HomeMy WebLinkAbout18041-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219294 Date AUGUST 15, 1990
THIS CERTIFIES that the building ALTERATION
Location of Property 53860 MAIN ROAD SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 61 Block 04 Lot 7.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 5, 1989 pursuant to which
Building Permit No. 180412 dated APRIL 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 BUSINESS ALTERATION---ROBERTS JEWELRY STORE
The certificate is issued to ALBERTSON & KATZ
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
1 .C cii ~-~1... t3l.~.C~
Building Inspector
Rev. 1/81
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
('PHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°- 8 0 41 Z Date ...~~~.~.....l...y 19.~s.
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Permission is hereby grantedpto: C=~~
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at premises locotod at . y~~..~~~.~.,.~..fQ..!~.L,ld.
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J..~.rlr{l... .
County Tax Map No. 1000 Section Block Lot No.....~I••~ .
pursuant to appiication dated . ~~~/~!'Y.LIJ•.. 19.~~, and approved by the
Building Inspector.
Fee S. /d,~jt.d.U
Building Inspector
Rev 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
.a APPLICATION FOR CERTIFZCATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and subma.tted to the building
" inspector with the following: for new building or new use:
i. 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 Chan 2/10 of 1Z lead. '
S. 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.
3. 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 aad ,
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
L'puatad Certificate o£ Uccupancy - $50.00
S. Temporary Certificate of Occupancy - Residential~$~15'~00, CommOercial $15.00
Date
,~w Construction........ Old Or Pre-existing Building J h.........
.cation of Property....~~~~.........~~:h. ~C?
..............~c3~'~01~.._......
House No. ~~JJ Street Hamlet
'lower or Owners of Property... ./I~~~':y"rO`'
County Tax Map No 1000, Section....Xl.~......Block......`?........Lot....~•.~............
Subdivision ....................................F11ed Map............~~Lot......................
Pcrmlt No.../, ad.~~,/.~~„Date Of Permit.. 7.Iy~~...Appl leant. ..C +Q
6Ayf ~ SG:.G~
iiealth Dept. Approval ..........................Underwriters Approval......................
i
?lanning Board Approval
Request for: ,Temporary Certificate........... Final Certicata........... ,
Fee Submitted: $ „ cTS
5re a . .
$~/Sy~JG APPLICANT
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OCCUPANCY OR
USE [S UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
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i! APPROYEO NdTED
DA ~ S.P. M.t=L=11-Z_
oTIFV BUIi.D1NG oEPARTMENT a7
765-180'1 9 AM TO 4 PM FOR 7NE
FOLLOWING INSPECTIONS:
~ 1. 60UNDATION 'iWO REQUERED
FOR POURED CONCRETE
2 ROUGH - fRAMtNG S p1
UMSiNG
~ ' 3. INSUl.AT10N
i ~ 4 fINAI - CONSTRUCTION MUST
~ SE COMPLETE fOR C.O.
ALL CONSTitt,ICTtON SFW3. MEET
i ' THE REQUMiEMENTS OF TF~ N.Y.
~ i STATE CONSTRUCTION i ~GV
Cf1DES. NOI' RE8PONSISLE FOR
it ~ Dc'SiGN OR CONSTRUCTION 81R0R3 3 S/
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EOARD OF fIEALTH
3 SETS OF PL<1NS
FORM N0.1 SURVEY •
TOWN OF SOUTNOLD CFIECK .
BUILDING DEPARTMENT SEPTIC i'OR~I
• TOWN HALL
SOUTHOLD, N.Y 11~J71 NOTII'Y
TEL.. 7657802 CALL
E~amtncd I9 MAIL TO
\pproved • • 19Cl.~ermtt No. 1.G7 ~-/~,L~
Disapproved/a/c
...~..tr..:.:....
