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HomeMy WebLinkAbout17660-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bulldlng Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19069 Date MAY 22r 1990 THIS CERTIFIES that the building Location of Propert~ 1450 FAIRWAY DRIVE House No. County Tax Map NO. 1000 Section 109 Subdivision FAIRWAY FARMS RENOVATION Block 05 Filed Map No. CUTCHOGUE Street Lot 14.008 Lot No. 8 Hamlet conforms substantially to the Application for Buildlng Permit heretofore filed in this office dated DEC. 6, 1988 pursuant to which Bulldlng Pernklt No. 17660Z dated DEC. 6~ 1988 was lssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for whlch this certlflcate is issued ~s RENOVATE EXISTING ONE FAMILY DWELLING BY CHANGING WINDOWSr CHIMNEY REPAIRr SIDINGr ROOF SHINGLING AS APPLIED FOR. The certificate ls issued to WESLEY W. LANG (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev, 1/81 TOWN OF $OUTHOLD 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~ 017660 Z Permission ~s hereby granted to' . .-~.~...~..9..~.~ ................................. ,...c~.~~....~.~t.,....~.~..~ ~.~-.... ~~~.~-.~.~.~-~.~., ~;i~.~,~ ,, .L~.~.....~.~. ~..~.~ ....... ~.~~ ........ Coun~ Tax Map No 1000 Section .... ]..~.~ Bilk ...~.~. ..... Lot No.. pu~uant to apphcat,on dat.d~ ....... ~ ., 19.~., and approv~ by the Building Inspector, Building Inspector Rev 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Thzs application must be filled in by typewrlter OR znk and submitted to the building Inspector with the following: for new bumldzng or new use: 1. Final survey of property with accurate location of all buzidmngs, property lines, streets, and unusual natural or topographzc features. 2. Final Approval from Health Dept. of water supply and sewerage-dlsposal(S-9 form). 3. Approval of electrical installatzon from Board of Fzre Underwrzters. 4. Sworn statement from plumber certzfying that the solder used zn system contains less than 2/10 of 1% lead. 5. Commercmal buildzng, industrzal buzlding, multiple residences and simzlar buildings and installations, a certificate of Code Compliance from archztect or engineer responsmble for the building. 6. Submzt Plannzng Board Approval of completed smte plan requmrements. For existing buildings (prior to April 9, 1957) non-conformzng uses, or buzldings and "pre-exist~ng" land uses: 1. Accurate survey of property showing ali property lznes, streets, buzlding and unusual natural or topographzc features. ~ 2. A properly completed applzcation and a consent to znspect signed by the applzcant. If a Certificate of Occupancy is denied, the Buzldzng Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwellzng $25.00, Addztzons to dwellzng $25.00, Alterations to dwellzng $25.00, Swzmming pool $25.00, Accessory buzlding $25.00, Addztzons to accessory buzldzng $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existzng Buzldzng - $I00.00 3. Copy of Certzflcate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Reszdential $15.00, Commerczal $15.00 Date ..~ ~.~ ~ ~ ~7~ New Constructzon ........... Old Or Pre-exzsting Building .... ~ ......... Location of Property .... [.V~.O. '~''~...... House No. Street Hamlet v County Tax Map No 1000, Seetion..Jl~. ...... ~loc~ ..... ~J.- ....... not..g.~...~.~.~. ......... Snbdiv~sion .......... e Map ........ Lot .............. Permzt No.~f.~..~.Date Of Permit.~...~.~.Applicant ............................. Health Dept Approval . Underwriters Approval ......... Planning Board Approval .................... . . . . Request for: Temporary Certificate ........... Final Certzcate.....~.. .... Fee Submitted: APPLICANT FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: BLDG. D,r. PT TOWN OF FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, NY 11971 TEL: 765-180:3 , I9~o.'~ Permxt No / .'7.~(e.©. ~ BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY CHECK SEPTIC FORM ................ NOTIFY CALL MAlL TO: Disapproved a/c ......................... i (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This apphcatlon must be completely filled ~n by typewriter or in ink and submitted to the Bulldmg Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locanon of lot and of buddings on premises, relationstup to adjoining premises or pubhc stree or areas, and giving a detmled description of layout of property must be drawn on the dmgram which m part of flus app~ cation. c. The work covered by this applicahon may not be commenced before issuance of Bmldmg Permit d. Upon approval of thru application, the Binldlng Inspector will issued a Binldmg Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupan,_ shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the msuance of a Bmlding Permit pursuant to tl Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances t Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply wtth all apphcable laws, ordmances, budding code, housing code, and regulations, and , admit authorized inspectors on premxses and m building for necessa~ections _ , (Signature of apphcant, or name, if a corporanon) au es~Jof apphcant) , State whether applicant m owner, lessee, agent, architect,, en~neer, general contractor, electncmn, plumber or bmldei Nameofownerofpremlses ~f~J~~.' (~rl~t~st'fiedd) ...................... If ffp:Tznature o ly authorized officer Budder's L,cense No. .l .'~/~ .q ~. ,~- E... Plumber's License No ................. Electrician's License No .................... Other Trade's License No ................ Location of land on wtuch proposed work w:,l be done /~~~. ~..~...gt~. '. ~..~.~ .... ... .... ....... House Number Streeff Hamlet '~ County Tax Map No ,O00Sect,on /O.~ ..... Block ~.~ ...... Lot . . ~?~ Subdivision Sta~e exishng us~ and occupancy of premises and mtcnded usc and occupancy of proposed comstructJo~ a. ~x~stmg ~sc and occupancy ...... ~,..' ..................................... b. Intended use ~nd occupnncy ·. ~- 3. ~ work (check which apphcable) New Budding .... ' . .. Addition ...... Alteration ........ f Repmr'f .. ~. ..... Removal ......... Demolition ......... Oth~km.~ ....... 5. If dwelhng, number of dwell~ng umts .. / ..... Number of dwelhng units on each floor ........... If garage, number of cars ......... ~.. , ........................................... 6. If bus~ness, commercml or m~xed occupancy, specify nature and extent of each type of use ................. 7. D~ensmns of ex~st~ng structures, if any Front ............ , Rear ............. Depth ........... Hmght ......... Number of Stones ..... ~~ ....................... D~ens~ons of same structure w~th alteratmns or addmons Front . . ~ ...... ~ Rear ............... Depth ................... Hm~t ................. Number of Stones ................... D~mensmns of entire new constmctmn Front . ~ .... ~ear . .~ .......... t~epth .. ~ .......... 8. Height ............. Nun)berofStorles. ;-:~ .'~~_ / - ~~. 9. Slzeoflot Front .~~~ .............. ~.~ De~ ................... 10. Date of Purchase .............. ~ ........... Name of Foyer Owner ...................... l I, Zone or use dmtnct tn wkich premises are sttuated ......................... ~2 ....................... 12. Does proposed construction violate any zomng law, ordinance or regulatmn .... ~Z.:.. ~ ............... 13. Will lot be regraded ........................ Will excess fill be remov~ from premises Yes 14 Nme of Owner ofpremlse~~t~Address .~~g.q.. Vhon~ ~o Nme of Architect . ' 't.:'~ '}~ ...... ~ .... Address ,: ....... ~ ..... <. Phone No.X..L...:. Nme of Contractor~.~.~~ Addre~ , ~~ ~e No.7~ ¢~ 15.Is this property located within 300 feet of aAidgl we~and? *YgS .... NO .... *If yes, 8outhoId Io~n Iruscees Per~[t ~ay be required. PLOT DIAG~ Locate cle~ly ~d distinctly fll buddings, whe~er exmt~ng or proposed, ~d in&cate ~1 set-back d~ens~ons fro prope~y ~es Gtve street ~d block number or descnpt~on according to deed, ~d show street nines and ~&cate wheth. interior or comer lot. STATE OF NEW YORK, COUNTY OF ........... S.S (Name of tndwldual stgnmg contract) above named. ·.. being duly sworn, deposes and says that he is the apphcm He is the .... (Contractor, agent, corporate officer, etc) of said owner or owners, and apphcatmn, that all statements contained in this appbcation are true to the best of his knowledge and belief, and that tt work will be performed tn the manner set forth in the apphcatton filed therewith. Sworn to before me thls ........... .. dayof · · . ......... 197.. Notary Pubhc ....... .~...L2.~..O..~. ..... County NOTARY PL~?C Slate? Hew Yo~ (Signature of applica~