HomeMy WebLinkAbout22187-Z
FORM NO.'4
TOWN OF SOUTHOLD
i BUILDING DEPARTMENT
i
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
i
11. No Z-24587 Date August 22, 1996
it
3 THIS CERTIFIES that the building addition
iI
Location of. Property 1065 Jasmine Lane, Southold
{ House No. Street Hamlet
1
County Tax Map No. 1000 Section 69 Block 3 Lot. 24.3
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
i
{I filed in this office dated June 28, 1994 pursuant to which
I~
~L
Building Permit No: 22187-Z dated July 15, 1996
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 a deck addition to a one family dwelling as applied for.
The certificate is issued to Susan A. Callahan
(owner, lessee or tenant)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
L
Building Inspea6or
Rev. 1/81
I
77
FORM NO.3
TOWN OF SOUTHOLD
x.. BUILDING DEPARTMENT
S TOWN HALL
g SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
` COMPLETION OF THE WORK AUTHORIZED) QQ
Date 19.l./
N2 22187 Z
i Permission is hereby granted to:
....:.........f.....
toj......C~ 2 4<4 "?-:...54..ee........ G r7~f.C
e
r te 1
..A
f ,
h at premises located at.............
i
......................I......... M
County Tax Map No. 1000 Section fA:....... Block Lot No..
pursuant to applicaton dated 19...f.........., and approved by the
Building Inspector.
Fee
.yE /
Building Inspect
Rev. 6/30/80
e
Form No..@
TOWN OF SOUTHOLD
i
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR.GERTIFICATE OF OCCUPANCY
A. This applicatiou must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
L. 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).
j 3. Approval of electrical installation from Board of Fire Underwriters.
4:X Sworn statement from plumber certifying that the solder, used in system contains
less t idn 2/10 of 1' lead.
5. CtAmercial building, industrial building, multiple residences and similar buildings
and in$tla latious, a certificate of Code Compliance from architect or engineer
rersponsibie'for the building.
6. SAj i"t 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.
I.
C.. Fees
1. Certificate of Occupancy - New dwelling $25.00 dditions to dwelling $2
I
Alterations to dwelling $25.00, Swimming pool $25.0; Accessory building $25.00,
Additions' to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy. on Pre-existing Building$1.00.00
3, Copy of Certificate of Occupancy.- . .251
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction... , Old Or P_-existing Building. J]
Location of Property ...f J.....
House No. Street - Hamlet
~
Onwer or Owners of Property..... ny 22.
County Tax Map No 1000, Section.l.:f.-? ock ................Lot......................
Subdivision... 77... e .Filed Map............ Lot
Permit No !.v . ....Date OfPermit..X-A ...Applicant,...
"....:......,Underwriters Approval...`.?:.
Health Dept. Approval
Planning Board Approval....e
II.Request for: Temporary Certificate,.......... Final Certicate...........
Fee Submitted:
/ ~ v 'y • . • ..............~.®1.:
Y//~,,,~lssv A 0 V'-/~
(...Ali 2'76,F!
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO GH PLBG.
] F NDATION 2ND [ INSULATION
1
] fRAMING [ ] FINAL
] FIREPLACE & CHIMNEY
REMARKS: eL42Z
~
i
i
DATE INSPECTOR
i ;I
'7
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 ULATION
[ ] FRAMING [ FINAL
] FIREPLACE CHIMNEY
REMARKS: f' r-
f
DATE INSPECTOR `r
C
765-1802
BUILDING DEPT.
INSPECTION
4 [ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ 1; 1 LATION
] FRAMING E Z;
] FIREPLACE & CHIMNEY
REMARKS:.
I
DATE INSPECT R
~I
i i
VOtJ61ENI°
IFOUiIDATIOY -fist) - -
11DATI021- (2nd)
_ y
_ m
.CL,ue
UCH FRAME
f
PLUMBING
- C~h5
C/I
I'I.. ' . C~~ ° tie <C.~; ' e.~~: Gr ,~G:c... t1~1_ a n__ y S
tSULATION PER /N, Y. . e4~'Ut~,~ . C m f"
G 2:>- ,E6' ce~tr'~ vsArec[i L'~ Ce%«L-z., ' H
III. -
STATE EITERGX
e CODE ff
31
t, it • / ~ f f ~ pi's-~i~~: ; l : ' ; • C/
~ ~ •FI'JAL C~~~ s i ~e, <Ne~ ~ eG'~, L4.`.
