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HomeMy WebLinkAbout17565-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hail Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17589 Date DECEMBER 13, 1988 THIS CERTIFIES that the building Location of Propert~ 50 BLUE MARLIN DR. House No. County Tax Map No. 1000 Section 56 Subdivision WOOD STOVE Block 07 Filed Map No. SOUTHOLD Street Hamlet Lot 19 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCT. 18, 1988 pursuant to which Building Permit No. 17565Z dated OCT. 27~ 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 CONSTRUCT A CHI~gEY AND INSTALL WOOD STOVE. The certificate is issued to CLIFFORD J. BENFIELD (owner, ) of the aforesaid building. SUFFOLK COUN~ DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 '~ 'Building Inspector I~Oi~S NO. 0 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~ 017565 Z Permission is hereb~,~ra~nt~e~d to: ~ , ~,. /~/ ~..~.....,..~ ......... ~,~.....~'~ ..... ..¢....~~..~ ...... ~./.~..~/.. ~ _. ..... .~......~~ .......... ~ ........ ~::-.:...~...~....~-; ....... ~ .................... : ........... at premises located at .....~.....~. .......... ~~........~..///'~//~.....e~/~.~. ................................ County Tax Map No. 1000 Section ........ . .~.....~.. ..... Block ......... .~... ....... Lot No ......... ./...-~.. ....... pursuant to application dated .......... ./..~./,/'.~,,, ......................... , 19.,.~T.., and approved by the Building Inspector. Fee $...~~ ~:~ .. Rev, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Add£tions $25.00 ?OOLS $25.00ALTgAAT~ON $25.00 1. Certificate of occupancy New Dwellin~ $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ I00.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 /.~.~-'~.~. 5. Updated C.0. $ 50.00 Date ...~..~ ............... NewC°nstructi°n. ..J~..~'ldorPre-existingBuilding ..... ...... . Vacant Land .. ......... . . Location of Property ...~, ,0,, , , .~.~, House No. Street ' Ham/et Owner or Owners of Property ...~...~....~..?. · .~.~. !.~.Z~. ............................. . . . County Tax Map No. 1000 Section .... ,~, ~,¢ ...... Block ....... ~. ...... Lot.. ~..~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~..1~.~..~.~. ~te of Permit /~/;~/f~.Applicant.. i.~.. ~.. ~'~...~.~. ,.'e J~. ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~.~'.~. ~. 9. ............... Construction on above described building and permit meets all appli,ca~bl~des and regulations. Applicant .... ~.0. Zl?~~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ·PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS 765-1802 BUILDING DEPT. INSPECTION / [/,,,]/FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION ZND [ ] INSULATION FRAMING FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. £ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING [~NAL ~ REMARKS: DATE BLDG. DEFT, TOWN OF SOUTHOLO FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ../O./2-.7 ....... , 9 ~...~ ........ 190C/~. Permit No ./~.~. ,ff"~' Approved. ........ Disapproved a/c ..................................... BOARD OF HEALTH ............ 3 SETS OF PLANS ........ ~ .... SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY MAIL TO: APPLICATION FOR BUILDING PERMIT Date ~.e~../. INSTRUCTIONS a. Tiffs 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 9f buildings on premises, relationship to adjoining premises or public streets 'or areas, and giving a detailed description of layout of properW must be drawn on the diagram which is part of this appli- ~ cation. ¢. 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, buliding code, housing code, and regulations, and to admit authorized inspectom on premises and in building for necessary ins. gections. //, , // ~]~ ~ 0~%q0:5 ' ' '( ....... if'a' c'oi'~o'r~r~dn')' ' ' ........... * ........... . ...,,.,; ......... .. ¢"~J, .4..,,...gz,,,,.,~,,./.,~..0.,,~.S'.,, . ,... ...'~ :tt (Mailing address of applicant). State whether appli*ant:>is0owne;r,,~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ~: .A<)t,l,'. ~ G.