HomeMy WebLinkAbout23311-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24255 Date APRIL 2, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property 5025 MAIN ROAD GREENPORT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 35 Block 2 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 14, 1996 pursuant to which
Building Permit No. 23311—Z dated MARCH 18, 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 ACCESSORY SHADE SHED IN REQUIRED REAR YARD OF GOLF COURSE
AS APPLIED FOR "AS BUILT".
The certificate is issued to FLOYD KING
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building nspector
Rev. 1/81
FORM NO.3
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)
Date.............0 ..a 4............ 19./. ....
NP 23311 Z
Permission Is hereby graDlyd to; x4x.�.
(/s/ww
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to
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7—r4 .......
. ....
..................................................................................................................................................................
..................................................................................................................................................................
at premises located at........ .��....... ..'.. �..........................................
....................... ..................... ......... �.......................
County Tax Map No. 1000 Section ......... ..... Block........ .......... Lot No. ...if/...................
pursuant to application dated ....................... c,. .lCf, 19....�.F6., and approved by the
Building Inspector.
�G
Fee$ ..............
.....................w.. ....... ......................
Building Inspe r
Rev. 6/30/80
Form No. 6 f; - .I .._=4 �. 1..._r _
TOWN OF SOUTHOLD
BUILDING DEPARTMENT APR 2 — 19,c),6
TOWN HALL _
765-1802 n
.—,70VJN OF r
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-01 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, 1.957) 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 Buildine - $100.00
3. Copy of Certificate of Occupancy - $20-00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
.Date . . . . . . . . .)"5.h� . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . .
Location of Property.. . . . . .. . . . . . . Aw-41&P 4'ern) -i"WAZY,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r. . . . . . . . . . . . . . .
House No. Street Hamlet
A�W1614 M7P 4#ff AKIO 47v/&W zwo
Onweror Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000,' Section. . . . . . . . . .Block. . . . . . .z Lot. . . �7-1
. . . . . . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . . Date Of Permit. A- Jf% A . . . . .Applicant&W.I�r4JA
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . .. . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: .. . . . . . . . . . . . . . . . . .
ATIPLIGANT
C
o��g�FFO(�co
c�
co 2
Town Hall,53095 Main Road p • Fax(516)765-1823
P. O. Box 1179 y� �� Telephone(516) 765-1802
Southold, New York 11971 �j `1►a
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
March 25, 1996
Robert Brown Architect
P.O. Box 521
Greenport, NY 11944
Re: Island End Golf Course
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons :
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $50.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984) .
BUILDING PERMIT # 23311-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
F I HIM J I tj IjI'*j'()Ij'I' DATE
C ut-1 III I"t ITS
I'MINDAT 011 ls'r)
MONDAT I 011 (2ND)
----------
HOIJGII FHAUIF &
NC II
• al_ p_a �1
iI
INSULATION 111--1t ti. Y .
STATI, EUPIMy
CIODE
- ----------
.........
F I IIA I.
------------- a====a==1i=_a ----------
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ADDITIONAL C()j-Itjgtj'rS:
------- --- ----
-----------
............
.................
..........
BOARD OF HEALTH . . . . . . . . .
3 SETS OF -PLANS .
FORM NO. 1 SURVEY . . . . . . . . . . . . . . • •
TOWN OFSOUTHOLD CHECK . . . . . . . . . . . .
BUILDING DEPARTMENT SEPTIC• -F6RM . . . . • • • • • • •
. . . . . . . . . . .
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL
Examined all-&V 19�� MAIL TO : . . . . . . . .
O . . . . . . . . . J . . . .
Approved r � .19�. Permit No/ 3l pGl I ry
�[ j
Disapproved a/c . . . . . . . . . . . . . . E h
. . . . . . . . . . . . . . . . . . . . . . . . ; . 4 1996r
• , .
��. . . . . . A -Tpw1v o Q�F�r .
R:j
(Buildinb Inspe or;
. m
PLICATION FOR BUILDING PERMIT
Date r3 . . . . . . . .. 1
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
sets of plans,accurate plot plan to scale. Fee according to schedule.
b.., Plot pl'aii,showing location of lot and of buildings on premises, relationship to adjoining premises or public street
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of tlus appl
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 permi
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 Occupanc,
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 o
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, housinti code, and regulations, and tc
admit authorized inspectors on premises and in building for necessary i ctions-
. . . ?�
(Signature,oz applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent �itectl
gineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
• • • '
Name of owner of premises . ./w,A?U4y5 ll/. . . .. Cod,�fl.�x!�i(•�•1 � �j�/e
_ _
(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.
