HomeMy WebLinkAbout18418-z FORM N0. 4
TOWN OF SOUTHOLA
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18847 Date FEBRUARY 26, 1990
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 870 PARK AVENUE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 56 Block 1 Lot 2.9
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 8, 1989 pursuant to which
Building Permit No. 18418-Z dated AUGUST 22, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE, DECK & COVERED
PORCH AS APPLIED FOR.
CLINTON & PHYLISS ROOT &
The certificate is issued to DAVID & GRETCHEN FOSTER
(owners}
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL FEB. 21, 1990-89-SO-87
UNDERWRITERS CERTIFICATE NO. PENDING - FEB. 22, 1990
PLUMBERS CERTIFICATION DATED FEB. 21, 1990 - MIKE JACOBI
` uildin ` Ins ector
q P
Rev. 1/81
Fosai xo. s
TOWN OF SOUTHOLD
BIiILDING 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 41.8 Z Date ~ 19...Q../
Per~sion ' y granted ~ry „ / ~ ~~,r~ ~ ~
to .....~.~.~m.....
at premises located of .....G•<....................................................................
County Tox Map No. 1000 SectionC..........~.-6.... Block Lot No.........G.a~...L.~..
pursuant to application doted ....Gtj~ 19 . and approved by the
Bui ldf ng/I~ns/pector.
Fee $....iCl.~.
Build g aspect r
Rev. 6/30/80
TOF1N OF SOUTIIOLD
IIUILDZNG DEPARTMENT
T041N IIALL
SOUTIIOLD, NEH YORK 1?971
765 - 1802
APPLZCATZON FOR CERTIFICATE OF OCCOPANCY f /
NEN CONSTRUCTION ..:....OLD OR PRE-E%ISTZNG IIUTLDING......VACANT LAND........
Location of Property...0.~~ ~l/71~-~~ ..L:UL~._._..... ~UU7~CG7........
DOUSE NO_ STREET IIAMLET
Ovner or Ovners of Property.~U~.~ee~~.GG.....~~`'S~Cn
County Taz Hap No. 1000 Section V../ Block Lot~~~.(~._...
'
Subdivisioa~~l~G: PC~OW~_.C,~T~S.S~rFir~l1ed Ma,Sp~ ?~:3.~...Lot.
Permit No. o. ...Date of Permit !/i.??~~;[..Applicant .~U~~~~4c~:". a~~~s;
Health DepC. Approval Undervritcrs Approval......._......
Planning Board Approval
Request for Temporary CertificaCe Final CerCificate
GGyym ~
Fec Submitted: $~?'L:.'_.f~
APPLICANT ~~~~.~~v~~CL~'1G~-. CPA~~~ .
rev. ioiia/Bs
~~c.. 3 9 o y~. C ~ ~°"~t
Ca ~ 188{7 _
FORM N0. 6 111
TOWN OF SOUTDOLD
BUILDING DEPARTMENT
TOWN BAL.
765 - 1802
APPLICATION FOR CF~RTIPICATE OF OCCUPANCY INSTRUCTIONS
p. This application must be',filed in typewriter OR ink and submitted Co the Building
Inspector with the folloGing; for new buildings or new use:
I. Final survey of prope{ty with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final approval of Bealth Dept. of water supply and sewerage-disposalCS-9 form).
_ 3. Approval of electrica) installation from Board of Fire Underwriters.
4. Sworn statement from lumber certifying that solder used in system contains less
than 2/10 of IZ lead,'',
S. Commercial buildings,iindustrial buildings, multiple residences avd similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning BoardjApproval 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 Che applicant
and a certified abstract of title issued by a title company which shall
show single and separate ownership of the entire lot prior Co April 9, 1957.
If a Certificate of Occupancy is denied, the Building Inspector sha21 state the
reasons therefor in criting to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or ocher
pertinent informatioq required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
1. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abst~*act of title issued by a title company showing single and
separate ownership ot~ 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 reasc}ns therefor in writing to the applicant.
