HomeMy WebLinkAbout23594-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
~ERTIFICATE OF O~uu~AN~Y
No Z-24594 Date
SEPTEMBER 6~ 1996
THIS CERTIFIES that the buildin~ ADDITION
Location of Propert~ 5245 PEQUASH AVENUE ~uT~OG~/E, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 110 Block 4 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 5, 1996 pursuant to which
Building Permit No. 23594-Z dated JULY 19, 1996
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 ADDITION TO EXISTING OWE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to ANN BENBON-HILL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N/A
Rev. 1/81
//ui~ing Inspector
lrOK~ NO. it
TOWN OF SOU31'IOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.o 2359~ Z
Date ................. ~Z ..................... , ]9..~.~'
Permission is hereby granted to:
.........................
.... ~.1~...~..~.1l~~....~., ............
.
,o ...~...~..~.. .............. ,~.......Z~../ ........... ,~,.~Z~.....,.. ..~..... .................... ~,~.
.~...~ ~ ........... ~:.~ ~.... L... . '~. .~.~ ......... ~z. ...~....4~. ~,z..... ..~....~...,. ..................
/.
otp e~mises' located at ...,~.'...~/~,, '~,,...../,~.. ,~.,.~,,..'.~,,.~L ~j' ........ ~ ........................................................
County Tox ~op No. 1000 Section .... ........ Block ...... ~., ,~.,,,,... Lot No ...... ~,,~,, .......
pursuant to application dated ...... ...~..~(~ ....... ~.....'~.... .................. , 19~.~., and approved by the
/
Building Inspector.
Rev. 6~30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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 i% 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.
B. 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 Buildine - $I00.00
3. Copy of Certificate of Occupancy - ~ .25¢~
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - R~ilential~0.~i C.~.o.~.mm.~.cial $15.00
Construction.~..~..r . 01~Or Pre- 'isting B il[['''~'di -- .... ~' .... .....................
NewLocation of Prope~ty...~-~.~~ .. ~.~..kJO~ ~'ii'i''~ Vj2- .~ [[~
· ''' '''''''' '''''' ''' Street'' ' ' '' Hamlet'~ '''' ~' ''''
Onwer or Owners of Property k~7,~ ~ 2 ~ ~ .\.
County Tax Map No 1000, Section...J.~..~ ...... Block....~..~. ......... Lot..~..~. ..............
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $ .............................
................
FTELD INSPECT[ON REPORT DATF. COMMENTS
FOUNDATION (IST)
II
ROUGH FRAME &
STATE ENERGY
CODE
FINAl. II
CIIECK .........................
SIr. PT 1 (~ FOIIH ...................
HO'J'I F Y:
CAI,l,
Il^Il. TO: ....................
(IhJi hi.p, 4'nnl~actor)
AUI'I,ICATION lr(}R IIIJII,I)INC Iq~,RHIT
l)a t.e ................ , 19 ....
l ~q STITS, ICT I ('1~
n. 'lhin nlq)l|t:nli~ ri. mt. I~.' cmq)letely filled in Dy tyl~4titer or i. i.k n,~l m~lxnilted Lo the Ihdldl.
3 ~et.n of pl~um, ncct,rnte plot idms Io ncnle. Fee accordhsg Io
b. Ptol: plm~ nlg~in8 h~nl:i~ oF lot' nr~l of I~ildlnsn ~ proulse~, ~lnli~mhlp to ~ljoiolnff pr~isen or
st.r~t~ or nrenn, n~l Bivh~ n ~tniled *leset-~l)t.i(.~ of lay*~at: of i~x~rty .stol. I~ dr$.~, o~ the di~grm~ ~dch is l~nrt of
d'. tllX~l ;~l~..al of tlsi~ nH)llcnllt~, Lhe I~ihlii,8 hml~(:tor will iam~ n ~dhllog Permit to the nH~llennt.
l~t,,lt shall Ix, kept. (~s the proui~es ~oilal)le For h~sl~cl i~ Ih~lt the
e. ~) I~dhll.8 ~dsnll I~ c~:cupi~l or treed in ~d~ole or its I~rl I'ot n[ly ~rl~)Se ~ot~er until n (~rtifi('nte or
(k'~qx~:y ~dlnl I have Ix,o. IT~ ri.led by the f~lildh)g hml~elor.
