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Home My WebLink About20912-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20962 Date AUGUST 21, 1992 THIS CERTIFIES that the building ADDITION Location of Property 4340 GRAND AVE. House No. KATTITUCK, N. Y. Street Hamlet County Tax Map No. 1000 Section 107 Block 2 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 20, 1992 pursuant to which Building Permit No. 20912-Z dated AUGUST 21, 1992 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 "AS BUILT" ACCESSORY DECK ADDITION TO AN EXISTING INGROUND SWDIMING POOL AS APPLIED FOR. The certificate is issued to WILLIAM BURROWS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~jL-- Building Inspector Rev. 1/81 lPOUI NO. . TOWN OF SOUTHOLD IUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. IUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N!N9 20912Z Date ...........f:/!?!.t.............................., 19.21:- Pennlssion is hereby granted to: . M 4fJ' .4' ::~~~~:~::::::::::::::: ..I1JtilZ::t.,,~~.......d:.rf.r........II.~.r.~.. /..l.i"-........t.f.rL.........~.r.fl.d:..i..........b.i~........@I),.t.!z~.....79.......~....... ..t'...:f.~,f~G......;?;;.-;.;~~~.....~c.........I.1.[.....4.~.(,It......t.1.!........~ilJ...6.oe. at premises located at ....................~Jtf.t:?...............~..~..:............................. .....................................................r....~~.........1(.;r.:.......!.!..t...J(:~............... .....................................................l....~4.....4!l~!r.:l....~...J..................................... County Tax Mop No. 1000 Section ......./{2.,7........ Block .....l?.b....... Lot No. .......{!!./........... pUrsuant to application doted ....................l)!'t'!!a......................., 19..?~ and approved by the Buildfng Inspector. Fee $.....~~;.... ...A7..g~~;......................... Rev. 6/30/80 . Form No. 6 . " TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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. ' B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1. ~ccurate 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 - Residential $15.00, Commercial $15.00 g' Vt) '1 1.- Date....,;................................... . :ew Construction........... Old Or Pre-existing Building................. .' . '<{3I..fv G-,..~)v ~/1/1rHJ,'kc.(/h.A/_'1 tCiS'" .ocation of Property..........................................r. ~ l~""""""""""", 'J" 01- .'. House No. Street Hamlet W . f-L.. I1loV> /2. lA-f r-a-vv J . '. Property...................... .'1............ ......................... eo.... 'nwcr or Owners of ounty Tax Map No 1000, Section... (.0.7...... .Block...... 9. :~..... .Lot.........t............. ubdivi.sion..:.................. .'.....;....... .Filed Map........... .Lot...................... ermit No.... ........... .Dat'; Of Permit............... .Applicant........ ~"""""""""" ealth Dept. Approval......................... .Underwriters Approval......................... lanning Board Approval........................ Temporary Certificate........... Final Certicate... (....... 'quest for: 'e Submitted: $............................:ji ..' () , . , ~'K..- ~ . "X..-Vc..'14f.3r' ' , . ................... ......................... Co Z. 20 qc,J... APPLICANT .' ,:,:~'''~i~~-~.-,;,:",''~'>~J,.~ .1'\' /.c, (,..;, i : ! II.:'~::.-,-~:' . ; !,~ AOO 2 0 !992 FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765-1802 BOARD Of HEALTH ......... J SETS Of PL~US .......... SURVEY ................... CUCCK .................... SEPTIC rOR11 .............. EX3mincd . . " t/.~! .. . .., 1991-: \pproved .... .1;4--1....." 199~ Permit No.. ~.?!.i;t;. Jis3pproved ale NOTIFY: ,c;D!F~ r CALL .91/0. .-.'... /~.... ~ ~-;:................ ............................... . . ............... ............ ......... .................. ............ ......... ....... .... ....d~.2.~............ .. . (p6ilding Inspector) APPLICATION FOR BUILDING PERMIT {)/C~LD . .. 'ilrllrvJv}~ Date. . . .2:: . .7": ."?:'!. . . ., 19 f. .'2.- INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ,ts 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- Ition. c. The work covered by this application may not be commenced before issuance of Building Permit. ~. Upon approval of this application, the Building Inspectorwill issued a Building Permit to the applicant. Such permit lall 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 lall have been granted by the Building Inspector. APPUCATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the .jilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, bu' ding code, housing code, and regulations, and to 1mit authorized inspectors on premises and in building for necess~ry. i ~~. ~. . . . ~':1!::-:. . . . . . . (Signature of applicant, or name, if a corporation) 'f~ ~~... .c;"':~/. A-Y.. J .711q.,tf..:iu.c. It... .J}.!. i4 . (Mailing address of applicant) II <Y..l-./... t3te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... .O.