D. FEES:
1. CERTIFICATE OF O(CUPANCY - New Duelling $25.OD, Additions to Dwelling $25.00,
Alteration to DwQllivg $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.
py of Certific~tc of Occupancy - $5.00 - over 5 years - $10.00
3. Co ~
4. Vacant Land Certificate of Occupancy - $20.00
5. IIpdaCed Certific'~te of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $15.00 Residential
Commercial
ev
• 10/14/S8
i _ ~
TEL. 765-1802
~oS~EFOC/r~OG TOWN OF SOUTHOLD
y~c OFFICE OF BUILDING INSPECTOR D ,,,o,,~
c rn P.O. BOX 728
v' ~ TOWN HALL
"O,y~o~ ~ SOUTHOLD, N.Y. 11971 2 1
'''~~ll 61~7t3 DEPF.
C E R T I F I C A T I O N
Date a ~ C/
Building~"Permit No.
Owner ] ~ Z ~
(please print)
Plumber ~ KF'... ~,1,~tCp~j i
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
.
(pl er's signature)
Sworn to before me this
~~day of ,
19~• Notary Public
Notary Public, County
HELEN K OE YOE
NOTARY PUBLIC. Stale of Mew Yak
No. 470787&, Suflalk CaurdY
Term Expires March 80,19..../-~
'r1ELD I;:S:'ECi1U11 ~~UnTC. COMMLNr° ~
- ~ ~ ~
• ~ H
_ H
FOUNDATION ( 1 ~'t ) ~ -
~
2 7 gf Q O~ o ~
FOUNDATI0IJ (2nd) _ _ a ~ m
2. ,~L U ~ ~ s
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P,OUGH FRAME & C,
PLUMBING
1 ~
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3. / ~ - ~ m~
d/ c~
IIJSULATION PER N. Y. y
' STATE ENERGY
CODE x p\
4 . ~ y ~
FINAL `p~~
ADDITIOPJA COMMENT
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~ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST f ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~NAL
REMARKS: --~z~-
2 C~
DATE ~ J C INSPECTOR ~/u~,
~ / ~ ~ rss-is02
1 BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ~ INAL
I
REMARKS: '
J
-
~ / ~i
G~
DATE ~ ~1 ±C INSPECTOR
' 765-1802
BUILDING DEPT.
1 NSPECTI®N
[ ]FOUNDATION i5T ( ] RO GH PLBG.
FOUNDATION 2ND [ _ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~~~ro~~A~
DATE ~ IN5PEGTOII?J
~ t~.~soz
BUILDING DEPT.
1NSPECTI®N
[ ]FOUNDATION 1ST ~ ~OUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS : ~~?u'~~?___~~=~-'
~ -
DATE Z~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] IROUGFI PLBG. ,
[ ] FO NDATION 2ND [ ]INSULATION
FRAMING [ ]FINAL
REMARKS:
DATE ~ ~ ~ INSPECTO
~ 765.1802
BUILDING DEPT.
INSPECTI®N
[ ]FOUNDATION 1ST (RO ~H PLBG,
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
J
REM KS: .iii
r
DATE ~L ~ INSPECTOF~= .%I
k
' ~ 7 765-1802
BUILDING DEPT.
f NSPECTION
[ FOUNDATION i5T ( )ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
N ~ FI AL
[ ] FRAMI G ] N
REMARKS:
_~~2_._-
9 5
DATE ` ~ INSPECTOR
1 $ G ~ ~ ~ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ } ROUGH PLBG.
I
[//}FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~n n G~-~-c.cr ~~y~./L
a
DATE ~6' q INSPECTOR ~~`e.~~
~ ~ ~
. ~ BOARD OF HE.ILTH
G I[;
L i - I'I L~ ~ i
r 3 SETS OF PL~AVS l7:~:
,uf FORM NO. 1 SURVEY d~ • • • •
~j ~ $ ~ TOWN OF SOUTHOLD CHEC[t ~ .:'~la .
BUILDING DEPARTMENT SEPTIC FO[tM
TOWN HALL
BOF§O HOLD SOUTHOLD, N.Y. 11971 NOTIFY ~c~a
TEL.:7G5.1802 CALL tP 7
MAIL T0:
\pproved 7i • • • • 19Q.~Pennit No.
Disapproved a/c
m - ' ( ildi ~ nspector)
APPLICATION FOR BUILDING PERMIT ~i
Date E~• • . 15
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Buildin; 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
shall 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 Tawn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for7emoval or demolition, as herein described.
Tire 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 necessa inspections.
