HomeMy WebLinkAbout18294-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218191 Date JULY 17, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 1600 PARISH DRIVE SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 071 Block O1 Lot 26
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 12, 1989 pursuant to which
Building Permit No. I8294~ dated JULY 12, 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 NANCY E. RADMIN
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NjA
UNDERWRITERS CERTIFICATE NO. NjA
PLUMBERS CERTIFICATION DATED N/A
0-4 lJ~C
Bui ding Inspector
Rev. 1f 81
¦os~ 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 ° ~ g ~ ~ ~ Z Date ..........~......1..2 19....1
Permission is hereby granted to•
........11111...1./.~....:~.~.~':....~r.~....Q.(
ta ...1:%".~":4~:.is~P...:'....5.~......~.f.~.....~„~.4X..~k4rYxa...,~1.P.....a-~:,.....~!~~-~!'Y~.....r~::....
at premises located at ..[..T.~.~..........~.. ~ ?~-d~ ~
County Tax Map No. 1000 Section ........~?.:7..(...... Block .......e?..~......... gqLot No....s~.~a............
pursuant to application doted ............~.....~.Q 19...1., and approved by the
Building Inspector. II
Fee
~a'r'.
B Iding Inspector
Rev. 6/30/80
TOWN OP SOUTUOLD
BUILDING DCPART2IRNT
TORN UALL
SOUTIIOLD, NEFI YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPAC7CY '
NEH CO:ISTRUCTZON .17.,.,OLD Oft PRE-E%ZSTING BUZLDING......pACANT LAND......•
Location tt~~ ~ ~j y,
of Property-.~T75........ ~15.~... V~...._. ~Lt"l~o~~ _
HOUSE NO. STREET ~ " " "
NAHLET
Ovncr or Ouncrs of Propert ~
Covn[y Taa Hap No. ]000 Section ~ „ ~ +~r,
Block Lot"O~V,,,,.
Subdivision...
Filed Map ._...Lot.
Pcrmi[ :io. ate o Permit
D € ..__......A
PPLicant ~~~;''t~~. ~f~~l(
Ucal[h DepC. Approval J'
" " " Undcruritcrs Approval.......
Planning; Board Approval
Request for Temporary Certificate
Final Certificate
Fcc Submitted:
APPLICAN
KILL. 3)~6U
~P i ~d 9~~
L
yj
FORM NO. 6 i
TOWN OF SOUTUOLD
BIIILDINC DEPARTMENT
TOWN IIALr.
765 - 1802
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:
I. Final survey of property with accurate location of all buildings, property lines,
streets, aad unusual natural or topographic features.
2. Final approval of IIealth 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/!0 of 1Z lead.
S, 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 $oard 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:
1. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2, A,properlq completed application, a consent to inspect sigeed bq 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:
1. 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
Lhe 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, 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 - $!00.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4• vacant Land Certificate of Occupancy - $20.00
S. IIpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $/,5.00 Residential
tt $50.00 Commercial '
'v• 10/14/58 -
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IIJSULATION PER N. Y. y
STATE EfJERGY R
CODE
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B0.1RD OF HE.ILTH
FORh7N0.1 3 SETS OF PL,1NS
SURVEY
TOWN OF SOUTHOLD CffECK ,
BUILDING DEPARTMENT SEPTIC FOR:I . • ~ ~ ~ ~ ~ ~ "
T04VN HALL ~ ~ " ~ " "
SOUTHOLD, N.Y. 11+J71 NOTIFY ~t~-7
((((~~j~ qq TEL.: 7G5.7302 CALL ~ l,~ ,a~~J,D _
Examined . , 19~10gj p DIA I L TO
Approved ~~-Fr..~.2,.., 194./. Permit No. ~.~.`~.1.7.~ '
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
• Date 15.
INSTRUCTIONS
a. TIzis application must be completely filled in by typewriter or in ink and submitted to the Buildina+ Inspector, with
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street
~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl
:anon. ,
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant.
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY i4fADE to the Building Depart t+for the issuance of a Building Permit pursuant to tht
9uilding Zone Ordinance of the Town of Southold, Suffolk Co t~y }
• ')`ril>4f°a other applicable Laws, Ordinances o:
Regulations, for the construction of buildings, additions ar al~,~$tlisn~, ~rd~r ~e~P~l or demo]ition, as herein described.
,ize applicant agrees to comply with all applicable laws, o i~ iih
admit authorized acc~.~ bq _dut~ eo e, ousinG code, and regulations, and tc
inspectors on remts sand in build' ~u'kron
a , , . : , R mg for 'g~arv ifi~p ~ ,
x t ~
,a .
(S~_n ure of applican or Name, if a corporanon)~
~k~.
U1Q
_ , - % • (nI ` ing a ress o applicant)
State whether•,~pplicaht is nwner,,,lessee, ,agent, architect, engineer, general contractor, electrician, plumber or builder.
