HomeMy WebLinkAbout18397-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT '
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18409 Date SEPTEMBER 25, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 4545 ROCKY POINT ROAR EAST MARION N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 21 Block 1 Lot 19
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 7, 1989 pursuant to which
Building Permit No._18397-Z dated AUGUST 18, 1989
was issued, and conforms to alI 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 AS APPLIED FOR
The certificate is issued to EVANGELINE PENA & IRENE MARSHALL
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Buil~spector
Rev. 1/81
rows 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 18 3 9 7 Z Date ...~f 19. ~R
Permission is hereby granted to•
u.u a 4 '
to .L~~~ , ...fit..... .[,~Y.l.......~.. ....U
at premises located a~
~C'A.: .
............~:...`~,d.~
County Tox Map No. 1000 Section Block Lot Na..........,l.l.........
pursuant to application dated ........{~1"? 19.(,~J~.., and approved by the
Building Inspector. /
Fee $.ba..`'...~~/
/Bull I to
Rev. 6/30/80
TOWN OP SOUTIIOLU n
BUILDING DEPART?!L•'NT SEP FS ~ I'U1t
TOWN HALL
SOUTIIOLD, NEW YORK 1197 BLDG. DEPT. ,
,„,~~T®WN OF SOUTHOLD
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
DATE
NEH CONSTRUCTION Jc1~G',dC,OLD OR PRE-E%ISTING BUILDING.____.VACANT LAND........
Location of Property.:`?; '><S. • ~rJ~.~'~ -.~lo~.~..~s~~ li -
HOUSE NO. STREET c°1- .~C.~ _ _ - . -
p HAMLET
Ovner or Owners of Property...l_~,?1/,j.~.-~/~j~~'.j~(~j-~~'-~'/~q~..--/~~t7~~,~/
. J7! t~i F.l~_..~Y._.
County Tas Map No. 1000 Section ,
Block Lot .~7...._.
Subdivision..
n Filed Map ........Lot._........
Permit No./ilTj~~„-,Date of Permit .;~-:f~-.-A p~
PPlicant ..~7
IIealth Dept. Approval
Underwriters Approval
Planning Board Approval
RequesC for Temporary Certificate
q Final Certificate _
Pee Submitted: $„oS.,-7 -.m 0..-.....•_'- •
APPLICANT..~~~~:, ,,~~~j
eye~o ;g~88~
~ ~ I f
L
~ FORM NO, 6 p ~ '
' ~ i TOWN OF SOUTBOLD
a`e BUILDING DEPARTP~NT
i'
TOWN BAL
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS
A. 'This application must be~filed in typewriter OR ink and submitted to Lhe Building
Inspector with the following; for new buildings or nee 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 eater supply and sewerage-disposal(S-9 form).
3, Approval of electrical installation from Board of Pire Underwriters.
4, Sworn statement from plumber certifying that solder used in system contains less
than 2/10 of 1Z lead.
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 BoardiApproval of completed site plan requirements.
B, For eaisting buildings (Prior to April 9, 1957] non-conforming uses, or buildings
' and "pre-existing" land uses:
1, Accurate survey of prgperty 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 enCire 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 informationirequired 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 OCCUPANCY - New Dwelling $25.00, <ldditions to Dwelling $25.00,
Alteration to Dweliling $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 S years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
S. Updated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Commercial
i~
i' .
-eo. 10/14/S8
I
765-1802
~ Q~ ~ BUILDING DEPT.
l INSPECTION
[ ]FOUNDATION 1ST { ] !ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] IN ULATION
[ ]FRAMING [ FINAL
REMARKS:
DATE ~ INSPECTOR
?1cLD iI:S:'EC;iUt+ ~~U;,:F ~ COMMLN7° ~
ro~
1. a~
~
FOUt7DATI0N (1st) -
FOUNDATI011 (2nd) _
2.
o
ROUGH FRAME & (`FAQ
"4
PLUMBING
H
3
II7SULATIOPI PER N, Y. y
STATE ENERGY
CODE
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ADDITIOP]AL COMMENTS:
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D t2 (a R a ry R ~ BOAFD OF HE<1LTH ~ .
t5 lgJ L5 V L5 p ~3 SETS OF PLr1NS 8•
lU! FORM N0.1 SURVEY ..~1 :1'~./!b¢Ey~ •'¢1`ta.~y.c¢
A~7 1sr TOWN OF SOUTHOLD CHECfi .
W0~ BUILDING DEPARTMENT SEPTIC r•oart
• TOWN HALL
BLDG. DEPT. SOUTHOLD. N. Y. 11971 NOTIFY l~~~ I
TOWN OFSOUTHOLD TEL:7G5-1802 CALL •.~•%7
GG ~y
Examined . R..l.~ 19 Y.°. yy MAIL T0:
Approved ...~~j 19~ Permit No.. lp ~ .
DisapProveda/c
.........AP • aov...AS por~CC..... Y~
. .
DATE: B,p,K ~0~~7 ( ildi' Inspector)
~ APPLICATION FOR BUILDING PERMIT
NOTIFY BU ING DEPA E T AT
766-1802 9 .4M TO 4 PM fOR THE Date . . 15 .
FtlLLOWING INSPEC710NS:
1, fOUNDAT1pN - TWO REQUIRED INSTRUCTIONS
FOR POURED CONCRETE
ALlt)f&¢p1CBARiglNrptyyt~gplggl~tely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets3af I)a131t~,A1~Df6ate piot plan to scale. Fee according to schedule.
8- 1=11{YfiiLplan 51YOII~T~tUJ4~[PC2d9tl~q~$'st and of buildings on premises, relationship to adjoining premises or public streets
or area9~a3f71RgFRiF1;EaF(G~'t~j1Ad description of layout of property must be drawn on the diagram which is part of this appli-
catidhL CON MEET
~iETRE~ p1Ni>`°ation may not be commenced before issuance of Building Permit.
