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HomeMy WebLinkAbout18057-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18041 Date MAY 19, 1989 THIS CERTIFIES that the building ADDITION Location of Property 2930 WELLS ROAD PECONIC, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 086 Stock O1 Lot 10.5 Subdivlslon Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 18, 1989 pursuant to which Building Permit No. 18057-Z dated APRIL 20, 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 DECR ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to ROBERT RINGOLD {owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NlA UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 11OH71[ N0. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfH15 PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) . p N 8 0 5 7 Z Date ~ 19.4.9 Permission is hereby granted to: r . ta .c4.:!~:A~`.'!-4:4~~.....C'{v~..4Md..CIK.......S~.rNI..~1..4tiS~!.:~?...~?....~'!!a....~r.~,~l?.~......Q~:j,~., . 1 of premises located at ...r~..°.~..~~........4~1 ........4„~,3.......~~~.a;.e.~n;S;S,~ County Tox Map No. 1000 Section ~d((~.?a... Block .....Q.~......... Lot No ~.Q.' S~ pursuant to application dated ...~~~'.`:47c....~ g 19.~~., and approved by the Building Inspector. 1~ Fee B i Inspector Rev 6/30/80 . » TOWN OF SOUTQOLD EUZLDING DEPARTMENT TOWN UALL SOUTHOLD, NEW YORK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE. ~~~f _ . . HEW CONSTRUCTION ...._..OLDp OA PRE-E%ISTING BUILDING. Y. ...VACANT LAND...____. Location of Property....~I~~........h!p1'Y..~tll_......._..1.~~/.Cs.._.__.. HOUSE NO_ I- [ STREEfT UAMLL'T Ovaer or Owners of Property.. ~aUe~[[.,.~ ~n'~~~`' Gouaty Taz Map No. 1000 Section _~gQ. Block ~ Lot .l©'_~_. Subdivision Filed Map ........Lot...._....[~ L Permit No. 1L~~'S7 Z.Date of Permit ~~C:~.~.~~.f~Applicant r1uN~'v.t~~jot~ Health Dept_ Approval Underwriters Approval..__......__.. Planning Board Approval Request for Temporary Certificate Final Certificate ..Y Fee Submitted: APPLICANT..~~7~:':':*:".. _ _ r ~ ti ` ~a BLDG DEPT C O Z~'. ~8~ 4f TOWN OF S0O7H0LD rev. 10/14/88 f~ L' ~ • ~ FORM NO_ 6 TOWN OF SOUTHOLD BIIILDING DEPARTMENT TOWN HALL 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. This application musC be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: I_ Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or Copographic 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 is system contains less than 2j 10 of IZ lead. 5. Commercial buildings, industrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from [he 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 shoving 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 Che 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 inspecCion 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 [he application. If a Certificate of Occupancy is denied, the Building Inspector shall state Che reasons Cherefor in writing to the applicant. D. FEES: I. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions [o 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 dwellivg - $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 Coaunerciai } . ~t r 'Y'~~ APPLICATION ON BACK rev. IOJ14/S8 Imo;;;; TGL. ?C>5-i Cr„ ~G~ F ~f !fl' p r"~',., GL., T0~?'N or souTFro~.