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Home My WebLink About5519-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCcupANCY No Z-23939 Date OCTOBER 6, 1995 THIS CERTIFIES that the building Location of Property 240 SMITH ROAD House No. County Tax Map No. 1000 Section 98 Subdivision DWELLING PECONIC, N.Y. Street Hamlet Block 3 Lot 37 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 20, 1971 .pursuant to which Building Permit No. 5519-Z dated SEPTEMBER 21~ 1971 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 ONE FAMILY DW~.ING WITH ATTA~ GARAGE & PORCH * The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MARUKi.r~ LIMBACH AUG. 17, 1972-R. VILLA PENDING *NOTE: THIS UPDATES CO Z-4758 ISSueD AUG. 25, 1972. Rev. 1/81 FOE.~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5519 Z Permission is hereby granted to: ...... G,..~.Z~m..&....A/C..~,ee..Mmlmael[ ...... at premises located at ..... J~II~..~.....~IJlI~..~gJL~le ............................................................... .............................................. J~t.t~ .liee~ ........ Peeen~Lo ....... II~.X., ................................................. pursuan~ to application dated ........................ -~lJj)t~ ............ e~ ......... , 19.~,.., and approved by the Building Inspector. ~j ~t nbJeet te ~ et ~atta~ ~ betm 0/0 Fee $..J.J).e. JJ'~J .......... Building FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~a~.~h .]~,~d ................ Street Map No.X.~o. ~]~. ]~ Block No.. ;g ....... Lot No. ~ ..... 1~001~.0.. ]{,~, ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .59~.t....~.~..., 19 .~... pursuant to which Building Permit No. ~.~.. dated ......... $.~.p.t....2.1 ..... , 19..~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...1~. ~ .~.t. 9...o~.e...f..~.X.~..~w..e~.~,~a~ ...................................... The certificate is issued to . 6.~or&~ .l~k ...... D~I~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~. tXg.. 1. 7..1.9~....1~1r. ~., .¥~1,~. ...... UNDERWRITERS CERTIFICATE No...~.?.~...~.l[.... .................................... HOUSE NUMBER.~..!~0 ......... Street.. I~g~ }~O~ ........................ : .......... Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. 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 - $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 UPDATED Certificate of Date ..... ~P~.~.J~ ...................... Occupancy #Z4758 New Construction ........... Old Or Pre-existing Building ................. Location of Property.~P.P~J~.~999Z.~F99J~.~.Ygf~ ....................................... House No. Street Hamlet Onwer or Owners of Property ~r~DJ3D [J~D~b ..... county Tax Map No 1000, Section.~ .......... Block..~ ............. Lot.32 ................... Subdivision ................................... Filed Map ............ Lot ...................... Permit No................Date Of Permit ... ............ Applicant ............................. Health Dept. Approval ......................... Underwriters Approval ......................... Planning Board Approval . Request for: Temporary Certificate .... Fee Submitted: P.O. BOX 706 gUIgHOGU£,LI., N.Y. 1193§ APPLIC/~IT S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure / (Give deed 'location) / -/ located have been inspected by this department and found to be satisfactory. Ohisf of Ceneral~ginocring ~ ~ '~ AUG 1 7 1972 ~ Zo4- 7 [ hj 776k ~'./a ra~,/,f m.~ ,'Vfc, r~zqa'q e T BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Disapproved a/c .............................................................. APPLICATION FOR BUILDING PERMIT Date ~.~ ............................... 19,.~..../. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giVing o detailed description of layout of property must be drawn on the diagram which is port of this application. 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 progress of the work. e. No building shall be occupied or used Jn whole or in part for any purpose whateve[ until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLIC, ATION 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, hou,~J~g j~ode, and regulations. (~grp~ture otapp' , , ' . rpo ' ) (^dd~lss of applicant) ~ State whether applicant is owner, lessee, agent_, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ..... .~v.~ :~,,,~-... ~ ........................................................... ~ If applicant is a corporate, signature of duly authorized officer. ..~.~_ ~ ~ ~ .................. ................... ,, 1 Locat on of and on wh ch ro osed work w be done Ma No~..~MI,~I~' ~' ~'-- " · P P · P >.~..F.~.e,~r~ ...... o m~..' ........................ Street and Number JC~../~...~..~-'~..~....~.~gc~r';~..-~..~'C.~,~.....e~n~,,.l..P..~ ...... ' C]C/ Mu.,c,pa,,ty 2. State existing Use and occupancy of premises and intended use and ~cu~ncy of pr~ co~mcti~: a. ~i~ing -- and ~cu,n~ ..... ~...~.~.~ .......................... ~ ...................... use.., .......... ' ~. Nature of work (check which applicable): New ,Building .?~. ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demo t an . Other Work (Describe) ........................................ 4. Estimated Cost ............. ~.....~../...~..:..,...,~;; ........ Fee '...'...: ......... /...~...f..~ .................................................. :. (to be paid on filing this application) $. If dwelling, number of dwelling units ......... .....~.~..,.~....Number of dwelling 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 ................................ Dimensions of entire new construction: Front ........ .'~...~ ................. Rear ...... .~...~ ............ Depth .~...~.... .......... Height ..... ~ ...... Number of Stories ....~ ........... ~ .............................................................. Size of lot: Front ...... /..~2~( .......... Rear ......... L..Q~. .............. Depth/.~...~..~..-.../.../....O...~,..._~,.cu~/ Date of Purchase ..... of Former Owne, r~...~/.t.~C~e~,~..... ................ Zone or use district in which premises are sitUated ........ .~m~.........~....[~.~.~.....~__ ................................. Does proposed construction violate any zoning law, ordinance or regulatiOn? ...... ~....~..~ ........ , ......................... Name of Owner o f premises ~.~-.-..~dd ress ~.~..'~..'~..-. ~.~'...~../~.~~/I~.Y... ~ ................ Name of Arch tect ......... .¥. ................. Address .~. .... ...~..Ip'~oon~ ~. ~)*'.~. ~. 2,~ Name of Contractor .~,~.~....~..... ......... Address ~...~...¥..,.. Phone No.").3..~.....~o.?o~..Z... 10. 11. 12. 13. PLOT DIAGRAM Locate clearly and distinctlY all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot.! [~,~) [ STATE Of NEW YORK, ...... ~~-' .;~' ¢ .......................... being' duly sworn, deposes and says that he is the applicant u'~ame or i,naividual signing~applicati0n,~w~./,, above named. He is the ..................................... .~4,-~L4~.~ ......... i ..................................................................................... (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 conta.ined in this application are true to the best of his knowledge and belief; and tha~ the work will be perf,~Lrmed in the manner set forth in the application filed therewith Swam to before me this /I . ~ . ....... - fl // -' .... ..... .....' ............ - ~0T~RY PUBLIC, S~te of New Yo~k No. 52-8~25850, Suffolk Cough. Term Expires March 30, 1