar~4'cvsV!lJ~f~/1•S. , ~ . ; ; ' • Address y~,y~ Phone No... . , •
15.Is this property located within •AddressOlG!'.r<.~7,~Q~Y~~;,phoneNo..~~7:•r~a,;3 ,
*If yes, Southold Town Trustees Permit may bearequiredetland? *YES....N0.1.~!'
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 number or description according to deed, and show street names and indicate whether
interior or corner lot.
xr75' •
e
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s
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STATE OF \E1V Y RIti ~
COUNTY $•S
bein dul sworn, do ores and sa s that he is the a lie
(Name of individual signing contract) g y P y PP ajtt
about named. i
lle is the ........~~,ef%z~x•°~C~JCr......
I
(Contractor, agent, corporate officer, etc.) • ~ • ~ ~ • 1'
~f said owner or owners, and is duly'authorizcd to perform or have performed fire said work and to make and file tJ is
~Pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that ti{e
•vork will be performed in the manner het forth in the application filed therewith.
Sworn to before me this
\ I,
..day of .l / ........,19
rotary Public, County % ,
. ~ . .~Gf?WtaG~!t~! it
~ WALYIAt C~~~CG6R~l, , ,
iIANF'~ Sub.of Wrw ?et~ '
iM. c0. 6utroik Cou (Signature of appliean')