HomeMy WebLinkAbout17230-z FORM NO. 4
TOWN OF 50UTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217196 Date AUG. 15, 1988
THIS CERTIFIES that the building ACCESSORY
Location of Property 250 PARADISE POINT ROAD SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 93 Block O1 Lot 5.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 8, 1988 pursuant to which
Building Permit No. I7230Z dated JULY 19, 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 ACCESSORY BUILDING AS APPLIED FOR.
The certificate is issued to R. DOUGLAS & SUSAN BLIVEN
(owner, xxxxxxxxxxxxxxxxj
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Insp for
Rev. 1f81
eoaas xo. s
TOWN OF SOUTHOID
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No 017230 Z Dote l!~
Permission is her yyyg~~ranted to• ~ .f f
of premises located at .....a~e1......~~~~,G„"f••r~•~....~~.~~.~..~
County Tox Map No. 1000 Section Block ..........1........... L¢ot No........4?.c..~...
pursuant to application dated ...........~/,Fy 19p~Q, and approved by the
Building Inspector. J
O~
~~jj ' A
Fee $..ta!.`.S ...~.,+v /
~Bulldi Inspector
Rev. 6/30/80
V ~ r
('E FORM NO. 6
{ G
~~a TOWN OF SOUTHOLD ~
` Building Department ~ I ~i'~i ,~j
~,~„_~.-.._w~ Town Hall
SLUG. gEt'T. k .
TaW~
uF,~ ul'PtOi-G ~ Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ em~~~ to the Building Inspec-
torwith the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
~r natural or topographic features.
T Z. 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, acertificate 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 psbperty showing all property lines, streets, buildings and unusual natural or
topographic features.
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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 '
1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 10.0 0
. 4. Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date .....~.R-S. .(.~.....~.1~~..
NewConstruction„ `,,,Old ro~-r~Pre-existing Building (V~acantLand
Location of Property ~;1`0....J.9-.~t`+:~!.~P..~~....i.S~!I......Jt~.u.~;G.o~~P..l"~.~.:..~J.S`7/
House No. ~ Street ~ pHamlet
Owner or Owners of Property ~.1 ..1~,~? S>:~'..~ r4.S !4ti i!i.~. , , , ~ ~^-d:?..; , G-. , , ;~1, 4 4~ E= ~
County Tax Map No. 1000 Section ~3 Block Lot . ~ , - , , ,
Subdivision .................................Filed Map No. ..........Lot No. .
PermitNo.~~.1~~.°.Z'DateofPermit ..,~~lcG...Applicant ..:57."^-"'`~';~,,,,,,,,,,,,,,,,,,,,,,
Health Dept. Approval ........................Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate . .
Fee Submitted $ . , d, ~ .
Construction on above described building and p mi/t'~ is II applicable codes and regulations.
Applicant •~~G/~.~ :.y.-... .
I
Memorandum from .
BUILDING INSPECTORS OFFICE
' ~ TOWN OF SOUTHOLD
i
TOWN HALL, SOUTHOLD, N. Y. 11971
765-1802
AUGUST I5, 1988
Dear Mr. Bliven:
I am returning your check 114557. j
The amount of a C.O. for an accessory building
is only $10.00. Please send us anew check.
Thank you. _
Yours truly,
Secretary
`ir.~._
Flo
~SI.V\ R. DOUGLAS BLIVEN, JR. 4 5 5 7
SUSAN BLIVEN
55 LA RUE DRIVE ~ .7
HUNTINGTON, NY 11743 IJ 79 ~V 1-1487280
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ]FRAMING [~NAL
REMARKS:, ~t1Ls G ~ C~<
DATE ~ INSPECTOR
230
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~NAL
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BOARD OF HEALTH
3 SETS OF PLyY~NS
FORM NO. 1 SUR~{.IsY V
TOWN OF SOUTHOLD CHECK aI $U; : ~,ZS; !~'D• .
+ BUILDING DEPARTMENT SEPTIC roam
TOWN HALL
EOUTHOLD, N.Y. 11971 NOTIFY
- TEL.: 765-1802 ~L ...............Yly 1/7Sc3
Examined 19 (~//,~q~ MAIL T0: 5~ ~1
Approved ...~?r........., 19 .!)VPennit No.~.~~;~~
Disapproved a/c ~ ~ ~ ~
BLDG. EfiT.
(B ding Inspector) TOWN OF SOUTiiOLD
APPLICATION FOR BUILDING PERMIT
Date 19~~.~
INSTRUCTIONS I
a. Tlus 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. ,'lot 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-
ca~ion.
