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Home My WebLink About5368-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18987 Date APRIL 25~ 1990 THIS CERTIFIES that the building ADDITION Location of Property 200 CLEAVES POINT ROAD EAST MARION, N.Y. House No. Street Hamlet County Tax Nap No. 1000 Section 38 Block 2 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 24, 1971 pursuant to which Building Permit No. 5368-Z dated JUNE 22~ 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 PORCH ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTHAPPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MRS. JOHN BAZOVSKY ~Inspecto~~r Rev. 1/81 i;'O1~ NO. S TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PEPJVilT MUST BE KEPT ON THE PRE/vtlSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5368 Z Permission is hereby granted to: F~'ED F'~', ~-/ at premises Iocatedat ~0~ C/.~t' ~'.' ~- '~r!~'T 7~ pursuant *o application doted ~ V A~rI,L 19ZJ and approv~ by the Duilding Insp~tor. F~ $ ........................ Building Inspector Form No. 6 APPLICATION FOR CERTIFICATE OF OCCUPANCY-- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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. 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 $15.00 New Construction ........... Old Or Pre-existing Building ................. Location of Property ....... ~ f~ House No. Street Hamlet Onwer or Owners of Property ................ Section: ' .3..$ County Tax Map No 1000, ~. ? ..... Block .............. Lot .................. Subdivision .................................... Filed Map ............ Lot ...................... Permit No ............. .. . Date Of Permit ................ Applicant ............................. Health Dept Approval Underwriters Approval . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $...~...~..~ ..................... TOWN OF souTHOLD BUILDING DEPARTMENT TOWN CLERK,S OFFiC! SOUTHOLD, N. Y. Examined ................. c~ ~[~/~p.~'""/'~' ........... ' i 9'"'~/"~'~/ ~.,~P-' ~'~ ~---C~ Approved ............... ~9......~.. Permit No ............................. Disapproved a/c .................................. ~ ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 bui!dings on premises, relationship to adjoining premises or public streets or areas, and g~ving a detailed description of layout of property must 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. d. Upon approval of this application, the Building Inspector will issu& 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 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 alte~atioos, or for removal or derr~lition, as herein described. The applicant agrees to comply with all applicable laws, ordin~lr~es, building code,~ou, M~ f~J~), and regulatiOns. ~,i(~jnature of appl~j~, orjn~mq., if a corparation, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ................................................... Name of owner of premises .................................................................. J ....................................................................... If applicant is a corporate, signature of duly authorized officer. ................................................................................................ - (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .~'~......~.....~....~). ............... Lot No.: ....~... ............... ~ 0 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ..~....k~..~.....~..~...~..t.....~....~.[......~..'Lr'~..~,~,,,.~.~,~..~,.~.~. ...................... b. Intended use and occupancy ........... ...'~........~...~..~. .............................................................................. Nature of work (check which apptfeable): New Building .................. Addltion.................. Alteration ...?~.~..'~...... ........ . Repoir .................. Removal .................. Demolition ............. ii~.her Work (D~:rib Estimated Cost ...........'~......~.....(~....(~... :.....(~....~.~.. ................... Fee .............. . ..~....., ...O.......~.. ....................................... : ........ ~...i .... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling dnits 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 ................. i';~, ...... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .................. ~ .................... ........................ ,~-~__ ,~_r..~ .......... ,:.r....,~ ........................... Size of lot: Front ..... ~ .............. Rear ..... ...~......C~.. .................... Depth ......?~....~...O_~.~...-T.....?~...! ~-. Date of Purchase ...................................................... .~me of Former Owner-- ----.....~..~...~....W~........'~..~...~...~....~.....(~... ........... Zone or use district in which premises are situated .......~t....~m...~....~...~....~..~' '~"~ ................................................... Does proposed construction violate any zoning law, ordinance or reguk;~ion? ....... ..~.....~.. ........................................... Name of Owner of premises~..:..~~...~....~.....Address ............................................ Phone No Name of Architect ...................................................... Address ......................................... -... Phone No ..................... Name of Contracto~.~- ':.....~....~ ............. Address ............................................ 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 des~;~iption according to deed, and show street names and ,indicate whether interior or corner lot. ~'0~'~ ~ ~ ,?:, i 10. 11. STATE OF NEW' YORK, COUNTY OF .... IIIi,JL~IJ,~ .......... .................... ~I~:J~.~IIE..~...I~EI~IJ .............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............................ el~lll~lllltl~ ..................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said worl% and to make and file this application; that all statements contained in this appllLcaE, ion are true to the best of his yn~wledge and belief; and that the work will be performed in the manner set forth in Itl~ ~plication filed therewith. - I J Swam to before me this .......... of ......... ................ . ;_('J . ........ - ELIZABETH ANN I~EVlLLE NOTARY PUBLIC, State of New York NO. 52-8125850, Suffolk Term Expires March 30,