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Home My WebLink About8999-zFO~ NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF OCUuPAN~Y No Z--23087 Date JULY 8, 1994 THIS CERTIFIES that the buildin~ ADDITION Location of Propert~ 595 NEW SUFFOLK RD. UoT~HOGUE, N.Y. House NO. street Hamlet County Tax Map No. 1000 Section 102 Block 6 Lot 9 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 2, 1976 pursuant to which Building Permit No. 8999-Z dated DECEMBER 8, 1976 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 ADULT HOME The certificate is issued to JOAN SLEDJESKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Rev. 1/81 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. Submit Planning Board Approval of completed site plan requirements. o 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 Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .... ........................... New Construction ........... Old Ot Pre-existing Building.% ............... Location of Property ...... ~ ~. .~.qf~'A~.~j~..'. no~ House No. Street Hamle 0 Owners of Pr p ty ¢.~ County Tax Map No 1000, Section ..... {~! .... 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 $OUTHOLD BUILDING DEPARTMENT TOWN GLI:RK'S OFFI¢! SOUTHOLD, N. Y. , pr ed i ............. ,97.:5. Pe,mit ........ Disaplbroved a/c ....................... ' ...................... ~ ................., Application No.....(~....~.....~'.Z ............. APPLIGATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter"or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Con~r~$or Name of owner of premises ~.-~.~l~...~.l~.g.~,.~, ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... .~...~. .......................................... Plumber's License No ................................................. Electrician's License No ............................................. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ...................... Street and Number New Suffolk Lane, Cu¢~ho~..e Municipality State existing use and occupancy of premises and Jn,~ended use and occupanc~ of proposed construction: a. Exisiting use and occupancy ~",Jz*e~g ~omi~ b. Intended use and occupancy ..~. ....................... ; ....................................................................................... 3. Nature of work (check which applicable): New Building~. ................. Addition ......~ ......... Alteration ................ Repair .................. Removal ..................Demolition .................... Other Work ................................................ . .... /~--- ~ (Description) 000.00 4. Estimated Cost .......................................................... 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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nmure and extent of each type of use .~.~?...a.~.~..~....~..O..~...~l 7. Dimensions of existing structures, if any: Front J~0e Rear ~'0 e Depth b~0 Height ......... .~. ............ Number of Stories .......... .~.{~.J..(..~.) ...................................................................................... Dimensions of some structure ~with alterations or additions: Front ............. ~..~ ................ Rear .......... ~.~.'. ........... , * ' One Cl.) Depth ....... ~,~..~ .................. Height ......... ,JJ.,...,1,~ ...... Number of Stories ................................ 8. Dimensions of entire new construction: Front ............. ~.~. .................. Rear ......... ~..~..~ ............. Depth ........ Height ...... .1.2.." ....... Number of Stories ..0%~...(,'1~) ................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded ....~.~ .................... Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises~O~.~l'~...~,l~.~J3~,~ ......... Address t~g~f~l~. .......... Phone No. Nome of Architect ...~..~..d.~.?.~'.....~..~...~..~...~. ............................... Address .....C~...~..O.~..o...~...?. ........ Phone i'~ ........................ Name of Contractor ....~a~.a ............................................ ~.. Address ....... $~1~. ............... Phone No .........~.~.e. ...... PLOT DIAGRAM Locate clearly a.nd dist net y alt buildings, whether existing or proposed, and indicate all set-~3ck dimensions from property lines. Give street and block number or description according to deed, and show street names end indicate whether interior or corner lot. STATE OF NEW YORK, ~ S S COUNTY OF .... ~J~l,~'O1..k,... ....... ~ ' .................. ;','""(IOitJl'.t~l[~..~e ............... :;,' ................. being duly sworn, deposes and says that he is the applicam HName otJndlvlaual s~gnlng contract) above named. He is the ............... ~J~l~...JOJ~..~Oi~,~r, Om'. ............................... 7; .............................................................................. ~ontractor, agent, corporate orricer, 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 ti,aT the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... ~t~. day of ..... Ji~b~ .................... , 19...?~, ~ Notary Public, . ............................... ~ll.~.~Ol.~... County (Signature of applicant)