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HomeMy WebLinkAbout17011-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19082 Date MAY 25~ 1990 THIS CERTIFIES that the building ADDITION Location of Property 2065 MINNEHAHA BL~D. SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 3 Lot 54 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 29, 1988 pursuant to which Building Permit No. 17011-Z dated MAY 18~ 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 TO EXISTING ONE FAMILY D~ELLING AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A PATRICK W. LOHN & NORTH FORK BANK & TRUST Building InspeCtor Rev. 1/81 FOBM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 017011 Z Permission is hereby ~ ;~'""~,._ ._~~...-~~ .... '~Z~ ~.~'"'~"'"""'"'~' ................... ' ......... ............ .~...~>.... ~ .~.~...i~~..'. ........... ' ....... ~ ' -'7'"~'"'"~ ............... ~"~ .......... C,": ...... 2'7'-7/ ...... ,,~,..;:~....>,./ .................................... at premises located (3, .~.....~. ~...~... ~..~. f~ ....... County Tox Map No. 1000 Section .......... ~...~.. ...... Block ............ ,~... Lot No .......... ~..~-.... pursuant to applicaHon doted ............ .~..~... ............................... , 19...~...~.., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. r Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from'architect or engineer responsible for the building. 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 - $i00.00 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 - Residential $15.00, Commercial $15.00 ~// Date ..... ~. ~..~.....~.~.I. ~..©. .................... New Construction ........... Old Or Pre-existing Building ............. Location of Property ............................................. House Np.~. Street Hamlet Pro ert~f~77~l~' ~ .~......~. )~~/~)_ ~..~.~TJ..~..~.~..~..~..'~.?~ Onwer or Owners of p y ..................... -.. ...... County Tax Map No 1000, Section...~.~ ...... Block.....~. .......... Lot....~...~.o~ ........... Subdivision .................................... Filed Map ............ Lot ..................... . Permit No ...... Date Of Permit ..... Applicant ....... :. ..,.~.. ..... Health Dept. Approval .......................... Underwriters Approval ....................... . . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: * .... ~.~.~. ................... . i j ! i BLgG, gX,'. ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL gOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ......... , CHECK .......... SEPTIC FORM ............. : TOWN OF SOU'i'NOL[) Examined .~.7...~. ........ , 19~.~' Approved ¢..r. ........ 19s- . Permit Disapproved a/c ..................................... / L ............................... (Bui141ino I s~ctor) APPLICATION FOR BUILDING PERMIT NOTIFY CALL .... MAIL TO: 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, builj~t~ng code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i:~ ~ (~'i'gnature of applicant, or name, if a corporation) .a /, .$. .u/. ( c.b. .6J.,w · ' (Mailing address of applicant) ~ ! q'2/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises' .~.~?.{Lk~.../~.'...L~. 1].~..../r~.~.....~..~.'~...~..t.:l.(_.../A~...K, p...~..~..57: .~.- .~.. .............. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY Builder's License No. ~ Otu~/~ Plumber's License No ..... .~.1.1~ ................ Electrician's License No ..... f~) b ............... Other Trade's License No....~.lA. ............... OCCUPANCY OR L Ic '"sT.,ISE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...~.'] ............ Block ..... --.~. ........... Lot ~' L~.. .... 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 ..... .~../~.C./(.'j fl.~..~ ............. .O..~1.1~... ~(klbJi. k .~....~0. V.~..~. ............. b. Intended use and occupancy ..... .~)~c_~P~ l~, ....................................................... 3. Nature ofwork (check which applicable): New Building ..... ' ..... Addition..i ........ Alteratio.n, .......... Repair .............. Removal .............. Demolition .......... i... Other Work..~..I[.C)~ ........ ! (DescripIion) 4 Estimated Cost I&.0 0 -- ...................................... Fee ........ ~ ............................ [to be prod on filing this application) ~]tq Number of dwelling uniCs on each floor 5. If dwelling, number of dwelling units ........... . ........... If garage, number of cars . · Iq~.[:l .................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ../x)].lq ............... 7. Dimensions of existing structures, if any: Front...~0]/3 ......... Rear .. ! Depth Height ............... Number of Stories ................. : ...... Dimensions'of same structure with alterations or additions: Front .......... Rear ................. Depth ...................... Height ...................... Number of Stories ......... Height lO Number of Stories . m P, 10. Date of Purchase ..iL ...................Name of Form*er .tq. ....... i... 12. Does proposed construction violate any zoning law ordinance or reoul~ii,~ ~-~ · i~'[ ~ ~'~'~-i, 5;(' ~ ~i ~Z ~ ~;~' ,~ ~" 13. Will lot be regraded .... ~a ............... hi~b...Wil~e~ce~[~r~,~fromg[e~ses'~ ~Yes No Name of Architect Address 15. Is this property located within 300 feet of a tidal we~l'h~n~d? .*~ ' 2:';;%~' ~Nb~'; · If yes, Southold Town Trustees Permit maybe required. PLOW 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. ¸%1 or L0't Notary Public, .~1~.~./~.,.~... ~ ~11:118 ~, BEGOf~ ~ ~7~ bommis~ ~ ~, 1~ STATE OF NEW YORK, S.S COUNTY OF ................. ................ PI f. Oq....L:.. t..........~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the ~aid work and to ~nake m~d file this application; that all statements contained in this application hre true to the best of hi~ 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 ....... County / '~ (S/g ppli t) nature of a can 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST (- ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ,r.//]~INAL *~-_-~' REMARKS: O~ {~"~ ~h_.~ ("~._ ~, / DATE ' NSPECTOR U~~~*~