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HomeMy WebLinkAbout17138-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE QF OCCUPANCY No 217350 Date SEPT• 26, 1988 THIS CERTIFIES that the building ADDITION Location of Property 845 MILL CREEK DRIVE SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 135 Block 03 Lot 36 Subdivision MILL COLONY Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 14, 1988 pursuant to which Building Permit No. 171382 dated JUNE 21, 1488 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 TO AN EXISTING ONE FAMILY DWELLING. The certificate is issued to PAUL AND HELEN FORESTIERI (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 no8as 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) N o 01713 8 Z Date ......~...~R.. ( 19.~ g Permission is hereby gronted to: Q-~....:1~..~.~-.~~ ...1.~. .a.....ni~.... pp nnnn ~ ct premises located at ....f~..~~........sXX ....1.~.~.:........... County Tax Map No. 1000 Section Block ....Q..e~i......... Lot No..~ . pursuant to opplication doted .r.(..4~e:lSZ......t..wL 19.~g., and approved by the Building Inspector. Fee $...w`?~.:.. (C.~ot- ...9. Idin I actor Rev. 6/30/80 ~ ~ FORM N0.6 TOWN OF SOUTHOLD ~ J3 ~ I Building Department Town Hall BLDG DEp7; Southold, N.Y. 11971 TOWN OF SOUTHOtp 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY r~a^-~ sv5 Instructions M ~ I I Cree kl~~ ~So A. This application must be filled in typewriter OR ink, and submitted ~ s..~.~ to the Building {nspec- 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 $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory I0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $190.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 . 4.Vacant Land C.O. $ 50.00 Date.....,. l/ l 0 " 5. Undated C.O. . NewConstruction,,,,,,OldorPre-existin Buildin ~ Vacant Land i,,, 9 9 Location of Property ~ , , l!,l,t--L n 1~ S ®f~~'~(jL y~ House No.~ ~ • ~ Street , , . , . , . „ . . ...Hamlet Owner or Owners of Property p~!! L;,,~,~,t~I;I= y? ~E7/~r $.`~-~~T~t.l County Tax Map No. 1000 Section ~ 3 , , , , Block Lot , . , , , , , Subdivision M.)L ~ :....C ~ y , , , , , ,Filed Ma ~ P No. ..........Lot No. al Permit No. G ~ 3.8. Date of Permit:. ,~,~~.Applicant P~U~-- , , ~ l;-.S,7-(6 l2 / Health Dept. Approval ............(...........Labor Dept. Approval . ' Underwriters Approval ........................Planning Board Approval . Request for Temporary Certificate . ...................Final Certificate . , , , , ~7 Fee Submitted $ . , y,~c??,C~,~ , Construction on above described building and permit meets all ap licable codes and regulations. Applicant . : ~ : . Rev. 10-tOJB ~ ~1 yl/ z i~~o r'lELD iGSP~~~U;J ~~Ui,iE ~ ~OMMENTv i. ~ a, - H OFI FooNDATION , clst) _7 - - . C FOUNDATIOtd (2nd) ~ 2. z oci o .,c, . ~ P.OUGH FRAME & -PLUMBING ' ti~ y 3 m Ii1SULATIOCI PER N. Y. y ~ n STATE ENERGY ~n"w VJ CODE x A 4. ~ FZNAL o z ADDITIONAL COMMENTS: x m x ro H N ~ H °G O ..0 z m m y - x Zy d tq ro H ~ 713 765-i80Z BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [~INAL REMARKS: r DATE INSPECTOR x r .//1 ~ryf Q ? U v 765-1802 BUILDING DEPT. INSPECTION ~-o~~, [ FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING I ]FINAL ' REMARKS: } i DATE--~?~, „t=-~ INSPECTOR V CP~ i ~ ~ / 3a 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ]ROUGH PLBG. [)FOUNDATION 2ND [ ]INSULATION [FRAMING [ ]FINAL REMARKS: 1~~:y . DATE 2~INSPECTOR J ~'u ` Q'p b ---F-- ° F- 1 . ~ a~ _ E f- i,~. j . __.._._R - M .~cC ~ w c~.'r ,>Pr'' / ~ a ~ ~ ~ O n _ ~ ~ ~ / Qs w z N ~ytY70~ / r oc ~ w z ~ u. O i ~ ~ % ~ Q W ~ z ~ W ~ W ~Wa a m zz ~az~~o~~ ~O~ WAz ~X e,,,.. y~ ~~aa W W ~ ~ .D~ C9"OOO~zW~~zIQOW WZ~LLr evaly a~-v~c~o / % / ~ , _..s~~t ~ (~L~( \ r// BOARD OF HEALTH ..v~ ~`~~(j~'+`~"9L~l~l~~~? 