~~!.~...... ".LL','~"""'" ',~"" ~.~.~........ .~~~ff~':;'O::.:OTJ;9;;~ Jme of owner of premises .....W.'........"Yl......... ~.o-; . . . . . . . . . . . . . . . . . . . ?;:t.i1 JiJ' . . . . . ';,$ '7~ . (as on the tax roll or latest d1~,FY B~ILOING ~lPARTivlENT AT applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM 10 4 PM FOR THE O'(\"CUDANCY OR FOLLOWING INSPECTIONS: .... ... ..... ... . . . . .. . . '" . . . .. '" . '.\J .f.'n 1. FOUNDATION ~ TWO REQUIRED (Name and title of corporate OffiCei)'SE IS UNLA'^'FUL FOR POURED CONCRETE U VV 2. ROUGH . FRAMING & PLUMBING Builder's License No. ..........:.............. 3. INSULATION H iJIHOUT CERTIFICATE4. FINAL - CONSTRUCTION MUST Plumber's License No. ............. .ff . BE COMPl,.aE FOR C.O. .d~- .. A CY ALL CONS1'RUCTION SHALL MEET Electrician's License No. ........... .Or. .OCCUp N THE REQUIREMENTS OF THE NY. . .' STATE CONSTRUCTION & ENERGY Olher Trade's License No. ..................... CODES. NOT RESPONSIBLE FOR /' DESIGN OR CONSTRUCTION ERRORS '-/~ 'f~ l-'--,.-~ Av- Location of land on which proposed work will be done. ................................................. . . . yY(cJ;f.'h.-...c.k... II'iS~ ............... .......... ............ ........ .......... ........ ...... ... ....... ...... ........ House NUI1l ber Street Hamlet County Tax Map No. 1000 Section .... f.(j.7. .. . .. . .. Block...... ~.:-:-. . " . . " Lot..... J.. . .. . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. .............. Lot............... (Name) Sl3te existing use and Occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... <t .~'f. . .. . r: ti:':"!: .( ~ . . . . .'!'!.S~'" ~ .,,-:'':2, . . . . . . . . . . . . . . . . . .. . . . . . . . b.lntended use and occupancy........ .c!-!-.S.4-... .~.~.'^;f/.... !.~ .~.~.l..;. .~~'!.~. ..;::~.... Iv roo / 3. Nature of work (check which applicable): New Building.......... Addition ~....... Alteration .......... Repair .............. Removal.............. Demolition .............. Other Work. .,." . , . . . . . . . . . . "'(Description) 4. Estimated Cost. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units. . . . . . . . . . . . . .. Number of dw~lling units on each floor. . . . . . . . . . . . . . . . . If garage, number of cars ........................................................................ 6. If business, commercial or mixed OCcupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front. . . . . . . . . . . : . . . Rear .............. Depth............ . . . Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear.................. Depth. . .. . . . . " . . . . .. . . " . . Height. . . .. .. . . . .. " . . . .'. . . . Number of Stories.. . . ... . . . . . . .... .. " . . 8. Dimensions of entire new construction: Front. . . . . . . . . . . . . .. Rear............... Depth ............... Height .............. '. Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front. . . . . . . . . . . . . . . . . . . . " Rear...................... Depth ...................... 10. Date of Purchase ...............:... ..... ... . .. Name of Former Owner ............................. II. Zone or use district in which premises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... .,................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises " . . . . ... . . . . . . . . . . . . Address .. . . . . . . . . . . . . . . . . . Phone No. '" . . . . . . . . . . . . Name of Architect ........................... Address .. . . . . . . . . . . . . . . . . . Phone No. ....... . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . .'. . . . Address . . . . . . . . . . . . . . . . . . . Phone No. ............... IS, Is this property within 300 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 whethet interior or comer lot. STA TE OF NEW,.-W)R~,- '5>- S S , COUNTY OF . .~ ~o. ~ . 'b ......... .'.. .Wl ~\ k. Y0. . ,. ..:[;;kJ.b.0-I;)..... (Name of individual signing contract) lbove named. 'leis the ..................... .... ....... .0. .~rv~.\.................... ...... ..... .............. (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this !pp/ication: that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;wom to before me this being duly sworn, deposes and says that he is the applicant . . . . . . . . . . . . ~ .t?t;h . . .day of. . .. . . .... . ., 19 (t,?-: Codi~.!,~\..~.... (Signature of applicant) I II~ S./50 28 40 ~. REEVE t:! c:: ~ .c::; .u t1) -i Q> U ~ ~ \.:) ."" 1::. Q> l:: ~ ~ ~ 0;:, 1t 0;:, <: ROAD ..- i""" ~ ,.. 1- ~1 ci ~ l() - .. . 1"1.0' :. .. .. 4 ~A."" ,_ " ~(O",e. \ .;,n(". aa((]a~ ,",0\,\5e. <-. J J 'Z."l..\ ------ 'IA.A' ;. ,"0' .. .. 4.6' /1 \ " . / / ,"~.~ ~,,/ / \'~ '01 / \ ~'\~ ,,"/ , '\; . / t3'" ,,\ .. Ii '" on' , \ \ , \ \ ~ Cl 5'l 'l' l() . to "- <: \ . \ .; . 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