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HomeMy WebLinkAbout23424-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24535 Date July 30, 1996 THIS CERTIFIES that the building accessory Location of Property 8440 Main Road, East Marion House No. Street Hamlet County Tax Map No. 1000 Section, 31 Block 07 Lot 03 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 25, 1996 pursuant to which Building Permit No. 23424-Z dated May 9, 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 two car garage accessory in the rear yard as applied for The certificate is issued to John Whitehead (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 G Building Inspecto 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.............. .. ..............................., 19A NEE 23424 Z Permisslon Is hereby granted to; , x.. ..41-1.................................................................... � ........ ......................... to ... ./ .% ...'"........fl`......../��%�'.............�?F ...... ........... ......�.... .... �. ....... r ..... ....... �. i� ..........r - .................. 001 .. ................................................................................................................ .................................................................................................................................................................. ...................................:................................. ........... i� .- �� ...... .......................................... at premises located at.............. /..... 1 % �..... ........... ................................................... ........................................................ 1... ..................................................... County Tax Map No. 1000 Section .....5--W........... Block"...... 4577........ Lot No. .......... ............ pursuant to application dated ...(!�) ...........�``-�� ........... 19..../...5,."., and approved by the Building Inspector. Fee$....�..0-1 .`l.... ............ .........11�/. ....; '.-. .................................. / Building Inspector Rev. 6/30/80 �n �L 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 . 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 Buildins - $100.00 3. Copy of Certificate of Occupancy - .25e,. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . 7 . . . . . . . . . . . . . . . . . . . . . New Construction. . ... . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . .g`f.`f�. . . . . . . . . ,4ie� . . , �. . . . . . . . . . . . .�"2S .�I.!�'?!o.��.�:�j../.��13.J�' House No. Street Hamlet Onwer or Owners of Property. . . ��.. . . . . . . . . . . . . .-?. .:.'.7 . h�E.g . . : . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . .�-f/ . . . . . . .Block. . . df. . . ... . . . .Lot. . . . . . . .. . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . . Permit No. . r 3. /a9. .Date Of Permit. . 5.:9 ".c1.�.. . .Applicant. . ... ....?. . .. . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . -. . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1"e c . . . . . . . . . . . . . . :�. . . . . . . . . . . . . . ...s, PLICANT 3 765-1802 /UILDING DEPT. OUNDATION PECTION 1ST [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL . [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLB [ ] FOUNDATION 2ND [ ] INSU ON [ ] FRAMING [ AL [ ] FIREPLACE & CHIMNEY REMARKS: e-- 41 ,, -a DATE � � INSPECTO 17 T. .......... tK 1:0111111AT I 011 1:;*I,) .......... I)A ------ -------- ----------------------------------no nn my ti u. I(011(Al FRAIll" & O I I I C ...... ------------ -------------------------- -- -------------------- ----------------- tt ............. I 11MI1.AT I 011 IT"ll 11 STAA R FI 11,it(1,y CODE ........ ;ol------------- F I IIAL ............... ------------------------- ---------- --------------------------------------- ------- ------------------ ADDITIOIIAI. ---------------------- ............... .......... 0 ------------------ ............. tj FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . . . . . . . . . . .. 19 .`. Application No. . . . . . . . . . . . . . . . . . Approved . . . . . . . . . . ., 19 F.�Permit No. .VIA KZ.S��' Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •17 '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /hs�ec; 7Co� . . . . . . . . . . ( i ingor) APPLICATION FOR BUILDING PERMIT Date .F4yrrt�.Z.