~;~i;~ ~.'~. ~.'..- ................................................................ Name of owner of premises .":~C .": .'. ~':,'."/.. · ~: .A-.~ O~..'/-'/.. A.~,..,¢,'. ................................... ~"~',~ ' ~ 't~,~' '· ' ' (as on the tax roll or latest deed) If applic3¢[.!S a cqrp~ratiqn, signature~ of duly authorized officer. ,,.. (Na~ ;and title,of co.orate officer) Budder s L~cense No .... ~. sS.~ ~.¢~. ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. . .,.,% ........... .,g..4,,~..4..,,.,~d,.;..0.,:. ......... ~,.~.a,,.~. :.~... .... ,.,.?.~.: ................... House Number Street Hamlet County Tax Map No. 1000 Section O~'-~ Block .~. ...... Lot../..~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ .~$r'~/e.,o,.¢ .'~ ........................................................ b I d · ntende use and occupancy .................................................................... 3. Nature of work (check which tpplicable): New Building ..... ' ..... Addition ........ Alteration Repair Ret total Demolition Other Work .......... .off./. ?./. ~. . ~ . 'el l (Description) 4. EstimatEd Cost ...................... F-- , ' . : .... .. ~...~ .... ~.to be pald'on-nl,.n~ th~apphca~otl'~ 5. If dwelling, number of dwellin units .... t ...... Number of dwelling units a '.i, ,' If garage, number of cars ...... ~ ............... ~"" ' ' ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .... Height ............... Number of Stories ............... Dimensions of same structure with alterations or ia. ns: Front ................. Rear ....... Depth .................... Height ... r- .............. Number of Stories .......... Dimensions ' ' ' of entire new constructmn: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ....... I Rear ...................... pth · ' ............ De ...................... l 0. Date of Purchase .................... Name of Former Owner /~,..~.,~./.e. ~ ............. 11. Zone or use district in which p~emises are situated ..................................................... 12. ocs proposed construction violate any zoning law, ordinance or regulation: .g~-o ............................ D ' 13. Will lot be regraded ........ I ................... Will excess fill be removed from premises: .(~) No 14. Name of Owner of premises {2,.3y.'15~..n,~.:! }(t ..... Address ................... Phone No. ~.'x 2~,.{~gc.... N amc of Architect ......... i.., ................ Address ................... Phone No ................ Name of. Contractor ff.-.Z,e. ¢./e,?na~.~ ~ .c..,6.,=~./r'~,.~... Address ./~?.~'~..~t,-r, ~ .~,{. Phone No'O'S. 15.Is thxs property located wxthxn 300 feet of a trdal wetland? *Y~-$.~...NO .... · If yes, Southold Towfl Trustees Permit may be required. · .. i 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 interior or corner lot. : · 8. APPIK)VED AS NOTED FEE: IIIV:. 766-180~ S AM TO 4 I~t FOR THE FOLLOWING INSI~CTIONS: 1. FOUNDATION , 1WOREQUIRED FOR IN)URED CONCRE~ 2. ROUGH - FRAMING & PLUMSING 3. INSULATION 4. FINAL CONSTRUC110N MUST BE COMPLETE FOR C,O. ALL CONSTRUCTION 8HALL MEET THE REQUIREMENT8 OF THE N.Y, STATE CONSTRUCTION & ENERGY COOES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF .... $.S ..~. t/¢~..~,.,, ~.....~..,. ~..e..~..~.~/.~. ..... being duly sworn, deposes and says that he is the applicant (Name of individual signipg contra'c'ti ....... above named. He is the ~ t.O a,:'. ¢ K i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyl authorized to perform or have performed the said work and to make and file this application; that all state~nents contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner!set forth in the application filed therewith. Swam to before me this : ....... ~..~. ............ day of.i.. · .... , I Notary Public ........... . ...... County ................ Notary Public, State of New York /'5// / / ..... / ~,~gnature az apphcant) No. 4822563, Suffolk County ,~ LINDA J. COOPER !Term Expires December 31, 1 Notary Publlo, State ~f New ~brk ~No...4822563. ~d~ ~ .....