8:~~tfd.hdlpT6~1ffi3iAGa~Nls~.f4l~n,..the Building Inspector will issued a Building Permit to the applicant. Such permit
sha14 ` •Npt dith'heg3ir sSt&hFlabt~fbr inspection throughout the work.
'e. T sed in whole or in part for any purpose whatever until a Certificate of Occupancy
shall h~g_fpgDpgSaa~t{pFl~y ~}tP~u~~t~~,pector.
A ~ ~tn(~~}~to the Building Department for the issuance of a Building Permit pursuant to the
Buildi qn r, ' nc , WTI"QZ Southold Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations,1.for the "c6nstrucuon of buildings, additions or alterations, or for removal or demolition,,as herein described.
' The a~p~,iC,ant~ a~rrs~s fo"Cbhiply' Zvith'S11'applicable laws, ordinances, buIlding code, hodsira~Hcode~ni~e-rr~'{~~ ~o.
admitau zed uispcc>tp;s on remises and in building for necessary inspe~'
i~"s.
~~~~i. ;.~N.~rtd~c:T~uNn~!CS
~ a
-ve iOMe'~LETE' FC)Si Q PP P .
ALL CONS'fRUCTfON SHALL MEET (Si~na[ure ot" a licant, or name, if a cor oration)
'THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY ~~~a, z;1~C?-LCd~p°'2•%',?,i~.
Cf3DES, NOT RESPONSIBLE FOR (Ivlailing address ofapplicant)
DESIGN OR GONSTRUCTION ERRORS
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
rl.~ R:'.................................................................. .
`ameoFo:vnerofpremises
(as on the tax roll or latest deed)
1(applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. -
Plurnber's License No . .
Electrician's License No . .
Outer Trade's License No . .
1. Location of land on which proposed work will be done. ~ .
E louse Number Street " " "
~g.~^~. - Hamlet - q
County Tax \1ap No. 1000 Section .-7 • • a • • • Block • •OI • • , , Lot,' / /
Subdivision . ,~.[?-~:~ff.~l~le:~...~ i~'Cf~.' %~..Sl F.ilcd Rfap No . . . Lot .
(N:une)
State esrsting use and occupancy of premises and intended use and occupancy`of proposed construction:
a. Existing use and occupancy ~
b. Intended use and occupancy
f ~ n' s... -
'jl ;.;1 k q
3, Nature of work check which applicable): New Uuilding D ~G~, , , , i Si I
Repair Removal { Addition Alteration ; , , ,
• • • • • • • Demolition ~ ~
••••••••......Othcrlyor~, p
4. Estimated Cost . ~ (D~scription)
~I Fee......,
' ~ (to be paid on filing this a
• . • • units , , , , , PPlication)
5. Ifdtvcllin~,numberofdwcllin
If garage, number of cars ~ ' ' ' ' ' ' : ; Number of dwelling units on each floor . , , , , , ,
...r
6. If business, commercial or mixed occupancy, specify nahtrc and extent of each type of use , , , , , , , , , , , • •
7. Dimensions of existing structures, if any: Front , ,
Hei.ht Rear lam............ Depth
. Nur4tbcr of Stories .l..
imens~ons of same structure
p ith alterations or additions: Front • ~ • •
Dc th.,,,,,,
. IIcight Rear .
8. Dtmenstons of entire new const ' ' ' ' ' ' • ' • • • • • Num ber of Stories , ,
ntction; Front . Rear . .Depth
H~~ght Nurttber of Stories • .
9. Size of lot: Front Rear . ..........................I1'1'rv~'3s.t{r'Ty::<j.
10. Date of Purchase ISept'h .
1 1. Zone or use district in which prl ~ ~ • • ' ' ' ' ' • • • • Name of I-ormer Owner _ ~ :~.d ~ -1 ~ ••'--r ' ' '
emtses are situated , ~ ~ • ~ • " " " ~
- I2. Does proposed construction vio~ate any zoning law, ordinance or regulation: ~ t', ~ • . ~ ' '
. na:.:
13. will lot be regraded . , i , , , , , • . • • • , • . • , , • , , IVill excess fill be removed Blom' premises: • ~ • • ~S'es • • . •
i
14. Name of Owner of premises , , , N~
Name of Architect ~ • " " " " • • Address .Phone No; '
Name of Contractor ................Address ..............::";:`.'Phone No.. .
If yes, Southold Town•.•••,•.••••~•~•'Address Phone No.........
IS*Is this ro ert local,ted within 300 feet of a tidal wetland? *YES....Np:~'6
Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly ally buildings, whether existing or proposed, and. indicate ail 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 comer lot.
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" - ~r U`;~17 't'~GK 15 `~4~0`1~t~~V - STAINS
A
a - _ $ltfCT Gd~~ -AXIS?IN(~
STATL• OF NE1V OR
COUNTY OF .
• ~ • ~ • • ~ ~ ~ • • ~ H- ` • • " " " • ' " " " • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
about named.
Ifcistlte j
(Contractor, agent, corporate officer, etc.)
~f said owner or owners, and,ig ~uly~juthorized`to perform or have performed the said work and to make and file this
tPPlication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
-vorl; will be pertorntcd in the manner sit forth in the application filed thcrcwittt.
"vom to before mettt~~his
...............l........day of . I............. 19~?• ,
iotar3' Public, ......~Q,QL~oc.; . ~ 2.!!It_......
County
HELENKOEV~OtE (Signature of applicant)
~N~o~4701878 Su~4folk Courtk~„
Term Expires Merch 30,18..-~F