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Home My WebLink About17423-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z20158 Date AUGUST 22, 1991~ THIS CERTIFIES that the building. ADDITIONS Location of Propert~ 350 HYATT RD. EAST PVT. RD. 18 House No. Street County Tax Map No. 1000 Section 50 Block 03 subdivision Filed Map No. SOUTHOLD Hamlet Lot 23 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 7, 1988 pursuant to which Building Permit No. 17423Z dated SEPT. 14, 1988 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 ADDITIONS AND FIREPLACE TO EXISTING ONE FAMILY DWELLING. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED . N/A EDWARD & PHYLLIS STANLEY 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) N9 0~?~23 Z County Tax Map No. 1000 Section ........ (.~...~., ...... Block Lot No. Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN RALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features, 2. Final Approval from Health 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 the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 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, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy- Residential $15.00, ~omme[cial $15.00 / Date ........... ~ / .~.'l..~..~.~.// / ............ '~ .... New Construction ..... .~..... Old Or Pre-existing Building ........ Location of Property .... ~..~..~..~.....~.~..~.'~ o .~..2 .... .~ .... ~.~ .~.. ]~[~.~?. !.~ House No. . ~ ~reet Hamlet County Tax Map No I000, Section .... ~.~.~.~....Block.....O..~' ...... Lot ....... ...~D~. ......... Permit No...t.~...~. Health Dept. Approval ........ ' ...... Planning Board Approval ........................ / Request for: Temporary Certificate ..... Fina ticate... Fee Submitted: $...~...~.[.~.?/.[[.[[.[.' [~~~~." ' i ....... FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDIT%ONA'L COMMENTS'. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION ;ZND [ ] INSULATION [ ] FRAMING REMARKS: 765-1802 BUILDING DEPT. SPECTION []FOUNDATION 1ST [ ] ROUGH PLBG. []FOUNDATION 2ND [ ] INSULATION []FRAMING THOMAS 8 ANGELIKI TSONSAS' ~'~ ; ~,~O,/~,,F, SUSAN MANLEY z mm ~o 270.59 R.QW. N,4 046 40"W. 149.16 ' ~.~ S.4 o5 50 E 148.64 N/O/F JULES RIEFF & FLORENCE RIEFF N/O/F MARIE ALDI l /x._¢ c__.__c~_ lC BOARD OF HEALTH z..../... ..... 3 SETS VLANS q. ..... SURVEY .~.,, ............... ' . CHeeR .f :.. Z' ] · SEPZZC FOR~ .-...73 ........ NOTIFY CALL ~I~- MAIL TO: FORM NO. 1 /OWN OF SOUTHOLD flUILDING D[:PARTMENT TOWN HALL $OUTHOLD, N.Y. 1'197'1 TEL.: 765-1802 Examined. ~..~?. ,.,~. ..... ,..., 190~'' Approved.. '.~././.~. ....... , 19;~Pcrmit No...z/Z .~..~...~ ? Disapproved a/c ..................................... spector) APPLICATION FOR BUILDING PERMIT Date. ?f.~.~,,..7 .......... 19 .~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 l~yout 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 Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, a,d, ditions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housir~ code, anlirT,~Kulations, and to admit authorized inspectors on premises and in building for necessary inspection~ //~-~ · (Si~,~a-fure oi applicant, orname i(_~corporauon)' ' · . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~.~5~.~.?...~.'..~...~..H'.f.~./.~.../~....5~/Z~,'L,,dY . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... . . .'~.....~..u4 N ~l~ .... Plumber's License No ..... .'~/./f..~ ...... /~.¢! .~.f,-.. Electrician's License No....~'../f.~. .... /~ .O. LJf~ . . . Other Trade's License No....~'..~.~. , .~. q .N. ~ ..... 