HomeMy WebLinkAbout24079-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCu~,ANCY
No Z-25031 Date MAY 8, 1997
THIS CERTIFIES that the building ADDITION
Location of Property 200 (aka 65} WILMARTH AVE.
House No. Street
County Tax Map No. 1000 Section 41 Block 1
Subdivision Filed Map No.
GREENPORT, N.Y.
Hamlet
Lot 26
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL ll, 1997 pursuant to which
Building Permit No. 24079-Z dated APRIL 29, 1997
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 ONE FAMILY DWELLING "AS BUILT"
AS APPLIED FOR.
The certificate is issued to
CLAUDE L. & SUSAN KUMJIAM
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
IPOp~w NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING P EPJAIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 24079 Z
D~te .................... , 1
Permission is hereby granted,~Z ,~ / / '
..... .......................
~o~,~ ~o~ ~o. ,000 ~,~,~ o~ ...... ~.~ ........ ~,~ ......... Z .......... ~ ~o....~............~ ' ~ ~ .
pu~uont to opplic~tion d~ ........ ~..~ .................. , 19~, ~nd ~pprov~ b~ ~
~. ,./~ .............
Building
Rev. 6/30/80
Form ~o. 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 1% 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 c6mpleted site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
qpre-existing" land uses:
i. 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
i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory buiiding $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existin~ Buildin~ - $100.00 /
3. Copy of Certificate of Occupancy - , .25~
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. ........................
New
Location of Property ...... ..2~..~....(~.~./' ~ ..... ~Xp**.~. ~ .~.~~.-~..
House No. Street Hmmlet
Onwer or Owners of Property.. ~ ~ ~,
County Tax Map No i000, Section .... .~..[ ....... Block ...... ~ ......... Lot ..... ge ..............
Subdivision .................................... Filed Map ............ Lot ......................
Permi: Of Permit ................ Applicant .............................
Realth Dept. Approval ......................... ,Undez-~rriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate.~.~.. ......
Fee Submitted:
$. &-.sl. ................... oo .....
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BUilDING DEPT.
INSPECTION
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[ ] FOUNDATION 2ND [ydIISUlATION
[ ] FRAMING [vi] FINAL .
[ ] FIREPLACE & CHIMNEY (.(lPd. ~ ~b-)
REMARKS:
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APn I I 1997
l ,:
,[,I I
. ','. ,
FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTIIOLD, N.Y. 11971
TEL: 765-1802
BOARD OF HEALlll ...............
~3 SETS OF PLANS ...............
/,SURVEY .........................
/ CHECK .........................
SEPTIC FORM ...................
\~,\i~ l~ 0 ~ff \\1
. ._..._-~".~. ~.~,"",',M.'. ~""'1.,1 ~
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NOTIFY:
""'/7-{)03S-
CALL ------.--.n--.... ')
l <7> 7[,)' -")(. vv /
MAIl. TO:.................:..
LICATION FOR BUILDING PERMIT
. Date. . . . . . . . . . . . . . . . , 19. . . .
INSTRUCTIONS
a. '/his application oust be ~letely filled in by typewriter or in ink and subnitted to the &lilding 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 p.lbl ic
streets or areas, and giving a detailed description of layout of property DUSt be drawn on the diagran ....ich is part of
this f1pplication.
c. nle work covered by this application I'DY not he C0111Enced before issuance of Iluilding Pennit.
d. Upon approval of this application, the fuilding Inspector will issue a fuilding Pennit to tile applicant. Such
penni t shall be kept on the prenises available for inspection throoghoot tile work.
e. No building shall be occupied or used in "lOle or in part for any purpose ....atever until a C,ertificate of
Occupancy shall have been granted by tile &lilding Inspector.