3 SETS OF PLANS FORMN0.1 SURVEY S ~~8 TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FORM . . F31.DG. DEPT. c TOWN HALL TOWN OF 50UTHOE_t7 ! .,OUTHOLD, N.Y. 11971 NOTIFY 7// pp °°^°°°°~,„„,.R ..............._.,~,._.a TEL.: 765-1802 CALL ...(.~`~~.l.~P.Q~ . ' MAIL T0: Examined ,/~"!~ti-..2-). 19 Approved 4c?+!~.. ?:-1...., 19 Permit No.~ ~ 3:g Disapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . 19~ ( . 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 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 housin de, an regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature o"ap licant, or name, if a corporauon) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ® W ~U.~.~........^ / ~ ~ Name of owner of premises .P.A~~...~D.~1.~r.S~.(.F.i~.(....(7~~,h,l~~..~.D.~.~:~~lf~.lt (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. , „rQ_~?ff~~~ . Plumber's License No. ..!~~~j . Electrician's License No. . Other Trade's License No. . . I. Location of land on which proposed work will be done. 3„~~, rZ.l` Q-/Q F.r-~~ vJ~ ~ ~ ~ ..................~.V... U ~ ~~zr~ House Number Street Hamlet County Tax Map No. 1000 Section F.3.~.......... Block 'Lot. 3.~............ , 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 n,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, b. Intended use and occupancy ...~^~~G... Irv G~~-t'~~~ j.~ecl~ 3. NaPure of work (check whiRemovlal able): New Building A : •Other 1Vorkation • . Re air Demolition ddition • . • • • ' . . (Description) 4. Estimated Cos ~ Fee....... (tgo be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwellin units on each floor.-.............. . garage, number of cars 6. If business, commerciagl or mixed'occu ~ancy, specify~atu~e and extent of•eact} { 7. Dimensions of existin structures ~f an Front . ~ . , , Q....... Rear //ff 4 ype of use , , , , , , , , , , , , , , , Depth Height . Number of Stones . Dimensions of same structure with alterations or additions: Front ~ Rear , Depth IIeight Number of Stories . ' 8. Dimensions of entire new,construction: Front , i, { Rear . , { Depth y.3•p, , , g • • . • Number of Stories . 9. Size of lot: FrontF.... Rear De th Hei ht ~ Name of Former Owner 10. Date of Purchase p " " " " " ' Ep ~ 11. Zone or use district in ~hic]] premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: . IY.Q . 13. Will lot be regraded .......f1(, p... , ..14111 excess fill be removed from premises: Yes 14. Name of Owner of premises }.'ee~,~? ,~,p ~ ~ CU Address . : .....Phone No.S~~"~6 j;• Name of Architect r !%S. ~ CtrlQ.G..... ,Address , , , . ; .....Phone No.. Name of Contractor ..................:.......Address .....Phone No.... IS.Is this property located within 100'feet of a tidal wetland? *YES.C!.NO.... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number o~• description according to deed, and show street names and indicate whether interior or corner lot. j'' ~~~~,5'z' aa•~~ t ~ ~ . a. ~ _ V.1 ~ Q ~ ~ ~ ~ / ~ ~ - i w ~ ~ w ~ • ~ ~ ;'5~.. ~ I f: ~ ~ ~ ~ ~ o i, ~ ~ ~~~^ao-9•~ ~ I ~ ~ . .mac ~ • ~ x / O M r I ~ ~ I STATE OF NE1V YORK, S S -IV p s RJ ~~l COUNTY OF 7 y I ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' • • • • • • • • • • • • • • • • • • • • • • • , bein dul sworn de oses and says that he is the applicant g Y P, (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 Itis 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 ~'~~..,~.....day-'oaf/.... , 19 ~I Notary Public, ......~~'.........Cl•....lN~ U!C_.... County ~a ' '1 , G~. HELEN K DE YOE NOTARY PUBLIQ State of New Yak . No.4707878,SuHolkCouMy (Signature of applicant) . Tam Eapiree M:tCh 30,19.