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HomeMy WebLinkAbout20346-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20498 Date JANUARY 23~ 1992 THIS CERTIFIES that the buildin~ Location of Property 1645 ELIJAHS LANE House No. County Tax Map No. 1000 Section 108 Subdivision ALTERATION Street Block 04 Filed Map No. MATTITUCKr N.Y. Hamlet Lot 7.9 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 17r 1991 pursuant to which Building Permit No. 20346-Z dated DECEMBER 19r 1991 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 ALTERATION TO CONVERT ATTACHED GARAGE INTO LIVING AREA AB APPLIED FOR. The certificate is issued to RICHARD A. & AUDREY A. MOORE (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED H-026537 - JANUARY 17~ 1992 Building Inspector Rev. 1/81 I~ORM NO. 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~ 20~46 Z Permission is hereby granted to: ..t..~.~* ~.~.....~ ............ ,o .~..~=....m.~.~..a~..~..~....~....~.....~.....o~.. ~ p~m,~ ~oted o~ ..1..('.~.~. .................. .qO~.dr_ .................. County Tax Map No. I000 Section .... L.C~....~.. .......... Block ..... .(~..~. ......... Lot No.....'7.:..~ ............. pursuant to application dated~.-.~...~.....~J~.. ....... /..7 ............... , 19.~..f.., and approved by the Building Inspector. Fee $..~:....../~.. ...... Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTNENT TOWN IIALL 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. ~. For existing buildings (prior to April 9 1957) non-conforming uses, or buildings and pre-exzstlng 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .. I ~1~- /'?~ / ~;cw Construction ........... Old Or Pre-existing Building. ......... -~ ~ !~ ~. ~ ~7~-//~/~ ~ /~.. LOcation of Property .~.~.~'~ .~?~i__ ...... Hamlet House No. Street On,er or Owners of Property ..... ;~"-~i~.~....A.>.. _~kt ~,~c~ ... ............ ~... County Tax Map No 1000, Section .... ~'~-~ .Block ..... .~.~. ....... Lot. / '" ' ....... :~ubdivision.. ~?f ~' ...................... Filed Nap ............ Lot. Permit No ................ Date Of Permit ................ Applicant ............................. i!ealth Dept. Approval. ......................... Underwriters Approval ......................... 'fanning Board Approval ........................ :equest for: Temporary Certificate ........... Final Certicate ........... ee Submitted: $ ............................. ........... ~'~.y,~. rio ~. ~ 0 ¥ ~ ~ ~P~IC,~T .................. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: DATE l l~ :~'~ l~/ INSPECTORT~ /~./~/ / ?'iELD T"~',;- .... , FOUNDATION (1st) FOUNDATIO[4 2nd ) 2. ROUGH FRAME & 'PLUMBING INSULATIOH PER N. Y. STATE ENERGY CODE FINAL ADDITIO~;A'L CO~NE~ITS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exa'ninc '~'"~.\.~., 19 .qJ. ..',,pp~o,,~ .~... }~.., 19a~. Permit No. ~..o..~..6f..(p. ~ Disapproved a/c .... . ............................... ~/~/) DEC I T 1991 ; APPLICATION FOR BUILDING PERMIT BOARD OF HEAL'I'll 3 SETS OF PLANS SURVEY CIIECK .................... SEPTIC F 0 R,'I ,,O, I F'!: CALL HAlL TO: - . .,.c.',Z. INSTRUCTIONS Date °'lC-19... 77. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 .hail'have been granted by the Building Inspector. APPLICATION IS HEREBY blADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or {egulations. for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Die applicant agrees to comply with all applicable la;vs, ordinances, building code, housing code, and regulations, and to :dmit authorized inspectors on premises and in building for necessary inspections7 (Signature of apl~cant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ' ................................. '7 .... I:..../.i: o.~ ~ ........ (as on the tax r611 or'latest deed) .............. if applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ' Plumber's License No ........ ,. ................ Electrician's License No ....................... Other Trade's License No. Location of land on which proposed work will be done. 26- ~G ' cT ' ' ' "' ....................................... ' ......... ............................... .:,. ........................... (71; '~ fi ?~ .~:'7: ................. llouse Nulnber Street ' '~]'l~t " County Tax Map No. 1000 Se.ction ...... d?..~..'.G..O. .. Block © ~/' cs .................. Lot (Name) ...... ' ........ Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......................................... ~'3.~g)..~ '~- , ~,v~,;~, ~.,,¢...¢~ .,~.~-,~ ............ b. Intended use and occupancy t_3 ~2 % .............. 7f,d~. ~& o,~, ...................... ~.~'.,? e,. ~ ,~..%. · ~4%,- ..o. _.t~r.t~,,: '-. ~ ~,e;~ , i:,~,;[O ......... 3. Nature of work (check which applicable): New Building Rep:hr .......... Addition .......... Alteration .............. Removal .............. Demolition ......... -/ .............. Other Work 4. Estimated Cost .. 3 'b-c~ ~, ................................. Fee :~--~, ~ (Description) 5. If dwelling, number of dwelling umts // ... (to be paid on filing this application) If a - ' · g r%e, number of cars ............ Number of dwelling units on each floor / 6. If business, commercial or mixed occupanc . s ecif 7..Dfi.mensmns ol e. xml;lng structures ir ..... rr-Y~'--p y n~_at...ur~ and extent of each ty e of use. i lJJJilj Height / z/ y~ ., , .... ~. ~-~uut .... ~..% · . p .... 4~Y~~ ................... Dim .... _' ' "i .... .P<-.. l~umber of Stories ..... /. ..... ii ........... '~ '~' ....... Depth ...&.gL .' ........ ~lm~ns olsame structure with alterations or additions: Front .~ ~rz> Depth .......... -¢..9/. ........ tteight ....... /..~.. ' ................ Rear . :~. ¢~ 8. Dimensions of entire new construction: Front ........... Number of Stories../i ...... J J iJJjjj ~e_ight~..; .& ........... Number of Stories ............... Rear ............... Depth ...... 9. a,ze ollot: eront /'~c' 'I~;Jr' ...... 5'~-';~ ...................... :.:. I0. DateofPurchase .'''"~'--'/~'/3V)~'-''' ' ..... /'~--.~q.. r~,,,~ ,~3, ~, ............. II. Zone or use district in which premises are'sit'u~:~'X .... Name of Former Owner Z~¢5_~/tl '~.'4'~2~5,'~ ........ 12. -[cu ........................ ; ..... ir. ..................... Does proposed construction violate an~ zoning law, ordinance or re'ulation- ~ L?~ ..................... 13. Will lot be regraded ............ ~,_~.D.. ...... o · .., ..... ~ .... 14. Name of Owner of premises ~/lsr ~q. fi.~. ....... Will excess fill be rem ved fr g~:~C~dd i~ VY- < .... 9_ . 9Jn~4are~ises. ~ Yes No ............. ress ./. ~ ~/~: o///y ~,~ ,4/,~//-~' -., ' o~ ~l o' '3;~ .~.4-. Name of Architect ........................... Add . . -~ Phone No Name of Contractor · · ... · Add ..... ' '~ ......... rhone r~o ............ 15. [~ ................... Phone N ........ . ....... · If yes, Southold Town Trustees Permit may be required. Is this property within 300 feet of a t~dal wetland~ *Ye~ ~... ' ....... .,., 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 comer lot. OCC iP flCY OF OCCL)P LATE OF NEW--MORIi~, ~- ....... i')/ii'g.o..oc.< ,Dye named. ) APPROVED AS NOTED FEE:. ~-,%~ ~ - BY: _~ E~'", L., NOTIFY B[I)LDING DEPART~ENT Al:' 765. 1802 fi AC.I) TO ~ PK~ FO~ TNE being duly sworn, deposes and says that he is the applicant : is the .......................... ..~.~/ . . (Contractor, agent, corporate officer, etc.) ...................... said owner or owners, and is duly authorized to perform or have performed the said work .~nd to make and file this pi/cat/on: that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be pcrfomed in the m~nerset forth in the application filed therewith. om to before me this .......... .... ..... or.. ....., ta~ Public, .. ~. -~ ' · County · ..................... (Signature of applicant)