. . .� . 7�. . . . . . . . . . . . . . . . . . . MOW���eT� 2���. . . . . . . . . . . . . . .�i Hamlet.
lt/t( . . . . . . . . . . .
House Number Street
- -
County Tax Alap No. 1000 Section . . . . . . . . . . . . . . . . . .. . . . . , , 2
- . . . . . . . . . . Lot . . . . . . . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. Lot
(Name] ti. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
State existing use and occupancy of premises and intended use acid occupancy of proposed construction:
a. Existing use and occupancy.. . . . . . . . ... .. . �GT�.'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . .
3. Nature of work (check which applicable): New Building . . . . .'. . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . .
Repair . . . . . . . . . . .. . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work Z�-�.-a. .�Tr�,
25a
(Description)
4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . ,
If,ara-e, number of cars . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If.business,commercial or mixed occupancy, specify nature and extent of each.type•of use �1✓q.s EZA�)C�
7. Dimensions of existing structures, if any: Front . . /o� ,`! Rear . ... 1P.`.?`.'. Depth .``I4 . . � . . . . .
Height 174. . . Number of Stories . .� , • , • . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front • . . . . . •. . .Rear . . . . . . . . . . . . . . . .
Depth . . . . . . . . . : . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . . umber . Stories
. . . .
Number of Stories . . . . . . .
8. Dimensions-of entire new construction: Front . . . . . . . . . . . . . Rear Depth . . . . . . . . . . . .
Height . . . . . : . . . . . . . . Number of.Stories . . . . . . .. . . . . . . . . . . . . . . .
9. .Size of lot: Front . . . . . . . . . . . . . . . . . . ... . . .Rear . . . . . . . ... . . . . . . . . . . .Depth
. . . . . . . . . . . . . . . . . . . . . .
Depth
10. Date of Purchase . . . . . . . . . . . ... . . . Name of IFormer.Owner
11. 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. �llll . Will excess fill be removed from premises: . • . . •Yes • • . . •o
14. Name of Owner of premises � !�?K? ���f.I ,IG;G. , Address .��.�5 ?S Phone No.%-cIV-sr?b
Name of Architect-'FAOW NZ�_ ,(L/A• pT. ' .
.�. . Address . �°a. K SZ� . Phone No. ?'q?..
Name of Contractor . . ... . . . . . . . . . . . . ... . . . . . . . . Address . . . . . . . . . . . . . . Phone No.
15 .Is this property located within 300 -feet of a tidal wetland? *YES.:1_.___'1N0. . . .
*If yes , Southold Town Trustees Permit may be required. "M4.1affes MMO"�f!'.�►+
PLOT DIAGRAM 12,04 'F2eNSovMD.
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.
STATE OF N`EjArYQR
COUNTF . . S.S
• . • . . J. •'• • • '' 1 • • • • • . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
fie is the . . . . . . .. . . . . . . . . . . . . . . . . . . . .
(Contract . , agenf . orporatc..gfficer, etc.)
of said owner 'or`owners, and is1'd'uly•authorized to Perform or�liave 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 manner set forth in the application tiled therewith.
Sworn to before hie.th•
. . . . . . . . �. . . . .day of. �. ' 19 �
Notary Publi . . . . . . . . . County
CLAIRE L.GLEW . . . . . . . . . . . . . . . . . . . ....
.
Notary Public,State of Now York
Nm 4879505 (Signature of applicant)
Qualified in Suffolk County 7
Commission Expires December 9,19
�
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� 1 - NOTIFY 13 ILDING DEP ENT , . V _ ,
;' ' I 765w1802 9 AM TO 4 THE ��I- I p
I- FOLLOWIfIG INSPECTIONS: , I41e a . -
',
",
,- I 1, FOUNDATION - TWO REQUIRED - Z
� FOR POURED CONCRETE -& - . . 0
j; 2.,ROUGH FRAMING & PLUMBING , i -
L . 3., INSULATION - - - -�I LW6
4. -FINAL CONSTRUCTION MUST . - '
BE COMPLETE FOR C.O. I z . - ,'
�' - ALL-CONSTRUCTION SHALL' - l . 4
THE REQUIREMENTS OF-,.THE N.Y.AW,6d-�"'-- 04 !1''
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k STATE .CONSTRUdT16N & ENERGY*rqA- ) a&Vp __ I 4' 0 clientlowner. I I
k"I CODES. NO T: 'RESPONSIBLE FOR 1 , - _ 4.
( DESIGNOR NSTRON ERRORS -a,�w'0 6 )6& - � I - 4
COUC71 Iw '� P/, � , In _�" _
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