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Home My WebLink About16795-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19078 Date MAY 24, 1990 THIS CERTIFIES that the building ALTERATION Location of Propert~ 1995 RYDER FARM LANE ORIENT House No. Street Hamlet County Tax Map No. 1000 Section 015 Block 003 Lot 001 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JAN. 20, 1988 pursuant to which Building Permit No. 16795Z dated MARCH 11~ 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 ALTERATION WORK ON EXISTING ONE FAMILY DWELLING. The certificate is issued to JANET SWANSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N127777 MAY 10p 1990 PLUMBERS CERTIFICATION DATED N/A Building InSpector Rev. 1/81 !~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TO~VN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST 'BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- 16795 Z .~_ /-'. J/ . . , ~ , cou.~ Tox Mop No. ,000 S.c,io. .... ~..~ ......... B,~k ...... ~ ............ ~o,,o ....... I. ............... pursuant to application dat. .... ~ ............. ~..~....., 19~ and epprov~ 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 BLDG, DEPT, TOWN OF~OU t J) _ 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 completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: i. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features, t 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. Ce 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 - $i00.00 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 New Construction ........... Old Or Pre-existing Building...~ ........... Location of Property.../[.~..~.~.~ .......... ~y.~.~.. ~-q~. y¥, .......... House No. Street Hamlet Onwer or Owners of Property...~.P.~.~.~...,. ,~r~[~ J/I ~'.~ ................................ · · · · / County Tax Map No 1000, Section ..... / .. .Block .............. Lot ...... Subdivision ................................. ... Filed Map ............ Lot ................... . .. ~.27~~ ~ Date Of Permit ~i~ a~ ~..Applicant Permit No ...... ~ .............................. Health Dept. Approval ....................... .. . Underwriters Approval ...................... .. . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $.. ~ ~.,.~ .~. ................. APPLICANT FOUNDATION ( ls t) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS ~A~ ~ BUREAU OF ELECTRICITY J'-'- 85 JOHN STREET. NEW YORK, N~W YORK 10038 HAY D~tP ,4ppliegfion No. on ftl~ THIS GERTIFIE$ THAT o~y the e[~trlc~ equipment ~ ~ ~ a~ int~ by t~ ~t ~ ~ t~ g~ ~ aum~ ~ t~ ~ ~ JANI;i ~AN~H)N, RYI')IR t/ARM LANfJ. P~]LF ~) , O~).KNI, N.Y, i.,~.~o,,o~,~.~D~~ ~., ~ ,.~,. ~ ~ ~,. .~.o. .,~ ~, ~ examin~ on a~found to be in compliance with the r~uirements of th~ ~. RXTUI~ IqXTURES OUTLETS FLUQIIESCENT aTHER :1 ~ RANGES OVENS BXHAUST FANS DRYERS FURNACE MOTORS IRAC1](INAI M0101'~; FOR IIYDI~¢~N/C-/ ceflificate must not be alte?d in any manner; return to the office of the Board if incom~t ~s.may be ~..~y their credentials. - '(~. COP~K FOR BLII LDdNG DEP~TMENT. THIS C:OPY OF CLqrTIFICATB IdiOT -~ BEALTERED IH ANY M~J~4ER. ;.~ /f l.'!. /? ' SOLD£R USED /N WATER . SUPPLY SYSTEM CANNOT EXC££D 2110 of 1% LEAD, PLUMBER C£RT~'ICATION ON LEAD CONT£NT /~£FORE CERTIFICATE OF OCCUPANCY BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY ~OUTHOLD, N.Y. 11971 TEL.: 765.1803 CALL ................ MAIL TO: Examined *.~..., 19 ~.~ Approved ~t*,O~..ll ..... 19g~Permit No. . ~.~. fT.. .~. . Disapproved a/c ................... '.'.: .... .' .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 auth°rizedinspect°rs°npremisesandin bulidingf°rnecessa~cti/~' ~f~ (Signature of applicant, or name, if a corporatio~n) .......... ~ · /./~/ ~ ad ress~}~) ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~~ ........................................ (J (as on the tax roll or latest deed) If applicant~is a co~pration~wsignat~ure of c~u/~y authorized officer. .... ~.I~.~:L.~...-:... (Name andtitteofcorporateofficer)- L zc~.~j~DCUPANC¥ OR Builder's License No ..... l' '~' O .............. ~. · '~" · Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY Location of land on which proDose, d work will be done .................................................. ...........- .... House Number Hamlet Cou,,y Tax Map No. 1000Sec,~o~ .... 2.~. ...... Block .... ~. ........... Lot ...... f. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and. occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy 3. Nature ofwo. rk{check which apl~licable): New Building ' Addition Alteration Repair .... ~/~ ....... Remov~al .............. Demolition .............. Other Work ............... t -"~/~ ! , (Description) { { i " (to be P0id~on filing thi~ application) 5. If dwelling, number of dwelling units .............. Number of dwelling gnits on ea~ch flQor ................ 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 ........ '. · .' ...... ~ ...... ,. i ................... ............. Dimensions of same structure with alterations or additions: Front ear .................. Depth ' Height Number of Stories -, 8. Dimensions of entire new constru~tinn: Front .......... ..... Rear ............... Depth ............... Height ............... Numb?r of Stories ........................................................ 9. Size oflot: Front ......... ..............' Rear ........................ Depth ...................... 10. Date of Purchase ............ [ ................ Name of Former Owner ............................. 11. Zone or use district in which premises are situated ......................... ,.. .......................... 12. Does proposed construction violat~ any zoning law, ordinance or regulation: .../~. ~). ...................... 13. Will lot be regraded .......... i ................. Will excess fill be removed from premises: Yes , No Name of Owner of premmes Name of Architect ....... {d ............ Address .......... . ......... Phone No ................ Name of Contractor. ~ .~ .~dress ~ ......... Phone No.. 2J". ~..._~z./ 15. Is this property located w~thin 300 feet of a tidal wetland? *Yes ..... No · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings whether existing or proposed and. indicate all set-back dimensions from property hnes. Gwe street and block number or descnptmn according to deed, and show street names and red,cate whether interior or corner lot. OCCUPANCY OR USE iS UNLAWFUL ¥ II1[HOUI' CERI'IF CATE OF OCCUPANCY STATE OF NEW YORK, S.S ' COUNTY OF ................. ................... ............. ; ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing qontract) above named. : He is the i (Contractor, 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 m the apphcatmn filed therewith. Sworn to before me this HELEN K, DE VOE I NOTARY PUBLIC, State of Now Yolk .............................................. . No. 4707878, S~k~un~v,~ (Signature of applicant) lerm Expires U~rch 30,1.: ~/