(Signature of applicant, or name, if a corporatton)
. Pa~..~~X. ~ ~?J~.... s~ ~~N~~ ?v•Y .
• (Mailing address of applicant)
Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~~t~!?~Vt1 ~ Q}{Yl~~s. ~O ~RVL + ~r~ `rCi~L:+i? • , ~'t?S' i PZ.
(as on the tax roll or latest deed)
ICapplica corporation at re of duly authorized officer.
('ame and title /of/corporat~e~officer) 1 f
Builder's Liccnsc No. ~ a 6 l` .
Plurnbcr's Liccnsc No. ~fDC~Pt<..`.l~
Electrician's License No. ../..G~t! • • • • • •
OtfterTrade's License No .
1. Location of land on~/w~/hich pro/p~osed work will be done. , ; • , • , , , , , • • • • .
house Number Street / Hamlet g
County Tax /\lap No. 1000 Section • • ~ • • • • • • • BI°ck • • • • •F • • • • Lot f
Subdivision,G-~~G, ~ST~~L g.. Filed ~fap No. . ~0~~..... Lot . .
•(Name> s~eF 7" ~ 71~~ nvr4r~ ~ /v~v°DS6 -1-~, 9
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Yl/ .
b. Intended use and occupancy S•~~~•~`' GG~. • • • • • • • •
it
3. Nature of work (check which applicable): New Building . Addition Alteration .
Repair Rcmovai Demolition &r tiVp-~k • • . .
(D~sctiption)
/
4. Estimated Cost .....~.3 . J. D u.~ Fee , .
g (to beFpaii~.on, f1'tfig.,tltit~,I.apPM&ation)
S, If dtvcllin^ number of dwellin
If ara_e, number of cars • • I units ....l.......... Number of dwelling units on each Cloor .
^ ^ a,
6. If business. commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front . ~tJ.~C:.... Rear Depth .
Height Number of Stories .
Dimensions of same structure vl~ith alterations or additions: Front Rear .
Depth . i • .Height Number of Stories / , , , , • •
8. Dimensions of ntire new constcttction: Front . ~ Rear G......... Depth ..b. ;K-....... ,
Height Number of Stories
9. Size of lot: Front G.U Rear ~ U Depth ~a~G~~.~.~........... • .
f 0. Date of Purchase ~V
?t'i=...! ~q .3 Name of Former Owner ~
1 1. Zone or use district in which prt miser are situated ,~r6':SL04`'.^: ~!r}( . •
12., Does proposed construction violate any Doing law, ordinance or regulation: . ~Q . ,
!3. Nill lot be regraded ..~Q~hl.'1~~; , , ~/GA¢?!/U~:' ~V11 excess fill be removed from premises: n,f~Yes Ak
14. Name of Owner of premises Q~k4, C~!t~Tt(YG?''. ~~dress . ~~~r~'(OL''? ~IP,,~~t~ne No. . .
Name of Architect . L~~I.tl.l?Cn!44-. .7'~ 1 1:4/ Address I~Q.t~vX.l6 fr,~~;"'O'PFtone No.~/.~~
Name of Contractor 7'k~~E.L,S,{;?t; • .e3,v,1u?4rf?S... Address i3ax/;(Z.f,Sgyr~fx!~ phone No. 76S .`~Q.° ~ '
15.Is this pxoperCy located within 300 feet of a tidal wetland? *YES....NO.~~
*Zf yes, Southold Towri Trustees Permit may be xequired.
PLOT DIAGRAM
Locate clearly and distinctly all~ll bui]dings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block ~tumber or description according to deed, and show street names and indicate whether
interior or corner lot.
•
i
' .
I
~I
STATEOFivENYORK' SAS
COUtiTY OF
i
• • • • • • • • • • • . • being duly sworn, deposes and says that !te is the applicant
(lame of individual signiii'~g contract)
about named.
ficisthc !
(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 this
tPplication; that all statements cpntairjcd in this application arc true to the best of his knowledge and belief; and that the
vori; tvdl be perforntcd in the manner set forth in the application filed therewith.
'wom to bclore me this ' •
\
votary Public, (i-:. ~.:t•1R.V.4.f::...... County ~ ~ ?vr~ ~
HELEN K. DEVOE ~ c ~ • •Signatuzeofap~ican )
N No~470®87A,SuflolkCenn41~
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