APPLICATI<JI IS IEmIIY.wE to the &lilding DepartIrent for tile issuance of a &lilding Pennit purSllant to the
fuilding Zone Ordinance of the '10m of Soutl1Old, Suffolk County, New York, and oUler applicable laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for rmDVal or dennlition, as herein
described. ~ applicant agrees to ~ly with all applicable laws, ordinances, building code, housing code, and
regulations, and to acbit autl10rized inspectors on pranises and in building for necessary inspections.
(Signature of applicant, or naue, if a corporation)
(Mailing address of applicant)
State lilether applicant is ownerJl lessee, agent, architectJl engineer, general contractor, electricianJl plmtler or builder..
.....................:............... t.~'~'.'."~'" '~'~'...""';'."Su.""'.";..'-:.. 'i1!~~~I:(lJ!.;{ Malin;" 7~'
N;m, of omer of prem,ses .................;JJfI.........../J:;./).c..,.......~IlJ;./......,..#L..'{If.Z-.BJ:JI. .~
(as on tile tax roll or latest deed) , ,-51 L/.e' ',iT ",.//15 f!1e" BY . ... '._
If 1.. " . "LJ.I/)j?I{~7f?1' H II" v l'lIIL"'''... 0"" I""
app 'cant ,s a corporat'on s'gnature of duly autl10nzed 'i,f"'lllS ell........, .' ., .....",~ ~. "," '
, ~i1 K -. !~i,,1802 \) AM TO 4 M FOH:'I::,
..................... .~.............................. . IlEQUIIIEI f-Ol LOWING INSPECTIONS:
(N;m, and title of corporate officer) " f'()IH~DATION - TWO RECllJiP,"""
OCCUPANCY OR FOJl POUREfl CONCRETE
. USE IS I.lMlAW-=Ul /. ROUGH - f'RAMI/llG 8. f'Ll.IM;e;,:r,:
11'- ~, 1I\1~~UIATlm~
Budders License No. ........~..............WITHOUT CERTIFICATE .. Fii.!r,L. _ CONSTRUCTlONM'I,F
PI...i>ers License No. ......................... OF OCCUPANCY Cr' COIViPLETEfOAC.O.
iU l C(JNSTRlJcrIOf~ SHAI.L '.liE;
Electricians License No. .... ..:-:............. TI-i~ fiEQIIIREMENTS OF TIlE N. ';
OtJler Trade's License No. .....=-............ ~:'V'\rE CONSTRUCTION & ENERii',
1 Loca' f land. . 7 /) 0 l,.AJ , /411 ~7''fI'SA v@T RESPONSIBLE Fcn
. t,on 0 on ....'m proposed work WIll be cIone.......4.v........... ."'NalfjN'.eWlC.'ONSIIlUCTfONcTlRflM;
...... .?:???........................ ~ -'.{-nt!.~.T.I!. ~':'."",..."""",."""", $~<;-:-:j!q~.r:...................
House Ibtber Street Ilanlet
. 'II I 2 IP
County Tax Hap No. IlXXl Sect,on................ Block ................ Lnt ................
Subdivision .........../{~~C::................... Filed Hap No. ....~//.!..... IDt ...-Yr........
(N;m, )
2. State existing use and occupancy of premises and intended use and occupancy of propQsed construction:
a. F'xisting use and occupancy ..........f:'!~:~":R~(..(:.f:i1'!'!...t)'Nf'?;r-......0...6.((.'.~.~. .. .. 0
bIt nded \,00 and c',f'l/l.e'H .'" n"~(:\; .IU'//J
. n e ~ occupalx:y ................;....................,_.....,.........".~""".....~......... .....F.!~.
JMi'!'!' k.,J)4o ".t!( .t-',n," .'
t li 4- II" "~itr\Ji".',,;to-r.!h~.\:.f'
/1,Je \,.J (Av~ I<L(.I::~~;:'~ S m;;-I) .,.."~~..",i.~.,,: i/\~I.i .
<()I ~ e f ;-:;"t;}(f;",_,i"..,j2"nlf1~1"'~llf
1.