' \ame of owner of pfethi'ses . , . ~ ~
- ,,j ~ • , ~ ; ; ' ~ ~ (as on the tax roll or latest deed)
Capplicant is aipo{~,ora4~pn, si:ghature~dFi3uly authorized officer.
~i ~ r,~ , .
(1\jam,e-~rr~d~t~Sli@:o-f'/¢rybrp'tiratc dfG'c'eY),
Bui]dcr's Liccnsc No. I?, ~?!v
Plumbci s License No . .
Electrician's License No .
Otltcr Trade's License No . .
Location of land on which roposcd work will bu done.
1louscNumbcr Strcct. ~ ~
Hamlet '
County Tax ,11ap No. 1000 Suction Bluck , ~
Lot.a
Subdivision F.ilud ~fap No. .
Lot
(Name)
' State existing use and occupancy o(,(p~remises and inrendud use and occupancy of proposed construction:
a• Exist+ng use and occupancy a4 r.~ ~.~)":~1~.~:...
b.Intendcd u ~ .
se and occupancy 1I~:E+V,r{ A1;-, , , , • . • ~~qq(,
x
' I'
3. A'ature of work (check which a
Repair , , , , • pplicable): Ncw UuilJing
• • • Removal • • • • • Addition 4-~t~~, , , ,Vt:ra[ton
• • • • Demolition • . .
• . Other lti'ork .
4• Estimated Cost . ~ ~ • ~ • ~ ~ • ~ •
(Dacr,puon
Fec~::
• if dwcllin„ number of dwelling units • , tto be paid on filing this application)
Ifgara,c,numbcrofcars Numbcrofdwcllingunhsoncachfloor..,,,,, •
6. If busmcss, commercial or mired occupancy, specify nature and extent of cacti t ~ •
7. Dintcnsions of existing structures, if any: Front YPc of use .
Hcicht Num ber of Stories , Rear Depth . ' • • . • • •
Dimensions ofsamcstructurcwithaltcratio
Depth . • . licight •ns or additions: Front . • • • ......Rear • . • • • • • .
' 8. Dimensions of entire ncty construction: Front " " " " " • • • • Number of Stortcs . ~ • • • "
Hei;ltt Number of Rear . •
9. Sizcoflot:Front...., Storics...,,,,••.••... """"•'••••Dcpth
10. Date of Purchase Rear .'............Depth
1 1. Zone or use district in whidt p . ' ' ,
remises arc situated • 'Namc of Former Owner
12, Does proposed construction violate any zoning law, ordinance or regulation:
l3. ~ti'ill lot be recraded • • .
14. Namc of Owner of premises . • • , ~ • ~ • ' ' ' ' ' ' ' • • • Will excess fill be removed from premises: Ycs • • . '
Name of ,architect ~ ~ ~ ~ ' • " " • • • Address .Phone No.. •
Name of Contractor • • ......Address ...................Phone No.. ' • . • .
IS.Is this property located ""''Address.., .PhoneNo..••~~•~~
witt[in~00 feet of a tidal•wetlaod? *YES..,.l70
*If yes, Southold Togn Trustees Permit may be required.
PLOT DIAGRAhf
Locate clearly and distinctly all buildings, whether
existing or proposed, and. indicate ail set-back dimensions fro:r
propcny lines, Give strut and bloc}; number or description according to decd,
[ntcrior or corner lot. o and show street names and '
tndicate whcthc;
OC
i$PUNMW UI.
USA APPROVED A5 NQTED
~IITOF OCCUPANCY oATE:
" ~ ~ Nf~IFY BUILDING DEPARTMEry q7
' " ` 766.1802 8 AM TO 4 PM FOR THE
fOLLOWING INSPECTIONS;
t. FOUNDATION TWO REQUIRED
• FOR POURED CONCRETE
2. ROUGH -FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
8E COMPLETE FOR C.Q.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y,
STATE CONSTRUCTION & ENERGY
"CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
T,1TL• OF \'Ell•~y'O
UUNT SIS
J~~s ~tr~G~~
, c oCindicidual si~ninq• • • ~ ~ ~ • ~ ~ ' ' ' " " • • bcin^ duly sworn, deposes and says that he is the applicant
~ovc na ~ 'ton tract) °
med.
is the .
said (Contract ,agent, orporatc officer, etc.) ~ • ~ ~ • ~ ' " " " • • • • • • • • • •
owner or owners, and is duly authorized to pcrf rm or have performed the said work and to
ilication; that all statements contained in this applicgtion arc true to the best of his knowledge and belief'
tk wdl be pcriomtcd in tlic manner sat forth in the application filed thcrcwitlt, m~'O and file this
°m to bciorc me this ,and that the
.....~.Z.~.....
a;; Public . ............4~~, ~~~E~.......
• • County
. y
(Si;naturc of applicant)
i