HomeMy WebLinkAbout22997-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24053 Date NOVEMBER 30, 1995
THIS CERTIFIES that the building ACCESSORY
Location of Property 28375 COUNTY ROAD #48 PECONIC, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 74 Block 1 Lot 42.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 28, 1995 pursuant to which
Building Permit No. 22997-Z dated SEPTEMBER 7. 1995
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 STORAGE SHED IN THE REAR YARD AS APPLIED FOR.
The certificate is issued to RICHARD & ELIZABETH MEAD
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
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...................f. ....�...............................,
N2 22997 Z
Permission Is hereby granted o;
......... ....... ..........................................
x.. ..,.... ... ... .......................
........ ........1115F�...................
�s� �10 fed 1.......
to ............... .C-1. ............. ..................fr`...................
' ................ ........1_15. . ............/��'............ .... .../ -..:....................
..................................................................................................................................................................
..................................................................................................................................................................
......................................................................�� .........................................................................
at premises located at.............. .pp�7� -Joed...................... ....... ......................................
....................... ...................................... ... C....................... ......................... ............
County Tax Map No. 1000 Section ..... .......... Block...... ........... Lot No. ..7 e.2...`5 .......
pursuant to application dated ..........���ri.....eF-61........... 19...... and approved by the
Building Inspector.
Fee$.........................
............ , ...............................
wilding Inspector
Rev. 6/30/80
V'�Q Form No. 6
CfL' L ( TOWN OF SOUTHOLD
BUILDING DEPARTMENT
�,QCo TOWN HALL
C 765-1802 i�!i�''! 2 9
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) nori-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 - $20.00
4. Updated-Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $1p5.00,, Commercial $15.00
Date . .``. . / . . .` ,`�'. . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . Y. . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . .
Location of Property. �lJ. 1.5 . . . 'Al.W. . . �. ? . . . . . . . . . . . Q Q . . . . . . . . . . . . . . . . .
House No. ,,,, pp��""Street Hamlet
Onwer or Owners of Property. xta ,". A. J.ej 1:Z.4�:"�J� . . .CJ.O'd. . • . . . . . . . . . . . . . • • . . . . . . • • • •
County Tax Map No 1000, Section. . . . 17k . . . . . .Block. . . . . . 0 V . . . . . .Lot. . . .`�:` . � . • . . . . . . . • •
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . .�. (. !./ .z .Date Of Permit. . ./ f!. . . . .Applicant. ��C lI(1�-��. �r.�. • • • • • .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . , /
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . .
Fee Submitted: $. . .�?. '.o 0 . . . . . . . . . . . . . . .
M---z
Qz_ S6 ��,`� . . . . . . . APPLICANT . . . . . . . . . . ..
e0 —?,- �� 05
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Town Hall, 53095 Main Road p • Fax (516)765-1823
P. 0. Box 1179 y Telephone(516)765-1802
Southold, New York 11971 �oj �a0
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
November 22, 1995
Mr. Richard Mead
Box 112 - CR#48
Peconic, NY 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 # 22997-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
765-iS02
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: . t)/r -,/
zz
DATE INSPECTOR
rtty.,"h-l'I .,PEcTiom RF,FORT DATE
COMMENTS
17.01INDAT T.QN I ST) s
t-'UUMDAT 2ND)
-----------
ROUGH rRAMK &
PLUMBING Isi
cn
INSULATION P17R N. Y.
STATE ENERGY
CODE
it �� - - --
------------------------- ---------;;----_------_-_--_____-_____COOT-________-----___COOT______
z�
FTNAT,
-- ---- -- 0 cl000l
ADDITIONAL COMMENTS:
ilOARD OF HEALTH . . . . . . . .
FORM NO. 1 3 SETS OF PLANS . . . . . . . . .
TOWN OF SOUTI-TOLD SURVEY . . , . . . . . . . . . . . . . . .
BUILDING DEPARTMENT i CHECK . . . • _ . _ . . . . . . . . .
TOWN HALL_ SEPTIC FORA _ . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL.. 765 1>302 t.OT I PY '471 , /`���.�
l CALL `t
Lxaiiiiiied . . . . . . . . 19�✓, HAI1. TO
Approved . . . . . . .� . . . . ., 19`.S. Permit No. _ . . . . . . . . . . . .
. . . . . . _ _ . . . . . . . . . . .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Bui di�/gisp ctor)
APPLICATION FOR BUILDING PERMIT
_.J Date '. . . . c�. . . . . . ...19 N
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted 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 preniises,,relationship to adjoining premises or public sti-eets
or areas, and giving a detailed description of layout of property must be drawn on (lie 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 issued a Building Permit to the applicant. Such permit
shall be kept on•the,premises available for inspection throughout the work:
e. No b yil i�inga all (ya&,dccupied�or used in whole or in hart for any purpose whatever until a Certificate of Occupancy
shall have sheen,grant,ecl�by the 136ildjn.g Inspector.
PI'LI.C,ATION LS .I:IEJI tBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
r a �: �. �r� ,r• i
13u'ildirig-7oi e�0'rdtllanee:'of•J1161' win of Southold, -Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for,therc.o;nst-nt,ction-of.bulldings, additions or alterations, or for removal or demolition, as liereini described.