APH,I(~TI(~ 1S I~I~BY ff~[~ I.o the I~dhll.g l~l~artn~nt For Ihe inm~a~e of n I~dldlng Permit D~rmmnl lo the
I~ildloB 7x~m ()txll.;n~'e of the 'lk~m oF ~d~old. ~fffolk (~ndy, ~4~ York, m~l oLher oH)I ic;fl)le l~s, f)~xllnm~es or
I~DdoLi~mn, l'or the e~mlr~'.l'i~ of I~dhli.gn, ~lll i~m or ~lterati~n, or for ro~al or dc~lition, on horeln
t~ncril~d. 'lhe opplicaut nRr~n to c~)ly wilh all ol~dlcnl)te 1~4s. ordhum~ces~ I~dhllng c<xle, h~mi.~
fi ~ , ..... ~ ............ .... :.., .~,~.:;...'.:'
~..~, ,r ,~ ,~ ,,, ~, ~. -~;~-. "}~"~';' :~"~" ':" "", .........................
If alq~l leant is a CO~lx)ratlcn~..slpfmtu~ or dtd'y rn,tl~)klz~<l of Eicer.
(Fk.m ;~ss(I t. lt le or cotpornte ofrlcei-)
Ik~ildern l,lcelme l'k) ..........................
ph~t~e, rn lAce.ne fro ..........................
b.
gill loL I~ tel~{mb(J ............... I ..... {4ill exc'e~8 fill I~ zmz~ed frml pioniBea: YE8
hi Ih}8 plojg~Jly ~JlhJn ~X} feel of jn lidal ~eLh.~l? ~ YI,~{ .......... ~) ..........
i~l,OT I) I AOIIAH
l~x:~lLe elem-ly nt~l dim, i~l:ly nil I~jJhlJngs, ~mlher exls[ infi or prolapsed, n~l Jl~lJc. ntn nil aet-Jmck
OCCUPANCY OR
USE IS UIdLAWFUL
WITHOUT iCERTIFICATE
OF OCCUPANCY
KII'~ (Xr Fi~4 YOi~K,
IlHl¥ (Ii,' .......................
m~? of i[xlivldue, I .~il~ni.B total tm:! )
,..l~!i[ll~ duly
APPROVED AS NOTED
NOTIFY BUILDING DEPARTMENT AT
7~B-1802 ~ AM TO 4 PM FO~ THE
FOLLOWINB
~. FOUNDATION . TWO
FO~ POU~ED ~ONO~ETE
4. ~INAL - ~ON~TRU~TION MUST
BE ~OMPLETE ~0~ ~.0.
ALL CONSTRUCTION SHALL MEET
TH~ REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
C~DES. NOT RESPONSIBLE FOR
DE HGN OR CONSTRUCTION ERRORS
tmid i~[~r ol <~.(!~, i],~1 i,~ duly authorized t() ix:rfmm ()[' have i~
pi lcfii, ion; Ihnl, Jill t;IBLJ~I~II(It COlilBiI~N~I ill Ihi~l nppl J(:Jl{ Jolt tl['(~ II
ill Ihe ~)rk ~itl I~ i~rl'm.~d ill the 11~11!11~[ IJol: Iolih in Ih(~ al)pJJc
dOYeE M.
~W PublJo, State of N~Y~
~o. 4~52246, ~uffol~ ~
~erm ~xpir~ June 12, 19~
'l'onl~-d Ihe Imid ~)rk m~l to [l~ll~e ;I.d file Ihil;
~a h) the be.t. of
)Lion filed thm'c~ith.
^ppi J Chill )
LOT~C~
)0'
LO7'0
E 75.00'
Ld
406,30'
~-~/2 STORY
FRAME HOUSE
N 32~15'00'' W /,).00
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