I,.
5.
6.
7.
8.
9.
10.
II.
12.
tJ"llIIe of wOlk (dN..'(:k ..hid. "l~lliclhle):
Hel"ir -........ _.. RenlOVlIl .............
/
I-<<..'W I~Jildio~1 .......... hklilion .......... hlternlioo ..........
llennlition ............ Other I~ork ..................................
(Jlescript ion)
E5till~tecl Cost
.. .. ~_ .S":'~?..... _... '"
..............................................
fee
(10 he plIid 'HI fit iog this IIpplicatiCHl)
If ch..-ellinn. .u,her of dwelling units ...~.lf!.... tlnher of (1\-lelling 'Dlits on end. floor ................
If garage. ...,her of caTS ........N/~.........................
J f husiness, canrercial or mhed occupancy, speci fy nature and extent of each type of UBe,', _.M IA.............
Dimensions of existing otnlCtuTes, j f any: FnXlt... _..5 .~...... Rear.... f..~..... Oeplh ... f-.~.........
lIeight ......!.'?:t:~~~.......... Ihlller of Stories ......................
nin~nsions of SOIl! stnlCture wilh alterations or lkklitions: Front ............... Rear ...............
Orep..h .................... lleigllt ...... _............. t-l.I'ler of Stories...............
niup.nsiofls of entire neW' construction: Iii-ont .....?:t?...... Rear .....?~......_ Depth ...I.~_.._...
I' /
Ileil~lt ........ .1$.............. Il..her of Slories .....................
Si..e of lot: I'ronl .......'1a.......... Hellr .................... Ilepth .....t.?~.........
Iklte of I',rd..se .....1J.~1/.~?:...... II,....., of I'o(lr-er Oolller .......4r.U/S.........................
Z \... "'d' . I 00< R _ 'I 0
.one or use (lstrlct In \011'1 . prenllses are ~litlJatec: ........ J~~.,....................................................
I\Jes (Jr-oposed construction violate any zoning law, onlinance 01'" regulation: ........................
1'1.
n. Will lot he regrllded ....H.O'............ Will exce.s fill he rellOlled fran prenises:
"""Ie 110.
YES
GD
N.,res of Owner of premi ses .......... _ . . _ . . . . . . . . . . ... hkkess
~ of hrcllitect .................. _................. Mlress
..............................
..............................
"""Ie 110.
tl<.ne of r.ontractor ................................... Address.............................. .Phone No.
15. Is Ihis properly within JOO feet of II tidsl '",tlllnd1 * YES .......... NJ ..........
*11' Y1!S, 9:Unnn lUoIllRUSlEllS l'IlHMrr Hl\Y \lll Rl'.QlIl1fill.
I'I.OT 1l1hGllhH
loellle clearly m,,1 distinctly all buihlings, IAlether exisling or proposed, 1In11 Indicate 1111 set-back din"nsion.
frUll pr-operty lines. Give street and block RDher or description according to deed, and slKM street na~s and indi<:ate
\vhether interior or comer lot.
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......................................................... .helug duly
(Naill! of ii'll.lividual sinning (:ontrnct)
nbnve nl'll~l.
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nwonl. deIX)geR and fmya lhlJt he if; the npplic:mt
lie i. Ihe .. ...... ........ ........ ..... ...~!-!-1~. .:... .... .... ... ...... ... .... ........... ....... .... .......
(nn,tnlctor. "gent, coqx)rnte oUker, etc.)
or Bnid uwuer or Ol"mers, nnd is duLy autlKn:ized tu perform or have I'ed'orned the said work arK) to rmke and Ii Ie lhis
nppllcnt ion; thaI: nll stalell'enln conlaill(~ in this "ppl lent ion nr-e tnte to the hest of l1i_9 knuwledge nnd hf!lief; :md
II...l the work will be perron I-.ir the 1T~U1l1er set forth in the appl.icntioll filed therewith.
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