The URL can be used to link to this page

Home My WebLink About16816-zFORM NO. 4 ToWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Zi9327 Date AUGUST 30~ 1990 THIS CERTIFIES that the buildin~ Location of Propert~ 530 House No. County Tax Map No. 1000 Section 91 ADDITION SUNSET WAY SOUTHOLD Street Hamlet Block Oi Lot Q9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 4, 1988 ~ursuant to which Building Permit No. I6816Z dated MARCH 15~ i988 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 SECOND STORY ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 LAWRENCE & GLORIA SIMON N037138 OCTOBER 3~ 1988 K & K PLUMBING SEPT. 27~ 1990 '~~/ ui/l~ding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~65'u Z pursuont to opplicotion doted ........ ~ .......................................... , 19~-~..., and approved by the Building Inspector. Fee $...~..3~. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 : . APPLICATION FOR.CERTIFICATE OF OCCI This application'must be filled in by t'ypewriter OR ink and submitted to the building inspector with the following: for new building or new use: l. 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 hlectrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system comtains ~ less than 2/10 of 1% lead. 5. Commercial building, indus, trial building, multiple residences and similar bu~/dings 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, 19~3) 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 consentS'to inspect signed hy the applicant. If a Certificate o£ 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 C~rnificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential ~15.00, Commercial $15.00 eet Hamlet Subdi~ision ....... [ ..... : ........... . ........... Filed Map ............ Lot. [ ........... .~ ........ ........... uate Of Permit ...... ' , ........... ~,~,~-~-can~...;..'~ .... 7~'~....~. · .'7~....~... ftealth Dept. Approval ................ Ap p .......... Underwriters royal ......................... . App ' Planning Board royal ........................ 4: ' Request for: Temporary C rtifxcate ........... Final Certicate ........... Fee Submitted: $ ............................. ·.... ........ . :": .................. TOWN OF SOUTHOLD ' OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL.~ 765-1802 Buildin~ Permit No. /~/~ Owner_ c~\ ch'No-o, (please print) (please pr xn t ~,\¢ Ccx%¢ I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) SWOrn,,to before/me t~.is tIOtary Public, ~/.[~ County Nota~ Publio, State of New No. 52-2162100 Ou~l~f~d ~n Suffolk Co~niy / Notary Public FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ~PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMM ,..7/¢ ,~ VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (516) 765-1802 FAX (516) 765-1823 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD August 30, 1990 Mr. & Mrs. Simon 150-28 22nd Ave. Whitestone, N.Y. 11357 Dear Mr. & Mrs. Simon: I am writing to you regarding a Plumber Certificate. I have all the other papers necessary for the Certifi- cate of Occupancy. I tried to call you today but no one was home. I have also called George Terry to tell him this was needed. trgly, Secretary 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ,r~'I~NAL DATE, ~'/~/~'~). I NS ~ECTOR ~. ?1//.(.//~/ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 15T [/~ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL DATE ~//~/~ !NSP~ECTOR .~*~~ ~//~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELEC1'RICt1'Y FIXTURE OUTLETS SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS FESTERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OE FEET SERVICE DISCONNECT $ E R V I C This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by the'ir credentials, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY h[kNtqER. FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Exanfined ............... , 19... Approved..~././.~...'~. ....... 19~.~.~ Permit No. l .~.?J..~....~ Disapproved a/c ..................................... ............................... ..... .~Buildiz}~/In sp ect o r) APPLICATION FOR BUILDING PERMIT Received .......... ,19... Date 9.."7...~/ ......... , 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 regu!atio?, and to admit authorized inspectors on premises and in building for necessary insp~t)ons. ,)~ ~ ..... .... rt. .... ............... (Signature of applicant, orname.'ifna e, ' a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................ Name of owner of preinises .~.' .~..~.'.r ?.q .c.~.. ~. '.;..rDg.D. .............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~. ,-~ ..C). ~.~.../~..~. ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ~ .~. ~q..~..~. ................................... ............. ...... .......... ................... House Number Street Hamlet County Tax Map No. 1000 Section ......... .~./ ...... Block ........ l ......... Lot.. 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.. 1~.'.~.~ l.d.~.tq C.'~ ................................................... b. Intended use and occupancy ..... .e.~. ~. ?..rl.¢.~ ............................................... 10. 'I1. 12, 13. 14. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ (Description) 4. EstimatedCost.C~:~.d.~..~.O.-..O..~.. ............. Fee ..~.:~...2.:~.O ............................ (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ........ /. ...... Number of dwelling units on each floor.. J ............ If garage, number of cars .... :. ~....- ............................................................... 6. If business, commercial or mixed occupancy, specify,,~a~ure and extent of e~asc~type of use ....... t;z. .......... 7. Dimensions of e:~isting structures, if any: Front...'~?.O ........ Rear .~(..c~ ......... Depth.~ .~..~.~.~. Height . . ./.~ .......... Number of Stories . . ./ ......................................... Dimensions of same st~cture with alteration~ or additions' Front ~ ~ Rear_ .cd..~:~ ...... De th f,~:2>. ~-~,, He oh* 2L~--, - · P __ · ........ , .... ~,, ...... ~ ................ rqumoer of Stories.,...-'f~--~. ...... r ........ 8. Dimensions of ~ntire new construction: Front ...~/x.~) ~ ...... Rear .~,'~.' .... Depth ~ O '-~. Height ,;~-.~. ...... ~... ~.umber of ~o.r~e~ ..... ,J,~..: .......................... .~.., .,i., 9. Size of lot: Front ...~ ~'~.'c~. ?.~...~'.'~.fl. Rear....~ ................. Depth /.~'.O.. t~.,Ptf~...] .7..~.. Date of Purchase .......... ~ ................... Name~ of Fp .[jner Owner ................. .... ' · ' ,:d ............ Zone or use &strict ~n which p[em~ses are s~tuated. .~'. ~. rz. .................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ............................. Will excess fill be removed from premises: Yes ~o~ Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect . ~, ...... , ....... jr~ ~e~ r 7'er*~ ........... Address ........... Phone No ................ Name of Contractor ... foj...., ..... ~/ ......... Address,.:. ~i ....... Phone No. 7.~ ~. ftC..Z:.~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl interior or corner lot. : number or description according to deed, and show street names and indicate whether ...... ~ ~ ....... -. · · [ ~ .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contra~t) above named. He is the ..................... (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 in the application filed therewith. Sworn to before me this ............ · t7 ........... day o~.~f..~ ........... ,19..~.?- Notary Public ...... ~'~r~' ' ' '~' :' ' '~' '~' ¢'~' ' ' ' C°un~ /~.-~~ t~.AII~._I~_.IIIJC, ~ of ~w.r0111 (Signature ~ applicant) . no. 4107878, Suffolk Ceunty~,,~ lerm E~pires March $0,