�. � . . ., 19cY.6 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. _ . . . . . . . . . . . . . . . . . Signature of a lica r name.: a corporation) (Signature pp X0, . .c?ax. .7l. /0ACo 2-? C./ ./.S tv. 1 9slg. . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. h/c.v-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Ery Q V N r �` r IFfR Builder's License No. . . .`���.�i. /'7�. �. . . . . . . . - ri D i G: Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . e= APR 2 5 W6 I Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . BLDG.DEPT. TOWN OF SOUTHOLD ry.. Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h4a h. .ROA d. . . . . . . . . . . . 4eRls Q 1r;© . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . .3 / . . . . . . . . . . . Block . . . . .0.. 7 . . . . . . . . Lot . . . . 0.,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 . . . .:5.+��c-�G:. . xn,.��! . . . . .�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . ��' anJ !.�'. . �� ^✓!`/. . ����i»•..Gj. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building Lqa 5.q' Addition. . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . (Description) 4. Estimated Cost . . . F./.J Q oG.b O . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . (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 . . . . ,i%u ,cG!!'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . ?..'i4 . . . . . . . Rear . . . . . . . . . . . . . . . Depth .2 ,/ . Height . .I . . . . . . . . : . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in-which premises are situated . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . .M. . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . ✓:V.¢ . j . . . . Will excess fill a removed from premises: Yes No 14. Name of Owner of premises JCX4.'. .4'Aji�d e��!. . . . Address/.'�Ii. 94. f° i�ubPhone No. V77 rR 7 3�. . . Name of Architect . . . . . . . . . . . . . . . . . . . Address . . . . . . . Phone No. . . . . . . . . . . . . Name of Contractor .CAai h,r. .—XQa-.'psP?'). . . . . . Address ,C+' J14vwc . /:��Gc��a�;c. Phone No. 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 whether interior or corner lot. r STATE OF NEB YORK, _ COUNTY OF .J. u l o �!. . _ • • • • • . IC being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . . r;..hC>in , a C4a V' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 his 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 of . . . . . . . . . . ., 19 � Notary Public, . .. . . . . . . . . ..tic.- � .. . . . . . . . . County uN®A AI;OOPER .� . . . . . . . . . . . . . . . . . . . . . . Notary Public,State of Now York• No.4822563 Suffolk Caunty (Signature of applicant) Term Expires December 31,i a N N •�n� U1 f y •.o. •o. z � r � N� gj y.�0� 6%�� �\ YZ �J►Z NLil- * 2FPP e SQo =G G' N S S o �p mooin ; N Cam•- . Fo Avg CERTIFIED TO .- !'ES TA TE of MILDRED DIESERUD BAPBARA NOISING TON COMMONWEALTH LAND TITLE INSURANCE COMPANY PRUDENTIAL HOME MORTGAGE e 5 1<1 00 oo 05�J� \G� 00 - - SURVEY OF PF O� E No TY y��o AT EAST MARION TOWN OF SOUTHOL® / �5 SUFFOLK COUNTY, N. Y. 1000 - 31 - 07 - 03 Scale 1 - a00 Oct. 25, .19.90 .� APR 2 5 1%6 TOWN OF SOUTPO�n \,AND S _ �i AREA - 2.5,820 s q. f t. �,o �q - Ilr 496'ka y0� Prepared in accordance with the minimum N.Y.S. LIC. NO. 49618 standards for title surveys as established .by the Ll A.L.S. and appproved and adopted PECON RVEYORS, P.C. forsuch use by The New York State Land (516) 765- 5020 Tit/e.Association. P. O. SOX 909 MAIN ROAD SDUTHOLD N.Y. 11971 : r i 6 Lo LC7 p�F J0� I C; I C It- Et - - � I ------------ 10 ht J} jJ,�� _- ._.._._..._._. _..___ ..,,-_„_ ��`7 �•�" I/7,1`,:/�<."!�!1. s/� rt q r i`,S - �.\<.J ��t.•7:�t'�i �.'..r:.61 _ I OCCUPANC"Y OR APPROVED AS TOTED USE IS UNLAWFUL �1 DATE: B.P.#�� WITHOUT CERTIFICATE a _ I FEE ° BY: - NOTIFY BUILDING DEPART`ENT AT :�: OCCUPANCY �' ,t�Q:..~;�c �,t �'"- / 765-1802 9 AM TO 4 PM,FOR THE I I FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ���-� :r `sue r FOR POURED CONCRETE 8.�NDERNRITERS CTI-MiFICA E 1` 2. ROUGH - FRAMING & PLUMBING REQUIRED j 3. INSULATION I c 4 X J 4. FiNAL - CONSTRUCTION MUST ! BE COMPLETE FOR C.O. t ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR �X S GC DESIGN OR CONSTRUCTION ERRORS � ,��srcra/` •� �_ /'�10:,� �,Tj� c Lo•r+GV;�`t-C' �S�G � 4� ! ;4� a l fnl U � 1,1;✓, LUtJ\r IS�`tol.\>n`� tC�C:�l� Y1�`J"`, � I i GJ0(Vc "Xi") j �__ I GJUOI� I YU/JOS.CGI _,ct (2 SGGIc i t. - t