HomeMy WebLinkAbout17024-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219712 Date FEBRUARY 7, 1991
THIS CERTIFIES that the building ADDITION
Location of Property 2575 BAYSHORE ROAD GREENPORT
House No. Street Hamlet
County Tax Map No. 1000 Section 53 Block 04 Lot 20
AMENDED MAP A
Subdivision PECONIC BAY ESTS. Filed Map No. 1124 Lot No. 44
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 6, 1988 pursuant to which
Building Permit No. 170242 dated MAY 23, 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 DECK ADDITION AND SLIDING DOORS TO EXISTING DWELLING.
The certificate is issued to PAUL F. WOOD, JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
~ ~
Building Inspector
Rev. 1/81
aoaai xo. s
TOWN OP SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISE$ UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 017024 Z Date ..3./..~...~ 19~F~
Permission is hereby granted to:
tt
at premises located at ~ ~uT ..............'E?:'..... ....d.2.~.....7~.:.~
' County Tox Map No. 1000 Section Block LLot No.........c..~............
pursuant to application dated .........~~.S.r 19&2.:C1., and approved by the
Building Inspector.
D~
F~
I a3ls~'
6Z.ec. 3y~/~ ,
Byd g Inspector
Rev. 6/30/80
Form No. 6 ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT [riff 4 L?
TOWN HALL ~W V
765-1802
FOWN OF StDjUp~®Lq
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OF, 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 17 lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from ar,;hitect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. 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 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 - ResidentialJ~$15.00, Commerciald$15.00
Date ....5..~.~:..~~t../~~!
New Construction...........~yOld Or Pre-exOisti/ng Buil/d~ing.........../.J
Location of Property...~~..,c 5 lJ.~k}lS/y n/?~. f:~ Lr:/,1~~R,~4~'~.~.....
House No. Street Hamle
Onwer or Owners of Property......l1.b:~... ~'....~.llv.t~,,,~ Jh~:
County Tax Map No 1000, Section.....4~.5..'~....Block......~ .......Lot....'' ~
Subdivision Fail/ed Map........... Lot.. „
Permit No..~l/.~~7..2'.Date Of Permit...`~~1 .~~Applicant... ~
~ ~..~~v~?~~,J~ ~
Health Dept, Approval ..........................U/nderwriters Approval.........................
Planning Board Approval /
Request for: Temporary Certificate........... Final Certicate,..
/s
Fee~Sjubmitted: $,,,,,~1„ C"~;}
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s Toy rr .or sour~oi,~ ~ ~ a ~
l'~7~6;;:+;~~ 3';° ~ OI~f'iCJ: C)t" BUILDING INSPECTOR
~ TOPIN I[ALL FEB - 61991
c+t. ~...3J
' ~y0~ a SO(1TI101_D, N.Y. 1 1971 a _ ~
r ~y .._,t
January 8, 1991
Mr. Paul F. Wood, Jr.
2575 Bayshore Road
Greenport, N. Y. 11944
To [9hcm This May Concern,
4.e arc unable r.o complete your Certificate
of Occunanc,~ because .of the follooriny reasons.
~;)~Q An application for Certificate of Occupancy
~ is nut nn fil.c.
/ / Dlo IJndertrriters Certificate on file.
'1'hc ahecF: .i:; (x~L^cbc~4atrt#~nut on file.) $25.00
D7o ltnal.th Dept. Approval on tile.
ho final inspr_rtion has been made.
Plc:asr, r_ontact our office on this matter. -
T:,tank you for your cooperation.
Ilu i,lc] inq Pcrm.i.t•. I! .Z .0. 4 2
Builc]inq DcpL-.
tlo Plt;mbcr :;older Ccrt.ificatc on file.
( nl.l pnrt:tits irtvolvi.ng plumtrinc~ being
issued aft.r_r ~~prS.l 1,1984 )
S.~~FOC.~~;'r TEL. 7C5-180?
c. T0~'N OI' SOUTIZOLD
l~ ~,.wu f;`' ; < OI"I'ICl3 OI' BUILDING INSI'rCTOR
~,.C.Ji TOIINIIALL
Off' SO1JTIiOLD, N.Y. 1 1971
~Ypl ~3 .
f
January 8, 1991
Mr. Paul F. Wood, Jr.
2575 Bayshore Road
Greenport, N. Y. 11944
To D7hom This t4ay Concern,
We arc unzble r.o complete your Certificate
of Occupanc;~ because of the following reasons.
An application for Certificate of Occupancy
is not nn fi].c.
No tlnderc~rriters Certificate on file.
~g/ The chcc}: .i:: (~x~tacD~4xxD/nut on file.) $25.00
Db Ilcal.th Dept. Approval on file.
No final inspect:ion has been made.
P]<a->o contact: our office on this matter.
T!,;ank you for your cooperation.
llu.il<]ing Pcrm.i.t: 0 ~ -Z .0. - 2 4 Z
Building Dept,
tfo Plumber ;;older Ccrt.ificate on f-ilc.
( a7.1 pnrmiCs involving plumbinr~ briny
issucci aft.cr rlpri.l 1,1984 )
INSPECTORS
Principal Building I pector ~O~pSUFFO(~-CaG
Curtis Horton = 'y` SCOTT L. HARRIS, Supervisor
Senior Building Inspectar y Z Southold Town Hall
Thomas Fisher P.O. Box 1179, 53095 Main Road
Building Inspectrn ~ • ~
y Southold, New York 11971
Bui'lding Inspectar ~ ~p Fax (516) 765-1823
Vincent R. Wieczorek Telephone (516) 765-1800
Ordinance Inspectar
Robert Fisher
Assistant Fire Inspectar OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
December 21, 1990
Paul F. Wood, Jr.
