HomeMy WebLinkAbout17906-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218759 Date FEBRUARY 2, 1990
THIS CERTIFIES that the building ACCESSORY
Location of Property 45125 MAIN ROAD SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 75 Block 02 Lot 3.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 6, 1989 pursuant to which
Building Permit No. 17906 dated MARCH 10, 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 ACCESSORY GARAGE.
The certificate is issued to DANIEL & LISA SEROME
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
Rev. 1/81
!'OBEs NO. f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUtLD1NG PERMIT
(THiS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 017 9 0 6 Z Date 19..~J.
Permission ~s hereby granted to•,
.~~a~"
.
ct premises located at ......T~~o~~5~ .......~,~4f~,t .....:..~1.P~"
~ n
Cnunty Tax Map No 1000 Section~~.. Block Lot No ...'J.'.!.
pursuant to npplication dated 19~, and approved by the
building Inspector.
Fee S•
wilding Inspec r
Rev 6/30/80
~q'~~
~ TOFIN OP SOUTIIOLD `
`\V,1.J ~ ~ BUILDING DCPART:IC27T `~~~5 ~ Lq='q"~~~Vyy~~~'
TONN IIALL ~ ~ 21.A77J ~I
SOUTIIOLD, NEp YORK 1197i~
~~~JJJ
765 - 1II02 BLDG DEPT.
~ TOWN OF SOUTFiOLD
APPLICATION FOR CERTZ£ICATE OF OCCIIFAtICY /1
DATE. L 1~ Z. G..... .
HEH CONSTRUCTION ._1....OLD OR PRE-E%ZSTI77G IIUILDING....._DACAt7T LAND........
Location of Property..; [.~-'._???.._....~laG~-=\ -'F'C~'-'-'--~G-•_ tr
UOUSE NO_ STREET tIAHLET
Owner or Owners of Ptoperty..~:tn:~-:__„ ~L~C 4__..~/r.~~.C~~~
a
Cauaty Taz Hap No. (000 Section ~.~IIlock Lot
Subdivision Filed Map ......_.Lot..._....
y /
Permit No. G _Date of Permit ~ /G _~~..Applican[ ._~..~'s~..___...._..
Health DepC. Approval Underwriters Approval._______._.___
Plaaning Board Approval
r'
l--''f
Request Eor Temporary Certificate Final Certificate
f~~~~
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Fce SubmiCted: $
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FOUt1DATTON ('IsYJ
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cOUNDATI0IJ (2nd)
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pOUGH FRAME &
• PLUMBING
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IIJSULATTOPt PER N. Y. 'j
STATE ENERGY
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AD TIONAL COMMENTS: s
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Cp BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ~ J ROUGH PLBG.
[ ] FOUNDATION 2ND [ } INSU T10N
[ ]FRAMING [ INAL
REMARKS:
r
O
~
DATE I ~ INSPECTOR
w
l ~ l 765-1802
BUILDING DEPT.
1 NSPECTION
[ FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ }INSULATION
[ ]FRAMING ( ]FINAL
REMARKS: ~ (5~-i~~~_2~ U~'
DATE l J ~ INSPECTOR
. ,
~tjSF;EF~
XL;~ TEi 7f•5•l807.
q Z'E)~~'N t}I' SOUTIIOLd3
!'+11~~a7it~,~~ -c Orf'ICii Ol~ F1U[LU1NG FidSPPCTOR
' ~ 1~} i 1( Mr
~I ~~j~f~vy ~-'l 3'.O. fJOX 7~8
cy, ~ ~ ~ "I01~FJ 1lALL
~'~"~~c~~ SOIIFI(OLU,N.Y.11971
`~~~j~l :j~,
January 19, 1990
Daniel Jerome
45125 Hain Road
Southold, N.Y. 11971
To Diitcm This May Concern, ,
[•:e arc unable to complete your Certificate
of~occupancy becau~c of the following rcason~.
An rtnplication for Certificate of Occupancy
is not nn file. (ENCLOSED)
:?o Uader:uriters Certificate on file.
/ / The check is (o+Sggggd[N$not oa file.) $25.00
Nn ?tr'nlth Dept. Approval on file.
P?c~ final inspection has been made.
Fl ease contact our ofL-ice an this matter.
Thank yon for your cooperation.
Build:cnr, Permit 11 1 7 9 0 6 2
BuilclincF OenL-.
Pip PZumher Solder Certificate on file.
( all permitu involving plumbinc3 being
i~:xted after April 1,l~IId
NOTE: BEFORE CERTIFICATE OF OCCUPANCY CAN BE ISSUED, A
CERTIFICATE FOR TRUSSES MUST BE PROVIDED TO THIS OFFICE.
• _ _ I
Unauthorized elMatbn a eddhbh
to this survey Is a violetlort d
](~4 - Section 7209 d the rNw Ygtk Blele i
I I Edueetim taw. ~
CodN dlhN sueveY 111ey lntlNl(li
i S. 4..~ L_ .t``,j ' ~ j . ~tf l"O t~1 ~ the land surveye/e MiMI MY Of
i i/ 1 emhwaed seal Nrp /wt M mMM~N
to 6e a wIM true eopY,
~U.
Q A GueranteNlttdleeesdM/MtttlArAtM
- !~•SB~AfiB'C• --1~1.?3_ i!t_5'~~39 ~ ~oNt l'/v1-21°Y only to thetMrsentorwltwtttltetlstrq
O Ll gig aeaered. endmli bMWNstM ~
~ ? i r lenAi InB
n~
R
tlen MIM~~10~
~ In thB eelipnep dfheleMlly Mle~.
tunon. GuerentaN Ke1101 trely~l~
,'~(j ~lz( ttridditional inetltutkMaettbeegttMtr
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S. 56'!2' DIV.
