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HomeMy WebLinkAbout23525-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of. the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25137 Date JULY 18, 1997 THIS CERTIFIES that the building ADDITION Location of Property 1780 HENRYS LANE PECONIC, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 74 Block a 2 Lot 4 Subdivision Filed-Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 3, 1996 pursuant to which Building Permit No. 23525—Z dated JUNE 19, 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 DECK ADDITION TO EXISTING ACCESSORY INGROUND SWIMMING POOL AS APPLIED FOR. The certificate is issued to DONALD & LORRINDA STARON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspec r Rev. 1/81 FORK NO. f 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) N°. �/// 23525 Z Date .................. ........................ >I9.....Y� Permission is hereby grant LaAl� o: ................................................................................ .... ...............1....... ...................................... to ..........Ji7t...(....... .......��.: :;TJo!L:. ................... ..................................1. ........... . ...c..... ............................. .................................... ............ .......................................... atpremises located at ..................�� ........��� . . ..... ...: ......4 '��................................... .................................................................. �1 .................................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ...... ............. Block ......!�!A;...... Lot No. .....® ...... pursuant to application dated ................ .......i�.................., 19.l. ..., and approved by the Building'Inspector. Fee $...!o. :.. ..... ...... ............. ` ../ .................•............ �iId��g Inspector 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 ofproperty 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 Building - $100.00 3. Copy of Certificate of Occupancy - .2 . 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . � /: l. . . . . . . . . . . . . . . . . . . . . . . L New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . .O.YD. . . . . . . . S �n.�. . S . .�.�':�1�. . . . . . . . . . . . . . . . !;�C. ... . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . ��/ „R. . .h �. , ,�' ,2��. . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . .'. .... .... . . . . . . . . . . . . . . Permit No. . 3 :�.2:�. . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . .D(),,f. . .::'411'0"). . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . r Feq,-�Subm'tted: $. . . �:D 0. . . . . . . . . . . . . . . . . . . ViP) '� APPLICANT �'� o�O Gy�c Town Hall,53095 Main Road y Z Fax(516)765-1823 P. 0. Box 1179 1 Telephone(516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD July 11, 1997 Donald Staron 1780 Henrys Lane Peconic, N.Y. 11958 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. )$25.00 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 # 23525-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. ,65.1802 BUILDING DEFT. INSPECTION [ J FOUNDATION 1ST [ ] ROUGH PLBG. ( ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ ] FINAL REMARKS: DATE / INSPECTOR . l 70-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ NAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 765-1802 BUILDING DEFT. INSPECTION [ Vr FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOU DATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: - G7�C= T cip— DATE (// � INSPECTOR—/4/ja I I I'.I.�I I Il:il'�a, l Lllll Ill;l'llll l Ufa I I:. Ill 111) v00 r 111•'i11I•n'f l llll I'I Il II , Y "" "'"-' COI)li - -� - I• I Ilnl. .. ----. ti... e, .. .,,., ....... .��.y.... nlll)I c) ......,..r.............�..,......,.,b.-:...r�,c►IIn1. cu111ILII t�; . l . . .. .. .... N.44'Z-7—Y-30"E. o W ' F-0T-7=! , 43 `. way 46 ) 44 CRRI NDer ,QT To wN oj= <',o a-rH01 D, Y. 'I ,�Q i r•'D/'7 P%per - 1 +o +0e A Qric.cavi .""f f td ctf-i<.i -ta' rV/0t�. Pasco/^i G f•t'C r`iC.'S+ "" `:t.4:1' rY '�•Jr,+• (�" V O�,sv-- { -�..n-�{ -. _ �. :+,.: r r� -:,;J �.i,%�a'4�: :C...�/',i /,'E•r K'� L�;!6"'..v�d L _. "e:i ._. 'r`ir2'� ^!"� i �+ BOARD OF HEALTH . . . . . . . . . . . n n�, FORM NO- 1 3 SETS ✓OF�I.ANS•�. . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . L' F^� BUILDING DEPARTMENT CHECK_ G JUN _ 3 2� TOWN HALL SEPTIC FORM. . . . . . . . . . . . . . . . . . . . 6P,r 0m SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: BLDG.DEPT. 77 �� TOWN OF SOUTHOLD // CALLL . . . . . . . _ - . l Examined._. ....., 197ir!. MAIL. TO: . . . . . . . . . . . . . . . . . . . . Approved...... � ..., 19,r Permit No. .................................... Disapproveda/c .................................. .................................... ...................................................... ..... ..�(Buil ' .. _._. In tor) APPLICATION FOR BUILDING PERMIT Date. . . . .q� __P . . . . . 