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HomeMy WebLinkAbout17492-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27919 Date: 09/06 O1 THIS CSRTIFIHS that the building FIRE REPAIR Location of Property: FOX AVENUE FISHERS IS. (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 9 Block 1 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated pursuant to which Building Permit No. 17492-Z dated OCTOBER 4, 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 FIRE REPAIR TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR The certificate is issued to K. SERENA CARSON & ORS. (OWNER) of the aforesaid building. SUFFOLK COIINTY DEPARTMHNT OF HBALTH APPROVAI. N/A ELECTRICAL CERTIFICATE NO. PENDING 09 04/01 PLUMBERS CERTIFICATION DATBD 08/24/01 R.G. AHMAN hor'zed Signature Rev. 1/81 roses 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 o 017 4 9 2 Z Date ..C~..~.~.........~ ............... Permission is hereby granted to: ~~~ ~ /~ .... . . . . ... . . ! . ' .... . . .. .. . . . . f~ „ . .. . . .. .. .... .. . . ... .. ... . .. . . ... . of premi s located at ..................4••~••~....~ ~ ~_ ...., 19.L1!„~ ~..... Wit.... !~..1~ .:...: v,F.~............ .............................................................................. Caunty Tox Mop No. 1000 Section .......g...... .................. ... .. Black . .................................... .......1............ Lot No. ............................ .c~.~......... pursuant to opplication doted ..G~~~........ / / ..F.(/•• ........ ............ 19.f~~ and approved by the Building Inspector. Fee S••~~••AD•• Building Inspector Rev. 6/30/80 ~~ ~ ~~ 7o J / Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 I ~ IL-- ~ 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. B.f 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 - $100.00 3. Copy of Certificate of Occupancy - .251 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date /?~~d ` .............................. New Construction...... q ~ Old Or Pre,-~existing wilding... v. .l.~..~p.~ Location of Property..l.Y6~.~.......,/`b~..~~~ ............. • ~ls/LLFr~7.~?~.. House No. ////JJ Street Q/~ ~ Hamtl~et Onwer or Owners of Property~:.`:.~.`.)~~j.~ L:~//!(J7J511.//~~.'~.~~.~.~yynl.:~.~~~.~.~. County Tax Map No 1000, Section..~..........Block......L.........Lot. L.~ ................. Subdivision ....................................Filed Map............Lot ...................... Permit No~:../.,y'!.?!...Date Of Permits`:,l.~f/O.~.. lll ...Applicant/./~: . ~.~~7!,~Ir/.~~!... Health Dept. Approval ........... ......Underwriters Approval... ......... ...................... Planning Board Approval ........................ Request for: Fee Submitted: ~C- X0106 Temporary Certificate........... Final Certicate../~....... $~.Z.z ....................... ~,~~~ APPLICANT Town Hall, 53095 Maln Road P. O. Box 1179 Southold, New York 11971 ~~~vr~-ten CO~~ o ~ y x oy~o ~ ~~o Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I CAT I O N DATE: L7 ~/ Building P rmit No. Owner: ~.(/d~/f'f/9 ~~sw L~/~G (please print) Plumber: tI~,C.`~ ~I ~L~-~'l. (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1$ lead. (Plumbers Signature) Swo o before m his / ~e day o S~- Notary Public, u~~~.- County TNOMAb I, t)OFilIITY dp, ~ Net11ry Public itete of New York No. ~/06{SO Oueliflea In 6uflolk County Term Expire 72/7/A•L- ~~ ~ i7 ~~~ ~6S-isoz BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION iST [ ] ROUGH PLBG. ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL DATE __~~' O/`~ INSPECTOR - ~'~/ REMARKS: O • .~ ,~.~ ~: •D. ~r BUARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. 1 SURVEY -.I~.... ' TOWN OF SOUTHOLD CHECK .. . BUILDING DEPARTMENT SEPTIC FORM ,,, , , ,, , , , , , , , ; TOWN HALL ~OUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL • • - • ........... . MAIL T0: Examined Q~.. ~ ....., 198 ~ /~ ~~ ApprovedrJ.~ ~ ~ Y q~ ,~ Gr_~~ Ci ..~......, 198QPermit No.... .... / /~J Disapproved a/c ..................... G~~G~~ ................ .................................................. (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 ins ti~~ns. (Signature of ap icant, or name, if a aor oration (b)ailing address of applicant) State whether applicant is :owner, lessee;: agent, architect, engineer, general co tfi ractor, electrician, plumber or builder. .. i:5-' .. •.' .. ... ... .... .. . . . _... , Name of owner=+i7f premises ~.