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 issua>~ f a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New Ygrk; and her applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, otifor re v or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, b Ijding o sinti code, and regulations, and to
admit authorized inspectors on remises and in building for necessary ' spec ns
t~~i~~~~ ti'" . ,
~ ' ' (Sim atu~e of"`ap- , ~r name, if a corporation)
.f t °~2 `U S ~+.r t u g ,ti J
.~.W,.,~I~.I.,,#{"``<4',;i{1 P,i~'4'~i,;:S:t ......;1:`r,h~J.(~."~...~:5
' ~}T a#t~~ t<,~"t ~ t'"t' a fs D,(Mailing address of applicant) ,
r':IRCtfT.~~`trCU3 {..i) .,tai l.~u., i:_ zr•,, ot/ ~T 7 l/.
S
State w is cbS~t,O1~~~'e"~; agent, architect, engineer, general co~rtra~tot,~el~trician,,plulttber or builder.
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Name of+~~ dt-~ ~ / ~_F ~ r' _
~ (as on•the t2x 7o(Lor'latest deed) ' . , •
If applica~ ° cry authorized officer...,`. r ~ ~ ' ~ ~ ~ - ~
'3, a > '
r).........
Builder's License No. ~d?L~~, . ?F;o,?~i..~Ots~, :~g:~~+C.
Plumber's License No . . . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done . . .
House Number : Strce
• ...Hamlet i
County Tax hlap No. 1000 Section Blbck Lot .
Subdivision Filed 1\tap No. Lot .
(Name) a
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy y'~t~') / /
b. Intended use and occupancy ...r7?'~~...:~'!w"z..'~r...fh !L,~..~, . •`C®k"//
l~
3. Ret air of work checl. which applicable): New Quilling '
( Addition Alteration
p Rca~toval Demolition Other \Vbrl$ .
(Description)
4. Estimated Cost ~Q ~ Fee ~ { .
5. If dwcllin^ i 1to be paid on filing this application)
g amts • • • • • • • • • • . • Number of dwelling units on each floor
If garage, number of carsvclhn' • ,
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing s[ructu~es, if any: Front . ,Rcar • • ~ ~ • ' ~ ' ' ' '
Height ...............NujnberofStories. Depth...............
Dimensions;of same sttucturc with al;tcrations or additions: Front Rcar .
Depth ...i..:. . Ilcight . .
8. Dimensi ' ' ' ' ' • • • • • • • • • • . Number of Stories .
Hei ht 9's' ~ en~~tetion: Front . , I~~. Rear , . 1~.~ Depth ,~~y.. • •
°
° Numbei f S ories . , Q':'~4 • ;
9. Size of lt: 1wd7tY";;.`~ : ~'.i.~ik`ru~ Rcar . .
10. Date of u ~ t,"<:;. ,.'P~'sY • Depth
p Name of Former Owner ~ ~ ~ • • • •
11. Tone or use
di~tnct in whtch r j~ • •
emisesaresituated
12. Does proposed construction viglate any zoning law, ordinance or regulation; .
ill lot be re^raded Q,'I
° p • • • • • • • • • • • • . • . • Will excess F11 be removed from premises: Yes No
14. Name of Owner of remises i~
Name of Architect ' ' • ' ' ' ' ' ' ' ' ' • Address ...................Phone No.
Name of Contractor . • • • • • • ~ • • • • ~ • ' ' ' ' ' ' • • • Address ......Phone No............... .
y ..................Address ...................Phone No.
15.Is this property looted within X00 feet of a tidal wetland? *YES....NO....
*;Cf es Southold Towp Trustees Permit may be required.
' PLOT DIAGRAM '
Locate clearly and distinctly al( buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
~7 c~
i
AP~, ROVED AS NOTED
DAT : &P. N 7,30
er:
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C Y
T QEPA T T A7
786.1 BpZ 9 AM 1p a
F PM fOR THE,
_ 01.40WING INS
OCCUPANCY OR FOt/NDIgYON _
USA IS UNLgWFUL
WITFIOUT CERTIFICATE ~
OF OCCUPA',NCY
STATE OF NE1V Y ~
COUNTY OF •S
(1\ame of individual si°ni~~ ' ' ' ' ' ' ' ' • being duly sworn, deposes and says that he is the applicant
~ Ig contract)
about named.
lie is the • .........,I~......... cg~cv.Z:L•Q.!l..... .
(Contractor, agent, corporate officer, etc.) ~ • ~ ~ ~ • • ~ ' '
of said owner or owners, and is duly',autltorized to perform or have performed the said work and to make and file this
application; that all statements con[airSed in this application are true to the best of Itis knowledge and belief; and that the
work will be performed in dte manner Set forth in the application filed therewith.
Sworn to beforeyme~t~hi`s~
.day of. \ ' ~ -
\otary Public, County /
ru;,~;;rnn c~_~ri<e
Notary 1'a;iic, ~ : ~ ~ New Yorl< rl~/. .
ia~. ~ .:ai'7 ,.,gyp/'. ~TU~t)
(~ualii iec_ iii iS:,..s0 l;aunty
I ~ Geumilsstua Lx~,6as y' c4. u1, 7