~ j'~~T;~+~, Ol~('ICI_ PsUILDlIv'G INSI'PC:Oa U ti.4 ~Oit •'4 ~ P0. ll~~ 1179 ~~~"r„-=-1,~%•`°'.1~~ ~ TOtVNlS1LL ~'`Cy, ~ c~' SOIIT IIOLD, N.Y. 1 l97I a~~'/Oj 7~~ ~~r-:,r~ l a.c~ : d , i l ~y 'Ib Pihcm This May Concern, Pte are unable ro complote your Certificate of Gccu?ancy becaus~~ of the folloc:zng reasons. /X/ An appluation for Certificate of Occupancy is not nn fz]c. EKE-~-C~4%-~ / / ::o Undcr~:r:.tcrs Ci rtificate on file. _ as / 1 '~'hc checF: t:. (nutduLcd/r.ut on tiic.) ~p15 ~:o Il~a7 t1s Uept. nppreval on tile. C:o final ;.n~I.cc:t ion hay bees: made. Pl~a~~ contact: our office on this matter. Thauk you for your cooperation. I;u s lc] L r.cJ Perm s t 11 / ~ 0 .L 2 ~ _ IIuilc7incl Dept. tlo Plt:mbcr :,oldci Certificate on file. ' ( all pet;sit:; involv~nc3 plumbincl being s.ssucd after .1pri1 1,1J84 ) (.G. Poc~3is~- ~,u.i a u,~ it gs l ~L ~v,-cc c . 1::LD I;..~,: ~:.::U;. ~~De.iC~ ~ t;~:MMF:NT.^. ~e ~ 1. H _ _ _ y r'OUiJDATIO;i ~ ( 1st ) , c FOUNDATION (pnd) m- °,OUGH FRAME & E PLUMBING S- k r 3. IIJSULATIOPI PER N. Y. c STATE ENERGY ~ CODE m H FZ;7AL I ~ ~ ~ ADDITIOPiAL COMMEClTS: s ` i c r ~ X b H SJ • a H H O m a r H O [+1 -a H a C ~°~7 765-1802 BUILDING DEPT. I NSPECTI4N [ ]FOUNDATION i5T ( ] ROUGH PLBG. [ ] F//OUNDATION 2ND [ ]INSULATION [y~FRAMING [ ]FINAL REMARKS: a ~ ~~2~ DATE ~ ~ INSPECTOR 765-1802 BUILDING DEPT. 1 NSPECTION " [ ]FOUNDATION i5T [ ] ROUGH PLBG. FOUNDATION 2ND [)INSULATION [)FRAMING [ ]FINAL REMARKS: _Gx r d~ DATE ~ INSPECTOfi< ^ t~,, _ _ E N<--- ~5 ~iS~ ? I~o u sE 70 tJ~rs or - , " ~ - ,r' j.~ ,,r ~ _ .r ~ ~ - - rQCCA \ \ r ~ / ~ _i ~ I i C ~ of ~ ~ ' ~ ~ ~ 3 c. Cw~crciL ih i ~ ~ ' ~ ~ ~_____S Grp 1 • =.F ~ . ~ ~ f/o~se i ~-f~ \ ~ ~ ~ 3-~'s'CCA ~ ~ ~ , ~ ~ , i ' ~A i ' j ' ~'>s''cca ~ i Tort ~`f,S ///'''s-aka «Q ~ ~ ~6 NrJ" r ~ v ~ ~OrS~ ~~P•.5 ~ Ulr ~xS a'c~, c~4 !~Mti ~ _ _ ~ _ ,i ~ I Tost s.~s+ u-- ~ _ - - _ - ~ H .SoU'~"~ ~ 1eva.'~fi7Y~ y i SCc. ~ v - ~ D B0,1RD OF HE\LTH 3 SETS OF PL.~NS FORM NO.1 SURVEY TOWN OF SOUTHOLD CIICCK . ~~q~ . BUILDING DEPARTMENT SEPTIC FORPI . TOWN HALL SOUTHOLD, N Y. 11'J71 NOTIFY p TEL.. 765 1802 CALL ...."].GS.'. !r~.~l.l..... . ZO ~y MAIL T0: ~+z,Q~ Examtncd . 19 0.' Approved ,lq ..a'd 19~ Pct7rttt No / g.6S? ~ . Dtsapproveda/c t #iy_~.p~~... f ,t, (Building Inspector) T01h~R GF SGJTHut L7 APPLICATION FOR BUILDING PERMIT Date ~i9,~?!"1. / . ~f~.., I5 INSTRUCTIONS T a. Tltis appttcatton must be completely filled to by type~vnter or to tnk and submttted to the Butldino Inspector, wtth sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddmgs on premtses, relationship to adjoining premtses or public stree ar areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of t}us apps canon. c. The work covered by ties application may not be commenced before tssuance of Building Permit. ,d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such perm shah be kept on the premtses available for inspection throughout the work. e. No building shall be occupied or used to whole or to part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY bfADE to the Buddtng Department for the tssuance of a Budding Permit pursuant to th ButIding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Re,ulattons, for the construction of buildings. additions or alteranans. or for removal or demolition, as harem descnbe~ The applicant agrees to comply with all applicable laws. ordinances, building code, houstn~ code, and regulations, and L admit authonzed tnspectots on premtses and to budding for necessaryp~tnspecuons. (Stgnature of applicant, or name, tf a corporation) • (Matting address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electnctan, plumber or budder tltl Name of owner of premtses (4 ~.1). Pr~./~; n~°~4 . (as on the [ac roll or la[cst deed) If applicant is a corporation, Stgnature of duly authonzed officer (Name and tttIe of corporate ofFcer) Bullet's Ltcensc No. . l:Sr 7 • - Plumber's Ltcensc No Electrtctan's Ltcensc No O[hcr Trade's Ltcensc No . 