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HomeMy WebLinkAbout17133-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19046 Date MAY 14, 1990 THIS CERTIFIES that the building ALTERATION TO ACCESSORY Location of Property 400 NAKOMIS ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 3 Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 27, 1988 pursuant to which Building Permit No. 17133-Z dated JUNE 20, 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 T6 EXISTING ACCESSORY BUILDING. The certificate is issued to HAROLD & EILEEN WALTERS (owner} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 r~osat< xo. s TOWN OF 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) 0 01.713 ~ Z DateG~/~~ikxn ~ 19..f~~j Permission is hereby granted to: J,,....~1..~.....~......~./..9 7 ro ....«~.,u..Cl.Y..1............... ~ ct premises loca at .~~....~.r~`~:!~l,~l,.......~~.~1/.`.~~.C...................... r..~ ~...7..~.'~ County Tox Map No. 1000 Section ...7..G7........... Block .....1~............ Lot No....~...Q......... pursuant to application dated 19~~ and approved by the Building ?Inspector. Fee $...J.~1..~~ Building Inspector Rev. 6/30/80 ~ Form No. 6 ~L,~. ~ ~/~:"~,~1~~, h ~ TOWN OF SOUTHOLD 9 M~Y ~ Q~~yO " BUILDING DEPARTMENT ~ L1,'~~ TOWN HALL ~„Aam,...„-,..,v~~?~ 765-1802 flLt7G. DEPT. ; 'TOtitJ4V OF ~©LTh'CSta7„ 3 r .a._. APPLICATION FOR CERTIFICATE OF OCCUPANCY ~ A. 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: ' 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 - Resident/iyal~f$15.00, Co//mmercial/$/1/5.00 Date ..::.k ~ .~U New Construction...... Old Or Pre-existi`n'g Building......... .l/ Location of Property...~.~ ~ ...............1~.~.fC.®.11.1.$. ~4 ~......g.9.~~~!-V.~.~..... House No. Street Hamlet e Onwer or Owners of Property...~~.1'.ei~N.yO~~.d4.~',.~~..4.R-.f'1...~t~.~..t.~.P,~ County Tax Map No 1000, Section.. 1.P.........Block.....~.3..........Lot.....~:"~ Subdivision .............................pp.......Filed Map..........~.j.Lot...................... Permit No.Q.t~.I.3.,Z.~..Date Of Permit.~+.~?~~.~.....Applicant..Zds.;,4..¢~.~.c~.a,,4a~,;,.... Health Dept. Approval .........Underwriters Approval......................... - Planning Board Approval.~.~~~..~~~ . ~ . f':~... Request for: Temporary Certificate........... Final Certicate....~..... Fee Submitted: $.~.,°1~...F.: ~ d . /APPLICANT ~ P_o~ i4oy6 0 r'lELD II;SP°C:iON '~~UATF. ~ %OMMENT° -o 7 .~---yy~~ - '-3W FOUtdDATION list) c~ cn FOUNDATIOtJ (2nd) 2. z 0 . x DOUGH FRAME & Q PLUMBING J v H 3. ~ I1ISULATIOPI PER N. Y. y STATE ENERGY CODE x ca-~ 4. HQ FIiJAL o z ADDITIONAL COMMENTS: x ra M~ ~M O ~1 z 1 ro a r x v m b H c 3>~ BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FOR ' ~ TOWN HALL ~ C, SOUTHOLD, N.Y. 11971 NOTIFY, TEL.: 765.1802 CALL .0~~., 19g~' MAIL T0: Examined . ' ' Approved~~'~'!`~.. 19~~Permit No.Q ~~~J.J ~ ~~77~}/7 Disappro(w//ed arc D L7 \~l .5 (Building Inspector) TOWN OF SOUTFIOl6 APPLICATION FOR BUILDING PERMIT Date 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- catian. 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 layvs, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections:. 7. ~x . `av.