2575 Bayshore Rd.
Greenport, N.Y. 11944
Re: B.P. #170242 Deck Addition
S.C.T.M. #1000-53-4-20
Dear Mr. Wood:
I am writing to you regarding the above permit which you
took out May 23, 1988. This permit has expired and you have
never called for any inspections and you do not have a
Certificate of Occupancy.
Please contact our office regarding this matter. You are
in violation of the Code of the Town of Southold.
Thank you for your prompt attention to this matter.
Yours truly,
Secretary
l~ ~g
~
, BOARD OF HEALTH
~ 3 SETS OF PLANS
FORM NO. 1 SURVEY . .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
• TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL .....................i
MAIL T0:
Examined 19 ~~J . .
Approved .../.~aa........, 19 P. FPermit No. ~ 7~ ~ ~ ~ ~p.li d-N.OitPG• ICG{ ,
Disapproved a/c
~~e~~Y~ i , Na ~ ?I~Y~ s
I l.J;`.i f 'i
- ~ ~ ~ ! MAY - 6 i~~v
~,f
ildmg Inspec or) ~.,w,.._ - , " . =t a
Eat C.•k7 f
~APPL•ICATIONFORBUILDINGPERMIT TOV~tJQ°`~',<<~t`a~-`"'
Date . ,/,//A~..~....,. - , 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 azeas, 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 shad 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 Depaztment 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 inspections.
/ (!Signature of applic~fant, or name, if a co-ryp-o-ranon)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.....C7wNH~
...................(:........./~.~~.qq
Name of owner of premises J'i.4: L,V.q 0. ~ .
(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. U/i~~°K~ A~ V.FRI~ ~ ~20 ~~(~N-~2 y •?a"~r'~`~{ ~/~,r /fj~~
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
I. Location of land on which proposed wo k will be done. .
House Number Street Hamlet
County Tax Mgqap No.// 10,00 Section d~..?'~~.j... 7.-.'y--B~l~ock Lot 2~.......... .
Subdivision .t1~l~N.d~fA.. ~ . ~ . . 1~-:z°O.A~/.~ •t~F• ~~G.k~l°iled Map No. ...l.l.l' y Lot .
2. State existing use and occupancy"" off premises.~and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..t?~~lC. •~O..O./~0?!~~.:~~~~ao2. a~C~-~^rj y~,0~ ~-l~~`{~~/ ~~/:~/p~~,
b. Intended use and o cupancy /C.~ 4R~~ • • •!`fd•~T'~N.-FI• •,~.7~~17A!G•'"F1%~ .W(!t~/. •`~/Xp9!v/~~J~'d G/1F'~/~-•
~ /,tsi~ .~1~/y~' ~Oa/LS ~p,/[.~G•~L'" Od lo~adPG ,9CC•~d"~! T~d~- /t'r'u!A?~L r~~V~.000/
l diw ~~~jjy~y~~r~g"~ ?
3. Nature of work (check which applicable): New Building Aaddi~on * S.`...... A7t8iation• .
Rgpair r~ oval . Demoliti n Other Work rl*!0.. fe~C~fF~
~ C.tc~ .vd FidGiPKf ,S,v ~-X~ rT.v(r ~/ze>°rxd1 L~s4yL. fH ,~Tr~.p ~
~ escn tion'
4. Estimated Cost ............'..7"~ !ti?'t~ Fee .
(to be paid on filing this application)
k 5 Xf garagennumber of adwelling:units : ; ~ : ; ; Number of dwelling units on each floor .
If busi
7. HDimepness, commercial or mixed occupancy, specify nature and extent of each t p~ of use
sions of
fx' ling structures, if any: Front Rear Depth ~ .
t 3.:
g1~1 rpberes~:~ f~y............~~~ .
~j~
s~~ tth alterations or add'tions: Front ~a'~."-.. ar ~ .
.,r•
_ 8. D mensions of ea~6 new ~onst • • Height ~qs!~.g , , • , , Nudes/fiT!l . R4~p.:
{~^~'°E•PV ~~G!
~ ruction: Fron ..//.Rear D~th Ly' /
Height ..T~:T$!?µ.~"•3Qytrt~ber of Stofy~}N.
P ,/.?E•iol,~?e,~d, 111Z!i2,~• w ,/N.SYR!( ~l d/.~'. ~o.!J;
" p
9. :iize of ]ot: Front f.~,,.JJ Rear Dep~~? f~
10. Date of Purchase T .Name of Form r Owner .../.'!'!V L. l~.Gu0 0 ~ : S'IZ. • •
11. done or use district in which premises are situated , f. ~~AN.!~ .fit:
f! . ~lTd~~k••I .
12. Does proposed construction violate any zoning ]aw, ordinance or regulation: .../YD .
13. Will lot be regraded pp.~~ . , /L!4 tt/~~~ ....Will expgs,S. fi be rgmovedp om premises: Yes
14. Name of Owner of premises CrrV4.l~•..IN.bR A....... Addressbf d , ~1¢yf//4.!P:~ , //q~.• phone No. 7~~:',/.~9,
Name of Architect ...........................Address ...................Phone No............... .
Name of Contractor • . .................Address ...................Phone No............... .
PLOT DIAGRAM
Locate cleazly and distinctly all, buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
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aG~~l s- .
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STATI's OF NEW YORK, S,S
COUNTY OF .
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
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 fgrth in the application filed therewith.
Sworn to before m//e this
..............N... ...day of 19~~. ,
Notary Public, ~r,Nnl.t. A.',, V County ~ ~
' NEIEN K. b~ V0~ ~ ~ .Vi/ • !/.1.11... .
NOTARY PUBLIC, State of New Yak
No.470T87S, SuflolkCounry (Signature of applicant)
• term Xxpires,March 80,,}9 ,