(B~~ector
APPLICATION FOR BUILDING PERMIT '
Date ~/..1......., I5
INSTRUCTIONS
a. Tlus applicatton must be completely filled to by typewriter or to tnk and submttted to the Budding Inspector, wtth
sets of plans, accurate plot plan to scale Fee accordtng to schedule.
b. Plot plan showtng locatton of lot and of butldmgs on premtses, relattonshtp to adlotntng premtses or public street
or areas, and gtving a detatled descnptton of layout of property must be drawn on the dtagram whtch is part of ttus apph
capon.
c. The work covered by this applicatton may not be commenced before issuance of Building Permit.
d. Upon approval of tlus applicatton, the Building Inspector will issued a Bwlding Permtt to the applicant. Such permt
shall be kept on the premtses available for inspection throughout the work.
e. No building shall be occupied or used to whole or in part for any purpose whatever unttI a Certificate of Occupanc,
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permtt pursuant to th.
BuiIdtng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Reaulattons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described
Tlie applicant agrees to comply with all applicable laws, ordinances, building code, housin, code, amd regulations, and t~
admit auihonzed inspectors on premtses and in bwIding for necessary mspecttons__ ~
~~z~~~~
(Signature of applicant, or name, if a corporation)
• (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, enaneer, general contractor, electrician, plumber or budder.
.
:v'ame of owner of premtses ~~i~-v>~sgt;~....~ ~r./.~ .
(as on the ta~c roll or latest deed)
IC applicant is a corporatton, signature of duly authoaaed officer.
(Name and title of corporate/officer)
BuIIdcr's Ltcensc No. :nS(.'1.~........... • '
Plumber's Ltccnse No_ ;
Etectnctan's License No. J •P .
Other Trade's License No. ~/d~z'Q
I. Location of land on which proposed work wt[t be done .
house Number Street Hamlet t~
County Tan hfap No ] 000 Suction . ~ Block • . , , • , , , • , Lot
Subdivision Ftlcd Atap No. Lot
(Name)
State e~tsting use and occupancy of premt/s~es and mtendud ur`s~e ,rndloccupancy of proposed cons[ruc[con
a. Existing use and occupancy ......i' I.•Q~F•q~{ -a •t3 ?~{tS . .
b. Intended use and occupancy • • • • • 5 • •
3. Nature of work (check whtch applicable) New f3utldmg Addition ~Uterauon . 1~_
iZepmr I-:-~, , Removal DemoLUOn Other Work .
(Descnpuon;
~ja'on.c~ lC.
4. Estimated Cost ] Fee ! .
(to he paid on filing this apphcaUOn)
S. If du'eihng, number of dwelling units Number of dwelling unds on each floor .
Sf gara^_e, number of cars .
6. If bustness. commercial or mt~ed occupancy, specity nature and extent of each type of use .
7. Dimenssons of cresting structures, if any Front Rear De th
p
Height ...............NumbcrofStoncs.............................
Dimensions of same structure with alterations or addttians Front Rear .
Depth IIcight Number of Stancs .
Dimensions of entire new construction Front Rear Depth , . , , , , , , , , , •
Hci~fit Number of Stones .
9. Size ofIot. Front Rear.. Depth
10. Date of Purchase ...........Name of Farmer Owner .
t 1. Zone or use district in which premises are situated . .
1:;. Does proposed construction violate any zoning law, ordinance or regulation .
13. Hill lot be re;raded ................Will excess fill Ue removed from prcmtses. Yes 1`
iQ. Name of Owner of prcmtses .Address P}ione No............. .
Name of Architect ..............Address ...................Phone No............. .
Name of Contractor .........................Address ...................Phone No.... .
IS.Is this property located with in 300 feet of a tidal wetland? *YES..,.,NO~....
*If yes, Southold Town Trustees Permit may be required,
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dunenstons fro,
property Gnes. Give street and block number or descnption according to deed, and show street names and indtcate wheth<
intenor or corner lot.
C~a~~~
STATE OF \EW Y'ORl`, -~yS.S
COCNTYpOF ` cG/~• .
• • • •~~t ~ • • . • • being duly sworn, deposes and says that he is the appiicai
(Name of mdivtdual stgmng contract)
above named
EicistEie
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th
application, that a!I statements contained to this apphcyuon arc true [o tkic best of hts knowledge and belief, and that tt
work wilt be performed in the manner set forth m the application tiled [herewith
Swom to before me this p
rotary Public, ~ . A.'..~•%L.::°:` County ~~i
HOTARYPUBifGSt~atEeofNewYork (Signature ofapphcan
Tenn
ExWr
srMaih
30 1~U9~