HomeMy WebLinkAbout17253-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219648 Date JANUARY 10, 1991
THIS CERTIFIES that the building ACCESSORY
Location of Property 760 ORCHARD LANE EAST MARION
House No. Street Hamlet
County Tax Map No. 1000 Section 31 Block 06 Lot 22
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 15 1988 pursuant to which
Building Permit No. 172532 dated JULY 21, 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 SHED PERMIT AMENDED TO INCLUDE DECK
The certificate is issued to SHARON & DOUGLAS ROGERS
(owners)
of the aforesaid huilding.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRTTERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
°v
B ilding Inspector
Rev. 1/81
no8atz xo. s
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~ 017253 Z Date ..........~....~1 19.,~.tl
Permission is hereby grante~~dQQto:
o~...a 4.~
~o
,
-1 /I ~ p
ct premises lotated ot ...l.W.~......!?C.~...d`~.'.~!!a.4-~.8~..............'Fts.:?~'.....~'.t:1~nt.R?'Y.~......
County Tox Map No. 1000 Section .......Q.3.~....... Block Lot No......~r.Z'.........
pursuant to application doted 19A.~.., and approved by the
Building Inspector.
r
Fee $...P~..n~.:..:./....
' Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OP SOUTIIOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
a. 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 19 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.
3. 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.
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
S. Temporary Certificate of Occupancy - Residentia-ly-~$1"5.00, Commerciagl $15.00
/ Date :
~;~7Lf.:~t~, i,~. Icl, c ,
yew Construction... Y Old Or Pre-existing Buildr~i~n,'g. ~~,1 q • •
~.ocation of Property.... ~U.........1-.,:i~..Q~C~K~:'~~...~~~.. ~~7.~`:l,`^:Sr~c%~-.
House N~o'}.~~ 1-S^t-reet Hamlet
)nwer or Owners of Property...,4-1~.45~~;;~,~~':~iV,~//;
;ounty Tax Map No 1000, Section....~.~.......Block....~?..........Lot....:~.~...........
subdivision ....................................cc~Filed Map............Lfot~.................,~J...
'ermit No. .t.d.~~~ z..,.Date Of Permit..7.~?~~.1.'1g.....Applicant..~,G~cl.:\~.~.~t~.(~~
lealth Dept. Approval ..........................Underwriters Approval..
Tanning Board Approval
equest for: Temporary Certificate........... Final Certicate...........
ee Submitted:
~ Ylla/ ~ ......~`1A.1
Co~ ~/9~s~~ ~
~c~, cArl ,
lliol~/ .
• TEL. 7G5-1802
5~FF0[kC
o GG TOZVN Oi SOUTIIOLD
" ~ OFFICE OF BUILDING INSPECTOR
o ~ ~ P.O. BOX 728 '
't+'~"~ ~ TOWN HALL -
~O~~l SOUTIIOLD, N.Y. 11971
DECEMBER 18, 1990
RE: BP19507Z
bp17253Z
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because oL- the following reasons.
An application for Certificate of Occupancy
is not on file. ENCLOSED
% / No Underwriters Certificate on file.
J$g/ The check is(~ytr~Ytrc%~ot on file.)$25 for each permit
A*o Health Dept. Approval on file.
No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit 195072 Z
-17~-53~- - DOUGLAS ~ SHARON ROGB/(
Building Dept.
No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
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STATE ENERGY Sb
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I 1'~ ~ COR POURER CONCRETE
I I ~ ~ I 2 RO~)GH (`RAMING R PLUMBING
i i 3. INSULATION
fix, ~ ~ ~ ~ 4 PiNA4 - CONSTRUCTION MUST
~ I ~ BE COMPLETE FOR C.O.
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~ , ~ ~ ~ ALl CONSTRUCTIpN $HAU. MEET
J ~ tip' I THE REQUIREMENTS OF THE N.Y,
~ ~ v a- ) I~l STATE CON$TRUCTlON ~ ENERGY
p u.. ~ ~ ~ ~•a~ CODES. NOR RESPONSIBLE FOR
~ 6 ~ ~ ~ ~ J DESIGN OR OON$TRtJCriON ERRORS
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BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
REMARKS:
DATE l~ / ~ INSPECTOR
BOARD OF HEALTH
FORM NO. 1 3 SETS OF LANS , .
SURVEY
TOWN OF SOUTHOLD CHECK . jS61.'.$.aS;crr), , , , ,
BUILDING DEPARTMENT SEPTIC Foart
TOWN HALL
SOUTHOLD, N.Y. 11D71 NOTIFY t1
- TEL.: 7G5-1802 CALL t77~ .Q II.a2..•...... .