The appticant�agrees•�to'�conaply with all applicable laws, ordinances, building code, mousing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
Slate whether.ap,I?Ii.cgp,tJs_owtier, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . .
•.of 9w»er>qf j�reiia;ices;;:. .°::, de- V��Cl� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
if applic,ant.is,ac,orl•�ora;tnon,-sigi,�ahre of duly autlnoriied officer.
k ry (,u
(Name and titl'e-'of corporate officer)
.; AUG 2 8
Builder's License:
No:
VILIn:ibe'r'.s License No.
llecli`iciIi's Lice'n`se No:� _
Other 'i•rade's License No.
`
I . Location of land on which proposed wort' will be done. . . in.rfi . . . . . . . . . . . . . ..... . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . C�.�. . �c�: . .�.�. . . . . . . . • . . . . . . . . Pe-co.n.tc,, JQ �... . : . . . . . . . . . . . . .
House Number Street hamlet
1
County 'fax Map No. 1000 Section . . . .•7.7 Ll. . . . . . . . . . Block . . . . . . . . . . : . Lot .41 . .`"J. . . . . . . . . . . .
Subdivision . . .. . . . . . . . . . . . . . . . . . . . . ... . . . . .t .. ,vial) No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . .
(Name)
2. Stale existing use and occupancy of premises and intended use and occupancy of proposed construction*.
a. Existing Ilse and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy �TOYC L��. . . . . . . . . . . . . . . . . . . . I . . . ... . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .
3. Nature of work (clieck whicl, applicable); New Building
Repair . . . • • • • • • • • • � Addition . . . . . . . . . . Alteration . . . . . . . . . .
P . . . . . . . . Removal . . . , , , , . , , , • . . Demolition Other Work
• � .. .. . . . . . . . . . . . . (Ucscription) . .
4. Estimated Cost . . . . o.�75,po � .Qp p
. . . . 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
<. If business, commercial or mixed occupancy, specify nature and extern of.eacl, type of use .
7. Dimensions of existing stnictures, if any: Front . , Rear .
Ileight . . Depth . . . . . . . . . . . . . . .
. Number of Stories . . . . . .. . . . . . . .
Dimensions of same structure with alterations or additions: Front
Depth . . . .. . . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . .
Height . . . . , . : Number ofrStories
8. Dimensions of entire new construction: Front . . . . `Q.�, ' ' ' ' ' ' ' ' •2�/' ' ' ' '
Ileigt,l �. . . . . . Rear . . . . .I.Q. . . . . . . . Depth . . -
Number of Stories
9. Size of lot: Front . , . . .a? . . . . . . . . . . . . . Rear . . . . . . Q(o . . . . . . . . . . . . . . . . .��� . . . , . . . . . .
10. Date of Purchase , Name of Former Owner
1 I. Zone or use district in which premises are situated . - �-. . e�i,den/iu/ gAd
12. Does proposed construction violate any zoning law, ordinance or regulation: . .
13. \Vill lot be regraded ISO„ NP . . . . . . . . . . . . . . . . .
t 1Vill excess fill be removed from premises: Yes No,
v
14. Nanie"of Owner of premises � �/� t"bC . . . Addressf9m ,?CC,,pY1
Naive of Architect F- 1.C.. Phone No.
��'Q • . • . . . . Address . . . . . Phone No.
Name of Contracts, . • . . . . . . . . • •'•
Address . Plione No.
't5. l.s ehi.s properly vdtliin 300 feet of a Lidal wetland? *yes.
*If yes, Southold Town TrSL-eeS Permit may. be required. No• .Ir!. • • . •
u
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.
�OCCU ANCY OR
USE I UNLAWFUL
L4.' �r� S „zt " WITH UT CERTIFICATE,
nor OF OCCUPANCY
CUPANCY
AP OVED A 10TED
DAIF " 59.P.# �X9 9 7&
FEE: " ` BY:
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
D � • $ FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
Z FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
S. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
TATE OF NEW IC ALL CONSTRUCTION SHALL MEET
'OUNT1' OF . . . . . . . . S.S THE REQUIREMENTS OF THE N.Y.
,L— STATE CONSTRUCTION & ENERGY
. . . . . . . . . . . . . ... • . /. . . . . . . . . . . , . being duly sworn,-depoS098-sa VAT►at gQs , ! ricFRIR.
(Name of individual signing contract) DESIGN OR CONSTRUCTION III
Bove named.
�is the . . . . . . . . . . . . . . . . .. W '
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to rnake and file this
,plication; that all statements contained in this application are true to. the best of his knowledge and belief; and that the
ork will be performed in,the manner set forth in.the application filed therewith.
_worn to before me this
. . . . . . . . . .�`�.�. . . . .day of. . •� �1 , 19 S
Oil 'ublic. . . . . . SjT �ll�ounty
EI_IZA8ET11 AKIN NEVI E . . . . . . .
Notary Public,State of Nc York (Signature of applicant)
No.52-8125850,Suffolk Couotty,�
Tbrrn Expires October 31,19.Z&
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