HomeMy WebLinkAbout17129-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217361 Date SEPT. 28, 1988
THIS CERTIFIES that the building ACCESSORY
Location of Property 2005 PINE NECK ROAD SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 070 Block OS Lot 45
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 13, 1988 pursuant to which
Building Permit No. 171292 dated JFINE 20, 1988
was issued, and conforms to all 0£ the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ACCESSORY STORAGE BUILDING AS APPLIED FOR.
The certificate is issued to DAVID & BELLE DALTON
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building In ctor
Rev. 1/81
Fosas xo. s
TQWN OP 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~ 017129 Z Date ......~.c..t~....~:.a 19..~~
Permission is hereby granted to:
.~od.~....~~...~:~.~...~d
~~-:-~.R-~~-.... ~.:.y.:....~..1...9..7..1.......... ~Q,c~
ct premises located at ...i~c...:..:..~.........~..~~........ ~
County Tax Map No. 1000 Section ...Q.~~........ Block ........~.~....~pLot No..~~
pursuant to application dated .....~.~4~t:lA...,...~..3 19 ~.8.., and approved by the
Building Inspector.
Fee $.aZ~.S
. .
~...~f..._
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted a9~sio to the Building Inspec-
torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00 POOLS $2~ OO..QLTERATION $25.00
1. Certificate of occupancy New Dwelling $L5.00, Accessory 10.00J1Business $50.00
Z. Certificate of occupancy on pre-existing dwelling $100.00
3. Copy of certificate of occupancy $ 5 . 0 0 , over 5 years $ 10.0 0
4. Vacant Land C.O. $ 20.00
S.Updated C.O. $ 50.00 Date
NewConstruction,,,,,,OldorPre-existing Building Vacant Land
Location of Property 4~ r~ p{./~.,~,~~c~f{'..`j~.~:. , ...~4'~L? ~o~~
House No. r Street lHam/ef °
Owner or Owners of Property ,~,~.7. 2 B ~.~r../,,) ~ ~ Y.~!r1 .
County Tax Map No. 1000 Section Block
Lot....~~........
Subdivision .................................Filed Map No. ..........Lot No. .
PermitNo.~7(2.~.~. Date of Permit .~~./~~(~...Applicant~~V~l? .~~C.C.F.,~N~.'1`0.~(.........
Health Dept. Approval ........................Labor Dept. Approval
Underwriters Approval . ..Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted$..... .Q, mod,,,,,.,,,.„
/ ~f
Construction on above described building and per it eets all plica codes nd regulations.
Applicant....
nay. io-~o-~s
3.S ~'7
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I ~ ~ag~
ass-iso2
BUILDING DEPT.
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~-]'FINAL
REMARKS: ~ ~ h-- ~ ~,~L C
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DATE ~~~~_INSPECTOR
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FOUtJDATION (1st)
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FOUNDATIOIJ (2nd) 7$~$ e ~
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BOARD OF HEALTH
~r ' FORM NO. t 3 SETS Ov LANS .
u,~ SURVEY . .
U TOWN OF SOUTHOLD CHECK ~5' ~
~ .
d
BUILDING DEPARTMENT SEPTIC FORM ~,d/L-; , , , , , , , ,
i 3~I988 TOWN HALL
~ SOUTHOLD, N.Y. 11971 NOTIFY
r
. TEL.: 765-1802 CALL
YOVVlV O S U11-lOLtS 1 MAIL T0:
Examtned . 19~
,approved .~e<e~R . a-O 19~ ~ Permit No. 1.~.! ~~.~Z. ~ ~ ~
~ ,
Disapproved a/c C!~O~ n/~ G~~
C7~~~`~~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 15 .
INSTRUCTIONS
a. Tltis 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 gr~rtted 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, hou 'n~ code, and regulat' s, and to
admit authorized inspectors on premises and in building for necessary inspections.
a
(Signature plicant, o c aeon)
• (Mailino address of applicant)
State wh,~,e//ther??applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumUer or builder.
Name of owner of premises . U. ,rF ~ .c. ~ G..~S? . .