1. Location of land on which proposed work will be done . . House Number Sotreet Hamlet County Tai ~fap No 1000 Suciton ....Q • Blink I Lot ~~e . Subdtvtston Fled tap No Lo[ . (N.unc) Slate e~tsting use and occupancy of premtses aCnd intended use and occupancy of proposed construction: a. Eeisung use and occupancy S,. l e • .1i;~;.1N ~~Si dG't*?C~ . b Intended use and occupancy ~~)."-~1.`;~;C.+.=t'{.''.„••• '4 IJ u r 3. Nature of work (check which app]icable) Ney~ E3udding Addition • .Uterauon . Repazr Removal .....Y, Demoltnon Other 1ti'ork (Dcscnption 4. Estimated Cosi . .......~},~~D'~~? Fee SLR.: (to be paid on filing the applicaUOn) 5. If dwelhn„ number of dvvetlin~ units Number of dwclhng units on each floor , , , , , If garage, number of cars . . . 6. IF business, commercial or mieed occupancy, specify nature and extent of each type of use 7. Dimensions of cruung structures, if any. Front .Rcar Depth Hcig}tt .NumbcrofStoncs..........,.,........................................: Dimensions of same structure watt altcraAOns or addiUons• Front . . Rcar Depth ficight Nuntbcr of Stones . g. Dimensiorf~nt~it~w construction• Front Fem. a,z7 , Rcar ....o`2.C1.'~...... Depth ~.~r~, , , , Hci_ht ...:1.0........ Number of Stones . . . . 9. Size of tot: Front /:~~r©'........... Rear ~ur.~s ~ ~ Depth /•0 36~ ~ 10. Date of Purchase . ..............NameofFormer Owner 11. Zone or use district in ivhicli premises arc situated . 1Z. Does proposed construction violate any zoning lacy, ordinance or regulation• . . , F3, Will lot be regraded Nill excess fill be removed from premises: Yes 14. Name of Owner of premises .a~i^~t,~.: t, R; nap/~1, , , ,Address 11~?~S ~~'!~sc~~l~1'~'I'hone No..7~.5` °?.1~,$ , Name of architect ...........................Address P}tone No............. . Name of Contractor . ~I`f~`P; , ,//p,Jl~ y K... , , ,Address .IYc:~~ !Pd,i±g ;~t-; ;~yU~,ki'hone No. ,'j65: p`2h!~(, 15.Ls this property located within 300 feet of a tidal wetland? *YES....NO.... *Lf yes, Southold Town Trustees Permit may be required. PLOT D[elGRAbi Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dunensions fro property fines. Give street and block number or descnption according to decd, and show street names and indicate whet;t mtenor or comer tot. SE t..; SV v' Vein STATC OF \E~Y~ ORI;, S S COUNTY OF..•?.'?'~rFd.I~...... , , , , , , , , , f}!~ a.~'~ q. D,Gk • . , , • • . , , being duly sworn, deposes and says that he is the apphcm (Name of mdrvidual signuig contract) about named. ilcisthe (Contracto ,agent, corporate officer, etc ) ~f said owner or owners, and is duly authon7cd to perform or have performed the said work and to make and tilt tli 'pphcation, that at} statements contained m this application are true to the best of his Lnowledgc and bchef, and that [t work will be performed in the manner set forth in the application fled therewith swam to b~tore me this ~gcr -...........~.r6.~t..... day of.....~1k~.+.........., 19..1 ~otaryPublic . .....~~-~.5~... County ~~j /Wp~tg (Signature of apphcan ?~ppry PYW EtAti Of Til~NYOtk No. b2-812 SuttoMc Coy~tgt T F,~r,:,wa fk•te~wr Rt 9A F ~ ' ~,fy~npto~~ ~~~ii~ ~~""!r _ ~ ~ ~ y ~ ,rib ~ A~ ' ~ ~ ~ ~ ~ - Y , ~ b ~ ~ 5b ~ t7'L9S! 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