1199(,.P. INSTRUCTIONS a_ This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan sharing 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 mist be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. a 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 EEREBY 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 Iaws, 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 promises and in build' for nece;T lions. (Signature of applicant, or name if a corporation) (Mailing ad dr ss of applicant) �( - State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0 W 0 C'L- ...................................................n.........................-----.......................................-- 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) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... I. Location of land on which proposed work will be done.............................................................. ...... .... ..'.. .`.......�................................................ ....................._.. lbouse Number Street Hamlet County Tax Map fib 1000 Section ....7 ....... Block ......� ..... Lot ... .......... Subdivision .... .... Filed Map No. j�.I.... I.ot .....9.,5 ...... (Name) 2. State existing use and occupancy of premises and`intended use and occupancy of proposed construction: a. Existing use and occupancy ...... v ....\r. 4�. `C �. °�........................... ....... b. Intended use and occupancy ..........��./'�! ..... .. CJ.C. ....Co��J� .? ....... I • 3. IJ;jtiire of ixjtl( (cI)eck w1ii(Ji applicable): New Iluildinj. .......... h1dition .......... Al te,ratlon Re pa i r .......... IlEnvva I. ............. Demolition ............ Other Vlork .......................... ......... (Description) 4 tA Cost hvited C 60. ................. fee. ................................... .......... JJJJ (to lie paid on filing this application) 5. If dwelling, mid)er of dwelling units ............ Mid)er of dwel I i ng units on each IT I oor ................ If garage, txjni)er of cars ....................................... G. If liusiness, cannercial. or mixed occupancy, specify nature and extent of each type of use...................... 7. Dimensions of existing structures, if any: Front................ 11ear ............... Depth ................. lk-ight ......................... UnI)er of Stories ...................... Dimensions of same stn)cLure with alterations or additions: Front ............... Rear ............... Depth .................... lleiijit .................... 1AA)er of Stories ............... 8. Dinensiotis of entire new construction: Front ................ Rear ............... Depth ............... HeigliL ......................... MzJ)er of Stories ..................... 9. Size of lot: Front ....I-Ob........... Rear ...I.0 Qj-k�........ Depth ..1.0.7.......... 10. Date of Purchase ........I.q , 'xiv- of lioriner (Mier ...1U,0 A�,?f.......................... 11. Zone or use district in ultich premises are situated .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...(.0.6................. 13. Will lot be regraded .................... Will excess fill be removed from.premises: YES ND M. Names of owner of premises ........................... &klress .............................. 14 xx)e No. .............. Mince of Ardiitect .................................... f0dress .............................. 11 Kxie No. ......!....... Name of Contractor ......O.LiA� ................. lVklress ................................14ione No. ........ 15. Is Lbis property within 300 feet of a tidal wetland? * YES .......... No V...... *lF YES, Scull un lum -114ISM-9 Prumrr MAY w. Rc-(VlFn- ). PLOT DIAGRAM Locate clearly and distinctly all Wildings, whether existing or proposed, and indicate all. set-back dimensions Fran property lines. Give street and block rawher or description according to deed, and show street names and indicate x-Aietlier interior or comer lot. ,�t� �a ���f�� OL C, MINly U? �... �� D S—A-rc ..........................................................being duly sworn, deposes aixl says that he is the applicant (None of individual signing contract) aIxNe m-mied, lk-- is Lhe .........;......... ..". (. ,.k................................................................... (CcniLractor, agent, corporate officer, etc.) of said (m)er or omiers, aixi is (July authorized to perfonn or have performed the Said Work aril to nuke and file this ;jlq)hcat:ion; that all. sLaLorients containecl in this application are true to the best of his knowledge arid kll.iefz atxI 1.1i,IL the work will lie performed in the itrainier set forth in Lhe application filed therewith. `worn to before me 1.1d e- clay 0 f ................ .19... Notary INilit .. ..... ... . . .............. .... ................................ CLAIRE L.GLEW York; (Sigmt-We. of AppticanO Notary'Public,State of 148W No.4879505 Qualified in Suffolk County V Commission Expires December 8,19 De c D'd 5fo'ro' SOT �. CCA li.4ore Q � c doL) l Ird P r Where t d i 13 9M Q �o 6 � r 7 X (91' . ell) q0 Q a 5 92 18 51 72 3, 33 Saao 3�, a5 © 1.7'2 93 i �, 0 �q36 8q , S� a '3 T tYY 10 ® '77 70 5 3 . 9� �159a 18 aN36 , a;L ode- 1173 - - -- r r SIDG DEPT. P TOWN OF SOUTHOLD a.