(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. ....lJ:u?'?'S?!4!........... .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1, Location of land on which proposed work will be done . .
p / / e
a1~.-.®.°. SJ........ iY c., , /v!t-,c~ll../.t F0 ~~u~~P.G~{
Flouse Number Street Hamlet
County Tax Map No. 1000 Section ...~.a Block ....`J~ Lot ..~.5.-.......... ,
Subdivision Filed slap No. Lot .
(Name)
2. State existing use and occupancy onqf premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy lt. e.S l.~e:v ~ . .
b. Intended use and occupancy ~ /9..c1.:G/ .
l/
3. Nature of work (check which (applicable): New Suildin Cf,
Re yr g Addition Alters ion .
P Removal Demolition Other 1Vork . .
4. Estimated Cost ~r~~lz,~ cv:'
. . Fee . , , , .
5. If dwellin" number of dwellin (to be paid on tiling this application)
g units Number of dwelling units on each floor , ,
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of eaeh type of use , , ; , , , , , , ,
~ Nures, if any: Front , ~ , .
. Rear Depth .
. H~
ahtsions of existin structutnber of Stories , , , , , , , , , , , , , , , • • • • •
ns o same s ructure
with alterations or additions: Front . Rear , , ,
Depth Height Number of Stories .
8• HemY ts~,ol~ of entire new construction: Front ...2 ' ~ ~ ~
, Rear 2 . / Depth . .
" , Number of Stories , , ' ' ' ' ' ' '
9. Size of tot: Front Rear , ; ...................Depth , . .
10. Date of Purchase p
••••••••••••••.....NameofFormerOwner
1 I. Zone or use district in which •remises are situated . O'i. s.%. ~ /,.~,L, , • ~ ~ • • • ~ • ~ • ' ' ' ' ' ' '
es ro ose construction vt
• p p olate any zoning law, ordinance or regulation: /d/.O........ , , , ,
13. Will lot be re"raded
14. Name of Owner of remises , r • • • ' ' ' ' ' • • • Will excess G11 be removed from premises: Yes No
p ••••••••••......,Address. .PhoneNo..
Name of Architect .............Address • ...........Phone No.. .
Name of Contractor , , , , , , , , , , ,Address ..Phone No. .
15.Is this property Iodated within 100 feet of a tidal wetland? *YES....NO~,.
*If yes, Southold Town Trustees Permit may be required.
. ' 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 corner lot.
~ ~ ~ ~ s~ ~~y
STATE OF NEW YORK
COUNTY OF . S.S
.}Its'oontract) .
(Name of individual sin • • • being duly sworn, deposes and says that he is the applicant
above named.
fie is the
, g corporate officer, etc.) ~ • • ~ • • '
of said owner or owners and is dul (Contractor a ent, • • • • • • • ~ ~ • ' '
y authonzed to perform or have performed the said work and tom a and Gle this
application; that all statements contained in this application are true to the best of his knowledge and bel'ef; and that the
work will be performed in the manner' set forth in the application filed therewith.
Sworn to before me this ~
...day ~off's .~?-Q.., , 19~(~.
Notary Public, ....~~(~¢-!ti!, , ° , , , , , :f , County
NOTARYp
g
jC.~SYa~bn}NewYI X• .
Ter~m'F~~resMicah301ou~ (Sig at re of applicant)
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P/NE NECK ROAD
SURVEY OF PROPERT 1'
Situated at Surveyed by,
SOUTI~IQC D SMITH ~ JUIJG
TOWN OF SOUTHOLD _ ~'~f~~
SU~•FOLI~! COUNTY Professional ~a d rveyor
NEW rOR{'( 120 MEDFORD AVE.
SCALE I"° 40' PATGHOGUE, N.Y.
Phone 475-3192
survey Cerf i fled to~
DAB/D DALTON
$ELCE .8• DALTON
PROMPT ABSTR/aCT CO. /NC,
COMMONWEALTH LANUT/TlE /tits. CO•
DATES SURVEYED ~ /7ECEMBER2,/982 ~ .17ALT0~