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~"u}~olk z:OUe-: t:/ 1'dx I~crreel = /~%~.r' _ G /5' - Z 3.:
i
~ 6udr~lrfte~d ~"'o ISvuthold ~SUV~:7ps Bdr~lc
®stvronuensrrt end >o Comrr>onwedlt~ t.4tic/ t7tle Jer~uranee
t CG. 46 evr?eyev' .3'e~bt. 4, ~ 985
/ZO Q EarBJ CK VAh' Ttt Y"L, A. C.
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~L.ICe~~er~ G.onr1 Surv'QYoY,S
T. ~ ~
A _..le
22 nn BOARD OF HE=\LTH
t ~ L7~_~ t 3 SETS OF PLAYS . l7= R.'.:::
~ FORM NO. 1 SURVEY - . - K•
. ~ ~y~~ TOWN OF SOUTHOLD CHECK 9~~ .
BUILDING DEPARTMENT SEPTIC FORPI
' ~ TOWN HALL •
BLDG DEPT ! SOUTHOLD, N Y. 11971 NOTIFY ~j -9
TOWN OF SUUTHOL%+~ TEL.. 7G5 1802 CALIs~•.L`:Y ~ .Z. / .
/O 19~ MAIL T0. 7~e,Grwir-st ~1f Q
L-ranttncdv.~. ~c~
Maur
Approved 19"(. Permtt No..~~~.G~ 96~
Disapproved a/c .
/ (B dm nspector)
APPLICATION FOR BUILDING PERMIT
Date 15 . .
INSTRUCTIONS
a. Tlus application must be completely filled to by typewriter or to ink and submitted to the Building Inspector, with
gets 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 ad~ommg premtses or public stree
or areas, and giving a detailed description of layout of property must be dra\vn on the diagram which is part of this appt
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 Butldmg Permtt to the applicant. Such perm
~halI 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 Occupant
shall have been granted by the Butldm; Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Btuldtng Permtt pursuant to th
Butldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Reeulations, for the construction of buildings, additions or alterations. or for removal or demolition, as herein descnbe~
The applicant aerees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and t
admit authorized mspectots on premtses and m building for necessary inspections-
(Signature of applicant, or name, tf a corporation)
(Mailing address of applicant)
State whether apphca t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buAde,
~~IfCCt/l~ IS ~ tnl r12(L-
.
tt Ls R ~
Name of owner of premtses 1Va~:>? 1
(as on the tar roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builder's Ltcensc No. ....~w .
Plumber's Ltccnse No
Elecutctan's Ltccnse No • • • • • • • • • • -
. .
Other Trade's License No .
I. Location of land on which proposed work will be done . . .
E{ouse Number Street Hamlet
~ r
County Ta\ itlap No 1000 Seaton .7~ • • • • • • • . • • Block Lot ....J.:. [ .
Subdivision Filed i<fap No . Lot
(Name)
Slate e~tsting use and occupancy of premtses and intended use and occupancy of proposed constructton•
a Ertsting use and occupancy ~a C.~................. .
b. Intended use and occupancy Y. • • ~ • ~~?r'.rY.::. , • s , , .
;ure of work (check which apphcable)• New Building ...v~ Addition AlteraUOn .
parr Removal Demolition Other iV~irk .
_ O (Descnpuoi
4. Estimated Cost ..-1J D ~ ~ . .Fee .
(to be paid on IIlmg this apphcatton)
5. If dwelling, number of dwelhng~ni[s . Number of dwelling units on each floor . , . , , , , , , ,
If garage.numbcrofcars
6. IF business, commercial or mixed occupancy, speaty nahire and extent of each type of use . . .
7, Dimensions of existing structures, tf any Front Rear Depth .
Hct_ltt Number of Stones .
Dimensions of same structure with alterations or adddtans Front Rear .
Depth llcight Number of Stones rr .
8. Dimenst~s of~enttre new construction Front ..3 G.~........ ' Rear Depth ~ .
Hciglit K Q ...........Number of Stones .
9. Size of lot• Front 7. Z• Rear ....13.I• • Depth ~ ~ ~ .
itl Date of Purchase .............................Name a£ Former Owner S; f; e ~ ?.42 .
1 I. Zone or use distract m which premises are situated .
12. Does proposed construction vioiate any zoning law, ordinance or regulation• .
!3. Hill lot be regraded 1Vd1 excess fill be removed from premises: Yes ~
14. Name of Owner of premises Address ...................Phone No............. .
Name of Architect .Address .........Phone No.
Name of Contractor .........................Address ...................Phone No............. .
IS.Is this properCy located within~00 feet of a tidal wetland? *YES....NO....
*If pes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dunensions frc
property lines. Give street and block number or descnption according to deed, and show street names and indicate wheth
lntenor or corner lot.
s~~ ~4f~G~ s~l~~~s`
STATL O1' \ElV YORE, S S
COUNTY OF .
, . . 6cing duly sworn, deposes and says that he is the applica
(Name of mdtviduaI stgnntg contract)
above named.
Iletstlie
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authonzed to perform or have performed the said work and to make and file tl
apphcanon; that all statements contained m this apphcauon are true to the best of his knowledge and belief; and that t.
work will be performed m the manner scC forth m the apphcauon fac:d therewith.
Sworn to before me [Errs p
daY off/..... 19 rf.
`7.
~'otaryPubhc, lj•. ~t.y~... Coun[Y ~ /
E ~L. L ,
HELEN fL DE VDE . . .
NOtARYPUBItC,StataoftdewYodi (Signature of applicar
Na 47678/8. Sutfo~k County
Term LxQves Maish 30, t9~
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