Examined . a` 19 g.~ MAIL T0:
A roved 19 ~p Permit No..I, .~d~3 ;
=,a ~ `.a'-•,.
Disapproved a/c I
i JUL 1 51988
~.__.._m.,,~,...,.
(Building Inspector) TOWN OF StJt3Th;ptt~
.a.,....~,,,., v...,~„-.,~,,..w,..,,~......,.,,~
APPLICATION FOR BUILDING PERMIT
Date 15 .
INSTRUCTIONS
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. 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 shalt 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
Re;ulations, 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 inspections.
(Si~nat of applic t, or name, tf a corporauon
a •.~ox .~to5, . ~ a.s~;-, ?-taY i (s!ti. uY . !19.~~1
' (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Q'tl-3YLQ~t'
.......................................pp........................................................
Name of owner of premises ....7~L(3,5..tl,cX~,Q,Y.S.t~y, , ,~~pyL, ; ~Q~~y~ . . . . . . . . . . .
J (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. ~f,Q~~.QJ~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 . .
......Z~~
..........................~?~1~ .C~.'~~:~?M .4 lrlxt,~ ~.~d-, l-1CQhe yyL_.......... .
House Number Street Hamlet
County Tax hiap No. (000 Section Blpck , W, , , , , , , , , , Lot
Subdivision F.ilcd slap No. Lot .
(Name) '4
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 .
3. Napure of work check whiRh,applicable): New [Iuilding ,
( Addition Alteration
Re airMoval Demolition • • • • • • • •
Other work..............
4. Estimated Cost . (Description)
1obRl~'IL4~.~ Fee ......4?b:Pd..
5. If dwelling number of dwelliq (to be paid on filing this application)
5. g units Number of dwelling units on each floor , , , .
If garage, number of cars .
6, If business, commercial or mi~ed occupancy, specify nahrrc and extent of each type of use , , , , , , • • , , ~ • •
7. Dimensions of existing structures, if any: Front , • , , , , Rcar ~ • • • • ' '
Height • • • • . • • • Depth ,
tambcr of Stories .
p with alterations or additions: Front ' ' '
Rcar..................
D mtlnsions of same i tructurc Ilcight . . • • • • . Nuntbcr of Stones .
r
' 8. Dimension~of erl~tir~e new c NU'truction: Front . , , (`,f; ~-f- ~ ~ , , , , , .Depth I,
He.iglit b-1;1; , Rear f: t'3.~-7:~...... .
~nber of Stories . ,1 •
p
9. Size of lot: Front ~O I
r Rear ^15.U, . 2.:413...... .
10. Data of Purchase ...7L~S;,,,,••~••~•' Depth'
• • • • • • • • • • • • ...Name of Pormcr Owner ,~il:~'1
o femisesaresituated Cr
1... Does proposedsconstructlontvtolate any zoning law, ordinance or regulation: .
p ~
13. '1Vi11 lot be regraded .::n,t? , ,will excess 611 be removed from premises: Yes • • • • No
14. Name,
of Owner of remises ,~:~~q'h(pnp: Address fJ l4'~ Ca~e.~lc~td •~A-YID. Phone No. u..
Name of Architect • • ~ • •~r~.-'. .
Name'of Contractor . • • • • • • • • ~ • • • • ' ' ' • • Address ...................Phone No............. .
.........................Address....... .......Phone No.
I5.%s this property located within X00 feet of a tidal wetland? *YES....NO....
*If yes, Southold Towh Trustees Permit may be required.
. 'I PLOT DIAGRAM
Locate clearly and distinctly alt buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to decd, and show street names and indicate w.llether
interior or corner lot.
I'
I ,
~'i
i
STATE OF NE1V YORI`,
S
COUNTY OF,... LS
g ' ' ' ' • • • • • • • • • • • • • • . being duly sworn, deposes and says that he is the applicant
(Name of individual si nirig contract)
above n•imed.
Ieisthc
ofsa'
(Contractor, agent, corporate officer, etc.)
rd owner or owners, and is duly ';authorized to perform or have performed the said work and to make and file this
application; that all statements contairjed in this application are Iruc to the best of Itis knowledge and belief; and that the
work will be performed in the manner s,ct forth in the application filed therewith.
Sworn to before me this
........................day of . I'~i .
19...
Notary Public . County
I (Signature of applicant)