-~J:-~-! ~-..~.,... Y~~l~:~:~ .......................... . is ~h +T .. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer.,...,.~y..f r ;,., (Name and title of corporate officer) `" _ "'~' `~{"~' ALL CONTRAC~OR.`:S M BE SUFFOLK COUNTY LICENSED '.-;i Builder's License No. . ~~-~~~ .~,` ....... . ;. , . ~ Plumber's License No . ...............:....... . Electrician's License No . ..................... . Other Trade's License No . .................... . 1, Location of land on which proposed work will be done. ...:~ (~ , , ~~S ,~~ ~,~' ~~-, ~.: ~, < ~ , S LCD ~~q~ ....fix.. ~:f..?~11.1~ .~ .........................:............. House Number Street Hamlet County Tax Map No. 1000 Section .... ~........... Block ......`........... Lot ... pS... ........ 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 .....~~'G1~'.~.,,,,,,,,,,,,,,, ,,,,,,,,,,,,,;,,,,,,,,,,,,,,,, ,,,,, 3. Nature of work (, chgck which applicable): New Building .......... Addition .......... Alteration ......... . Repair ......(/ ... Removal .............. Demolition I~ .............. Other\Vork............... G o (Description) ~ ~ {~ / 4. Estimated Cost ...r .3 ~..~f .aDU ....................... Fee~~ . ~! .U~... ~.iC....................... . ~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units .. ~:L.~,,e , . , , . Number of dwelling units on each floor ............... . 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 additions: Front ................. Rear ................. . Depth ......................Height ...................... Number of Stories ..................... . 8. Dimensions of entire new construction: Front ............... Rear ...............Depth .............. . Height ...............NumberofStories........................................................ 9. Size of lot: Front ...................... Rear...................... Depth ...................... 10. Date of Purchase .............................Name of Former Owner ............................ . 1 1. Zone or use district in which premises are situated .................................................... . 12. Does proposed construction violate any zoning law, ordinance or regulation : ............................... . 13. Will lot be regraded ............................Will excess fill be removed from premises: Yes No 14. Iv'ame of Owner of premises ....................Address ...................Phone No............... . .... Name of Architect ... .... .. ... .. Address .. ................Phone No............... . Name of Contractor ... ,~G~~, .Address .~ 9'-,! .~ 7. ~ .......Phone No>~/~ - .. ~ ~ `rQ, l 15. Is this property ocated w hin 300 feet of a tidal wetland? *Yes ..... No ... *If yes, Southold Town Trustees Permit ma be reqgu~i~r~ed. PLO DIAGKAM 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. R -~~ -~ ~~ ~ ~~~~ ~ .~ ` ._-. - _ r. e 3{ i ':. of t i," a '~ ` . .__... ~' - .,..... P'WMBtN~'i All PLUM81N0 WA~S'TE UNDERWRITERS ~Ri1F1CATE A WATER UNES NEED REQUIRED ~~~ BEFORE COVERINl3 STATE OF NE~0,13,K, COliNTY OF .. u E'i'a-K-- , , • • S.S z~~~ S©LDER [/QED /N 1~/ATER ,~t,'PPLY SYST,~ENI CANNOT ~,'~CcE® .2/80 ~f 8% li.°,O. AP' /P ~ MdiED DATE: ~~~;L~~~tlr~ *-L~:~i..~~ ~.. NOTIFY BU~DEP14RTMENT A 785-1802 8 AM TO ~ pM FOR THE FOLLOWING MISPECTJONg; 1. FOUNDATIdN TiWip gETltApED FOR POURED CONCRETrE 2. ROUGH • FRAIYIMIC, A pupyIBINQ 3. INSULATION 4. FINAL - Ct,ONSTRUCTIOIY MUST ~ • BE COMPLt:TE FOR CA. ALL CONSTRUCTION SHALL,: MEET THE REQWREMENT$ OF THE N.Y. STATE CON§TRUCTION 8 ,ENERGY CODES. NOiT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ••••••••••••••••••••••••••••••••••••••••••....... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. "' He is the ..... (Cont~ractor_agent, corporate officer, etc.) of said 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 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. Sworn to before a this w pp .......~~ .. .. day o~. ..~X ~ ~ .... , 19°.~ Notary Public ./ .............. .. ...... County . THOMAS F; DOHERTv ,}r~ , l) ~` ~C~,~.~, Z,• ~ , ~~~ ~kV (.C ~... . Notary ~ublic~St•te of N•w Ygrk N•. YOR55! (Signature of applicant) ~•~~r~•~ir, sunrm c•~~,ty T~-rh 6~+Nea tj~rliq{