7 ,
d../i[l CC z'~[~ {•~'f~,'u.~~`~?/us <xi 'iY` ir2
Iii ,r... I e"+.C i ~c'tYti?~•. 'L [~rt.~! ( l'~~ "
• ~ _ _ II _ v c ~~~~.Li _+/?-~,w1j•~1.~'.: ~Z`y, ~ GC Y'~_L~~ ~ .A~ - / Y ~ •
iiiOiiHL CO7-1~tE27'PS: ~m
G~
-10
x
H
Vy
-
5
• r
' m 4
-1
d'
BOARD OF tl>*'iYLTX
01, 5'OS, 1
FC$NhNY3.1 ' 3 SETS``0 PLANS
c[[ TOWN OF SOUTHOLD SURVEY .
BUILDING DEPARTMENT CHECK
' TO'VVN HALL SEPTIC :I'D=RM
SOUTHOLD, N.Y. 11971
Il y a t.1D
€ 3 4y TEL.: 765.1802 TIFFS ~j f !
.t:Ll! s r CALL
Exaned 9!. MAIL' Tp
r ;approved 14?/PermitNo.P~..~
'Disapproved a(c. • , a s
,
q-
Igui drag Inspector) ~Y
rj
AP ,~L ~I~,C~Ofk ILDtNG PERMIT
~y 7!~N+1~t Date ..~.~.v~ .....,191.°
,
t TIONS
...a This application ::!,!tit ±a conwi.:. I T . c !n jib; t6! r lSr Orin ink and submitted to the Building Inspector, with 3 11 sets of plans, accurate niot ,I, , to r 1 ~ .o , to Ir i r I
b. Plot plan shw loc:i..o!, o; to ..r."! 01 .r i s relationship to adjoining premises or public streets
or,areas, and giving a ;i :.!ii: E ; : ip!io? o: lu} ou;, o:ipnx'•orty nmst be drawn on the diagram whichis part of this appli-
cation.. ,
! before issuance of Building Permit.
;,c." The wo k eov !:a !)is ro;ibeco: `rnc:: c:
'd.' Upon approwJ c !I ii m I! ti or ; ill issued a Building Permit to the applicant., Such permit
I shRL.be kept on the ..dr l oOt :..a work.
r e. No building s:u:if I%' "!r :>c l!ir. v..!•.Y,:.a: P•i pcr: for any purpose whatever until a Certificate of Occupancy
ishall have been granted I,..% 1 13.iil.li !.l Hsi%,cfor.
APPLICATION IS HEREBY MADE to 46 11,ldirs DPmartment for the issuance of a Building Permit pursuant to the
IiBuilding Zone Ordinance of the To,.,i oi' So!.!1101d, Su roll, C.o:...,>.:%ew York, and otherapplicable Laws, Ordinances or
Regulations, for the construction . f I:•..i:6irrigs, a;:ai!ion; or al:,;r:t!ions. o!• for rzmoval or demolition, as herein described.
The applicant agrees to comply will! Ir nl r iWi o ,!u r. ! ti r !I r code, housing cod and ulations, and to
!Lr ~!r
admit authorized inspectors onpren , , I n : s ! wa n~.. ! ons.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agentp architect; engineer, general contractor, electrician, plumber or builder.
r
Name of owner of premises JGLS . .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer. A~ fl~~ A~ NOTED
dy~ #j
(Name and title of corporate officer) -BY'
t s RlC RFY BUILDING OEP ENT ATV >
ytd' 765-1802 9 AM TO 4 FOR TW
Builder's LicenseNo . FOLLOWING INSPECTIONS:
1. FOUNDATION TWO REQUIRE
Plumber's License No . • FOR POUREGCONCRETE
2. ROUGH aBIwING & PLUMt3p
Electrician's License No. 3, WSULATiOEv
4, FINN CS3"I9 ~aTIOr`1 1~ .
COMPLETE FOR C 0.
ALL CO 'T t
Other Tr es License No.proposed 11 be done . ~TNE • OF.
.57A am", 11. Location of land on which work wt Six
WNW
42 16 5 ja z7!4 ~
` 1.
i P_- =mum -
House-Number !Street a
,tounty Tax Map No. 1,000 Section ~•?1... Block 3.. Lot A3...
Subdivision. .S.~: /00 .0.~ °4.............. Filed Map No. .Fi ....JJp..... Lot 2 . .