„ . (Signature of applicant, or name, if a corporanon) cv . (Mailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....O..W.~.t~..r......./;...., Name of owner of premises . ~ I.m-~..~-u,~1 c~+ •'V~ . (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. • • • • • • • • • • • • ~ • Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done . . .....'~.®.a .................~.t~?~~.,--mil . E{ouse Number Street Hamlet County Tax Map No. 1000 Section Block Lot....°2.~........... 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 . ~p~ ~ . w • • • • ~F4c.a,~d'.. . ~ ~ . b. Intended use and occupancy • J~ . >•~..~.SZ-•c~C• 3. Nature of work check which a ~ - ~ ~ ~ Rem plicable): New Building Addition E~ration ..'1 . Repair , pval . . Demolition , ...........Other Work . (Description) ' _ 4. `Estima(ed Cost... ~ ~D.'~a:~ ~ Fee . (to be paid on filing this application) 5, If dwelling, number of dwelling',units Number of dwelling units on each floor . , , . If garage, number of cars i . . . 6. If business, commercial or mixed occupancy, specify~ature, apd extent of each t pe of use . . 7. Dimenscons of existing structures, if any: Front ...:...Y: Rear D'epth . . Hei ht G Number of Stories . . . Depth , , • • • , ; ith alterations or additions: Front . Rear . ..Height ......................Number of Stories . I)imenstons of same structure suction; Front . Rear De th 8. Dime ne_.w const' p Heigh , . . Number pf Stories . . . . . 9. Size of lot: Front Rear Depth 1 hone of Purchase . . . Na e of F er Owner , , . ruse district in which premises are situated..,.~.T.fr,(~:ryl,r~,,.,,,,,,,,,•„••,,,,,,,,,,,, 12, Does proposed construction violate any zoning law, ordinance or regulation : , . 13. Will lot be regraded : . . .................Will excess 611 be removed, from premises: Yes No 14. Name of Owner of premises i . . . .Address , , ...Phone No.... , . Name of Architect , . . ..Address ...................Phone No. , , . Name of Contractor . .Address ...................Phone No............:.. . PLOT DIAGRAM Locate clearly and distinctly alIi 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. ' APPRCeVEID A5 NO"PEn 1~NG ~DEPARTM N7 A 785'-1802 9 AM TO 4 PM FOR THE IFO4LOWING INSPECTIONS: 1. FOUNDATION -TWO REQUlRE~ FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING 3. INSULATION ~4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O. ALL'i CONSTRUCTION SHALL MEET 7HE I REQUIREMENTS OF THE N. Y, STATE CONSTRUCTION & ENERGY COQE5. NOT RESPONSIBLE FOR ' DESIGN pR CONSTRUCTIpN~&RRORS. I STATE OF NE Y ~I~K>~~ COUNTY OF .~~"t`F.-!':`.i`.~ . , , , , S.S • • • • • • • • • • • • . • , , being duly sworn, deposes and says that he is the applicant (Name of individual si n'ng 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 manne{set forth in the application filed therewith. Sworn to before me this i C,y~, ~ , .........day of'~i... V. (G . 19 . Nota Public, . }¢9 County Notary ublic, State of New Yori~ No. 48 2683, Suffo k County (Signature of applicant) Term Expires December 31,18 r~, ~ ~ ~ a ~ _ ~ ~ ~ ' ~ ~ ti ~ a~ ~ ~ ~ o.a ~ ~ ~ a " 0~' ~ ~ ~ ~ C3 ~ ~ ~ 'i © ~ ~ ~U ~ ~ ' ' , ` w ~ ~ ~ ~ ' ' ~ ~ ~ ~ ~ x ~ ~ s ~ ~ .w.ei {..L.+ J ~ ~ C~ ~ ~ ® a ~ a ~ ~ ~ ~ Q e a ~ b~ ®y} x 60 ~ i~ ~ ~ ~ °u : v+ ~ ~ ~ 3 s ~ ~ ~ o o ~ ~ ~ H b 'r