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HomeMy WebLinkAbout17489-zFORM NO. 4 TOWN OF SOUTHOIg) BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20317 Date OCTOBER 29, 1991 THIS CERTIFIES that the building ADDITION Location of Property EAST END PRIVATE ROAD FISHERS ISLAND~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 5 Block 2 Lot 10.9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16~ 1988 pursuant to which Building Permit No. 17489-Z dated AUGUST 16~ 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 ~DDITION TO EXISTING DECK The certificate is issued to KATHLEEN METZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector 'J Rev. 1/81 FOwv.~ NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILD,lNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~.~..~.~. ...... ¢..z~ ............................... . . ,o ........... ~ .......... ~ ........ ~ ...... ~ ............ ~ ....... ......................................................... ~~ .......... ~ ........................ co~ **~ ~o~ so. ~000 s~.o~ ..... ~ ........... ~ ...~ ........... [o~ ~o ....... Z.~...57 ~uildln~ In~poctor. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE ....... NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ P Y ................. ~L HOUSE NO. STREET HAMLET Owner or Owners of Property... ;-.. .,... .~. . . ..................... Conn~ ~a~ ~ap No. ,000 Section .~.... Bloe~ .9. .... ~ot' .;~.~..q... Subdivision ....................... Filed Map ........ Lot .......... Health Dept. Approval ....TOJ.~. ........... Underwriters-Approval..~././~. ........ Planning Board Approval ...~./~ ......... Request for Temporary Certificate ....... Final Certificate ................ Fee Submitted: rev. 10/14,/88 co~03~? 'er. 10114/88 FORM NO. 6 TOWN OF SOUTHOLo BUILDING DEPARTMENT TOWN HALL 76.5- 1802 APPLICATION FOR C~RTIFICATE OF OCCOPAN~"/ INSTRUCTIONS 'This application must be ifiled in type~rriter OR ink and submitted to the Building Inspector with the following; for new huildln~s or new use: ]. Final survey of proper;ty with accurate location of all buildings, property lines, streets, and unusual n'atural or tOpographle features. 2o Final approval of Ueali£h 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/I0 of IZ lead. ' 5. Co~erclal buildings, industrial buildings, ~ltipla es~demces amd similar buildings and installations, a certificate of co4~ compliance from the Architect ., or Engineer respons~bl~ for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (P~ior to April 9, 1957~ non-confo~ing uses or buildings and "pre-existing" land u~es: , I. Accurate su~ey of property showing all property lines, streets, buildimgs and unusual ~atural or top6graphic features. 2. A properly completed ppl~cat~on, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show sln~le and separate o~ership of the entire lot prior to April 9, ]957. . If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in ~iting to the applicant. 3. Date of any housing code or safety inspection of b~ildlmgs or premises, or other pertinent info~tion ~equired to prepare a certificate. For Vacant Land Certlfica~e of Occupancy: ~- ~ appllcat~on for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate o~ership of ~he entire 10t prior to April 9, ]957 shall also accompany the application. If a~Certificate of Occupancy is denied, the Building Inspector shall state the reason~ therefor in ~itlng to the applicant. ~ES: I. CERTIFICATE OF OCC~Cy - New ~elling $25.00, Additions to ~elling $25.00, Alteration to el[~ng $25.00, Swiming Pool, $25.00. Accessory building $25.00 Addition to Accessdry buildings, $25.00 - Businesses $50.00. 2. Certificat~ of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificat~ of Occupancy - $5.00 - over 5 years - $I0.00 ~. Vaca~ Land Certlfl!cate of Occupancy - $20.00 5. Updated Certificate: of Occupancy - $50.00 6. Temporary Cettlficaite of Occupancy - $25.00 Residential $50.0~ Co~ercial FOUNDATION FOUNDATION 2. _., Ij at_i (2nd) ROUGH FRAME & ,PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL COM~gNT~ ADDITIONAL COMMENTS: APPROVED AS NOTED FEE' ,'~'~ ~::' BY' ~"~ N ~l~V BUILDING 76s-1802 9 AM ~ 4 ~ FOR ~E FOLLOWING IHSPE~ON8: I. FOUNOAT~N - ~R~UIRED FOR ~RED ~ 2. RO~H - W ~. INS~ 4. FINAL ~~N ~E ~MN ~Y. STA~ ~ 'FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 .., l , .%ermit No. 7 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY CALL ................ MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 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 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 Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The 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 necessary ~ ~,.~¢?t/~.~~ -' .....;-; .... .... ''' (Signature o''v'*' -- _ 'f~li~a'n~i ;; ~a~n'e~ if a co p ratio ) ..... : r. . . .f . ...//. F. . :: ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~/. ~:a} .o.n. ~)' '~ ~'''' ........... · If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ........... · ........... 1. Location of land on which proposed workwill be done...~. ~.~..~ ./.~-~.~ ......... House Number Street Hamlet County Tax Map No. 1000 Section ... ~ .......... Block .... ~'-. .......... Lot .... ./.~. '. · .7.. ...... 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 ..... ~,.~ ............. b. Intended use and occupancy . · ~,~-~-t/~,,r,z~.t-~lwj. · · .~,~,- ...... t,-~.~.!:. [/~,: ..~,. ................ 3. Nature ofwork (check which applicable): New Building Addition ~ Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... .~ . ~ ~-- o ~>. (Descriplion) 4. Estimated Cost . ,,~.A tg~ ~ Fee ~ ~ , : ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .............................................. ,... 6. If business, commercial or m~xed~occupancy, specify nature and extent of each t~pe~of use 7. Dimensions of existing structures',, if any' Front" , .... . ,,Rear ...... :'. ~ .... Dep'~h. , Height ............... Number of Stories " ' '" x/ ~.. ...... ;... Dimensions of same structure wi(h alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories - 8, Dimensions of entire new construction: Front ' Rear ...... Depth Height Number of Stories..,.. ..................................................... Sizeo or:Front ............ .......... ,, r .............. : ... e ~ ...................... Date of Purchase ............ ................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law ordinance or regulation: ................................ Will lot be regraded .......... : .................. Will excess fill be removed from premises: Yes No fp Name of Owner o remises .... ~ ................ Address ................... Phone No ................ Name of Architect .... ,¢.ff/.../.. ~ ~f. ..... ,, ....Address ................... Phone No ................ Name of Contractor . ~ fi..~.~ Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No *If yes, Southold Town Trustees Permit ma% be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block number or description according to deed,,and show street names and indicate whether 10. 11. 12. t13. 14. interior or corner lot. STATE OF NEW ~OR-K. ~ cou v om ....... ~~/.,~ .......... being duly sworn, deposes and says that he is the applicant (Name ofTndividual signin~ contract) above named. He is the * '. ..... '. ' ' ~ ", '1, , (Contract~or, agent, corporate officer, etc.) of said owffe/'or 6wners, ~fid 'is dlily'autho,rized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be, performed in the mm~ner s~t torrid,in the application filed therewil,h. Sworn to befo,~'~me this /j/ ' Nota ~ -lt//f~'i'~t°LT~l~g--l~/t'Jt/'~ Count -- o;,, ' ':' .... -: , 8~*t~ 9~.~ van~ '., ', , ,, ,.,, . ~,~ignature o~ applicant)