(Name)
.2. State existing use and occupancy of premises an ntend d use and occupancy of proposed construction:
I a. Existing use and occupancy
b Intended use and occupancy , . ; .
3. ' Iuatiire of work~heck~vhich app7ibable) New Building. _ Additio era on
Repair Removal Demolition g(}tlie 'iVOrk l
~a (Desch' ption)
4. Estimated Cost ~ . . 2 Fee 25 .
(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 /tlr .
6. If businessgcommexcial or mixed occupancy, specify n#ture and extent of each,-type of use .
7. Dimensions of existing structures, if any: Front/4X.. ;'Rear "fir Dept i;?g r.-?.
Height Number of Stones:,,.............................................
Dimensions of same structure with alterations or additions:` Front r .--Q.... 'Rear
Depth .32', _ Height i. Number of Stories ..o
S. Dimensions of e-otire new construction: Front Y-57"- Rear ,1,45.......... Depth
Height Number of,Stories
9. Size of lot: Front . Rear , . Depth
141. Date of Purchase , . 9'L „f,~9 epF Name of ormer Owner ai.' P rs 4~Y
IL Zone or use district in which premises are situated , .Sc' .
I4 12. Does pro
posed.eonstruction violate any zoning la~v, ordinance or regulation: X*? .
13. Will lot be regraded.. ,tom......... Will excess fill be removed from premises: Yes
J 14. Name of Owner of premisesScs5~ {ti ~~ce c Address ZOA I-, 3 Y~,?t Phone No.S167?2 S 7{
r Name of Architect Address Phone No .
Name of Contractor . ..............:.......Address , ; .............::..Phone No......:....:..
15. Is' thisproperty within 300 feet of a tidal wetland? *Yes........ No.>e.:....
4f yes, Southold Town Trustees Permitmay be required..
PLOT DIAGRAM
j 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.
t
I
i
f
f
4:S:?2€mis r.
.
a
P
STATE'OF N"EW Y S
COUNTY OF'.
~ 1- . • being duly sworn, deposes and says that he is the applicant
(Name of dual signing contract)
above named.
'%Ie is the r . O.W. . t .
(Contractor, agent, corporate officer, etc.)
j of said owner,or owners, and is duly authorized to perform or have performed the said work and to make as d file this
application; ihat all statements contained in this application are true to the best of his knowledge and belief; andi~af'the
work will be performed in, the manner set forth in the application filed therewith.
Sworn to before me, this
....F...... . ay of -"I v.............. 19147
Notary Public, County
5-
ROBERTf: .
NOTARYPt B-M to Of Ky (Signature of applicant)
Ne.47250&3,
Term,Egdm y 3,4
i9
O ~
3 N N O
M, p d C f' Y~ ~ n l
1 ~*,rr, r •r.."~ ,ate ~ . ~3-'~~"~ a
44k pR C Qy 0~ c
! " z -f,4 s w F n
N
z D 2 v Z C` W
O , o y
m s 0
t Q.eSO
d orb n~1 f w m Ir o`?j~ YQ,.~
W -4
AF. cri
Yca Y cypp ~ r J+.
t { W``u n t L.7 ,OO gO LL VO aj.A tom, ///J M 7
w 55 a:LL
rT w1fr :i oJQ o 9': s ' vJ ek ~(~-~QZ 6 x
x v
~ > a P _ p e
A r f
t
n
r
I~ryI i ra s l" a N
f n* j ~ Y y a l { F N X 1N,A t O G ~ m
• 1 ~7
~ = . e 5' S e. 3'',~-ru". EtwS.• OJ s Y 3 p L Q
1 Rk5 b y' sV r s~ ~tk ru+-"^G' t.-_
076 ry c pp
~"I ,srrw ~ Rr s " { : s 1 .5 ~ ate, p C
u
p.• 4 U L
.51
10 j W C-+' ^ p i p Z 2
k^ ~ I yq p R
1
" z
9 w
9 C4
Cf)
O ~0
L
O
~ V L
NJ o o J =ub_
C4
~
ub~
i LL
Q
V
4' % I U
•Y~ `t ~1I O OY.
~ W
•.u- rte-' -
i ~
i ~
M
U I
C ~
I
R ~/v A4
i
r ^ 1:
~I .
. { i
I
r
E ~ p a a
i
t P(` cL~ p a -D
'i
D-
i JUN 2 R
~ 1