1. Location of land on which proposed work will be done....~?."Y House Number Street Hamlet 5~a ct 7 HaL.b County Tax Map No. I000 Section .OS-O ' Block ~3 ~o~ Z3 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / i,~,d~t~.y b' Intended use and occupancy ,: .......... ~-- ~)~/~'; ' ' ....... ........................ · .. .r · k ( hi ppli ) ' Additioh 3 Nature of Wor check w ch a cable: New Building .......... ~>~c~ Alteration ......... plti .......... Re r .............. Removal .............. Demolition ........ , ...... Other Work . ~" d~ (Description) 4. Estimate'd Cost °°d~' - tt0 be paid on filing this application) 5. If dwelhng, number of dwelhng umtfi ..... ~ ........ Number of dwell ng[units on each floor ,2:... If garage, number of cars . . .'~/..'T. , ' ............. ' '' ........... ...... .......... 6. ,bus~n.ess, conunercm, lormixedoccnpancy, pci n~a ~e n exte t fca htypeo u e. 7. tamenmons of exist ng structures if any' Front 30. ~ r, xZ' ~" ,~, ' ' ;:.'; ....... · · ............... ear ,..,.,.~... ........ J~epth o.~.,~ ...... Helght .... .Z.~( ........ Number of Stories . . .2. .............. .e, structure with alterations or additions· Front 'i 3.~.'~ '!' ''i '. i 'R;~' ......Din~ensions of sa ,m. ....... r " .~ o ' :~ :' ......... Depth ...... .~. ~. ...... tteght .~ye, ' '' [~ ',' i' ~,2 ' . ''.,' ............... · 8. ' ' ' ' , ..... ;' ' '3 .......... l'qunloorolbtorles ..... ~- .... . .... D~menmons of e,nt~re new constructmn. Front I o v I ~ p .~ d' ~ I z ~' ~, ' ' ~'-; '- ,' Heio~t z-3' .... '~ · ........ 2 ....... ear ...-~.: .......... ~epth ... ~, ............... i'quml0er m atories ~//,~ - ' ..... 9. Size oflot: Front /.~.~.../d., ~ ./4/~, .......... ............... Depth ... 10. Date of Purchase · ~ ........... ..................... Name of Former Owner .~. ?.~.~.z.//..Y. ,~/~ i " 11. Zone or use district in which premises are situated ..... ..~. ~./?.~?.~/.~.~;. [.. ' 12. Does proposed construction violate any zoning law, ordinance or r~-u~ati,','-'.' ' ' ~;/~ ........................... 13. Will lot be rearaded /~' ..... s ~ ~"" · + ............................. ...... -~.~-~r~ ~> ........ -' .... will excess fill be removed from premises' Yes 14. Name of Owner of premises ~ ~.~..4',~'~6-r .~ ~'r.~v,~v',~.. ,~.~'e, · ..... ~ No ~J/t&[ ........... ,~uuress ............ , f: .... Phone No. ~!~.~ .~.'.7.g~/9,' Name of Architect . · · Address ............ ...... ~.2 ............. , ...... Phone No .......... Name of Contractor ......................... Address ............. ; ...... Phone No ....... ~ .,..'... 15.Is this property located within 300 feet of a tidal iwetland? *YES...~.. · If yes, gouthold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,! indicate all set-back dimensions from .pro~y lines. Give street and block number or description according to deed, and show street names and indicate whether 'nt~ or corner lot. ,STATE OF NEW YORK, ,COUNTY OF ................. S.S ................................ being duly sworn, deposes and says that he is the applicant above named(.Name of individual signing contract) He is the , (Contractor, agent, corporate officer, etc.:) of said owner or owners, and is duly authorized to perform or have performed the gaid work and to make and file this application; that all statements contained in this application are tru~ to the best of his knowledge and belief; and that the work wi/l be performed in the manner set forth in the application filed therewith· Sworn to before me this ' ,~,.~,f~.~y~ .... .,~1. ~ __. ~.. .............. ~470787S, S~olk Co~ ~ (Sign atu~ f applic~ t )