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Home My WebLink About6939-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-30573 Date: 11/22/04 THIS CERTIFIHS that the ~u/l~{-(3 ADDITION Location of Property: ~40 PRIVATE ROAD #3 SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 6 Lot 5.1 subdivision FiledMap No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 23~ 1973 pursuant to which Building Permit No. 6939-Z dated OCTOBER 23~ 1973 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 ENCLOSE AN EXISTING PORCH AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to PATRICIA A BUERKLE (OWNER) of the aforesaid building. ~u~OLK COUNTY DEPARTMenT OF HEALTH APPROVAL ~.RCT~ICAL ,'K-TIFICATE NO. PLDMBERS ~TIFICATI(~ DA'£~ N/A N/A N/A ~nature Rev. 1/81 Form No. 6 TOWN OF SOUTltOLD 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 Departm~n't Witl{ {he foll6wing: A. 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. Bo 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 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- $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 '"1( Old or Pre-existing Building: House No. Street Filed Map. Date of Permit. \C> .~z~ ."~x~ Applicant: Underwriters Approval: New Construction: Location of Property: Owner or Owners of Property: ?IX"~', CA~0x Suffolk County Tax Map No 1000, Section '"~ O Block Subdivision Permit No. Health Dept. Approval: (check one) Hamlet Lot Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~:::~ Final Certificate: N/(,/ (check one) · Applicant Si~natu~'e lvO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFi:ICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6939 Z Permission is hereby granted to: ......... ....... · a~tl~ ............................................ at premises lacated at ...J~l~,.~g~l~..~ ................... P-e~O.e.'d.e...O,~..,~L.~.~..~......A.?...e. .............. pursuant to application dated ..................... ..0~....~.. ......... ~ ............. , ~9..~,~.., and approved by the Building Inspector. Fee $..~.~,.~OJJ~ ......... 140 0 FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned .......... · '9..?) provod ................ ........... :'. ........ , ,9..Z. Perm,t ............ APPLICATION FOR BUILDING PERMIT 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 o~ areas, and giving a detailed description of layout ofproperty 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 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 pa rt 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, os 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. Leo ~wasnesk~. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. f; on~trac Name of owner of premises ..... ~o~,~J'~l,..J~tl~.~.]r~ ............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. l;~..e..F...?.?...1..b.~....~'.....H..t..g ............... Electrician's License No. '"]~O~'}.e~¢ ........................ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: .......... ~ ........................ Lot No .....~ ............... Street and Number ...J~,l:;L~..a.t,~..~g&¢~..~ ............ .I.~".Qe.~L~....~.~.~.~./..~..'..~..']f~..~.....'t~..~..A..~..e.....~..S..~.`u...t¢.~..~..~. ............ Municipal ih/ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and'occupancy ..... ~We~.l;/3~ ....................................................................................................... b. Intended use and occupancy ............. S.~...1~..t.~...{i, gl,.d..:~.t,.;l...o..D. ........................................................................ 3. Nature of work (check which applicable): New Building .................. Addition ........ ~ ..... Alteration ..~,~ .......... Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost ................. .l~lOOO....,e,. .................... Fee ....$.~[e00 .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... orte ............... 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 ................................ 8. Dimensions of entire new construction: Front ........... 1.0......t'. ............. Rear ........... 1'(~ ........... Depth ..... ~L~..._.~ ........ Height .................... Number of Stories ...... ~)l:te ...................................................................................................... 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 ...... nR4t..d.~.t: ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..rig ................................................. 13. Will lot be regraded ...... ~O ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..}{o'e/a~t..-.]~lJ~k.].~ ................... Address ....... ~ota, t,i~,Ol-cj, ..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..... ~e..~a~e~s[~, ....................... Address .....~.al,l.t,~D~[ ....... 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. STATE OF NDvV YORK, iS $ COUNTY OF ...-~U~.£~c ........... ~ ' .................. X'"~e~"~8.~r~'~ ........................ ', .................. being duly sworn, deposes and soys that he is the opplicam u-~ome or maw~OUOl signing contract/ above named. ~ He is the ..................................... Oon.~J~G~ez' ................................................................................................................... (L.ontractor, 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 thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .................... y o ......¥. .................... , ............ .................................. t'qgnoture of applicant)