The URL can be used to link to this page

Home My WebLink About8617-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27187 Date: 07/12/00 THIS CERTIFIES that the building ADDITION Location of Property: 56340 MAIN RD (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 62 Block 3 Filed Map No. __ Lot No. __ Subdivision SOUTHOLD (HAMLET) Lot 22.1 conforms substantially to the Application for Building Permit heretofore filed in this office dated MAy 28, 1976 pursuant to which Building Permit No. 8617-Z dated JUNE 1, 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 ADDITION ON EXISTING MAIN BUSINESS BUILDING AS APPLIED FOR. The certificate is issued to ALBERT W ALBE~TSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEFARTME~IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8617 Z Date J~e 1 19 76 Permission is hereby granted to: ~z~..e..z.:.t:.~.?.~...~.~...~!~.z. ............................................. Main Road ~ Locust La ~outhald t~ ~uild an addition on exi~tlng main bus.i~ess butlding after removit~ .......... ~.t...s.~.t..~...W~.~.~. ............................................... ~ ....... , ............................................................ at premises located at .~..~.~.~.~.D.....~...O.~..~..~.Q..O.~...[L..~vtf~...., ............................................................ Southold pursuant to application dated .. .............. .... · ...-;..,,.'~r. ';':';;'"~"7'"'28 19.,~,6, .....; and approved by the Building Inspector. F~e ,..~.~:.0...0... TO~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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). 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 i% 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 requireme~>s. B. For existing buildings (prior to April 9, 1957) non-conf~f~n~ u~es, or buildings and ~pre-existing" land uses: ~~ 1. Accurate survey of property showing all property linesl'i'~¥ee~BL ~u~l~ing and unusual natural or topographic features. ~\~, 2. A properly completed application and a conse=t to inspe~'s~g~>~..~by~the If a Certificate of Occupancy is denied, the Building In~pect~o~ ~shall s~Jte the 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-existinK Buildin~ - $100.00 3, Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..gPZY. P~.~ggg ........................... New Construction .... .~. .... Old Or Pre-existing Building ................. Location of Property .... Be f,.Pgg bg! . V..ti Zt ................................ House No. Street Hamlet Onwer Owners of rop y Albert AlbertpoF . . County Tax Map No lO00, Section. 062.00 Block ~:00 Lot ~22:001 Subdivision ................................... Filed Map ............ Lot ...................... Permit No... ....... ~l ~.~......Date Of Permit ............ . . .Applicant ............................. Health Dept. Approval...............-.-....- ..Underwriters Approval. ........................ Planning Board Approval .... Request for: Temporary Certificate ......... Fee Submitted: $ ........................... · Final Certicate..~ ..... PLICAI~ FOBM ~0, 1 TOWN OF SOUTHOLD ~UILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N. Y. ~..~ ........ ~4~-~...~3.~ ..... ~ .... ~ ~/~ z~ ~,~,~.~. No.~.~.~.~.~ ........... ~o~.. ........ ~.:~, ........ , ........ , ,. ........ ~ , . ..................................... ....................................................... ..................... : ........ :, .................. .......................... .................................. 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 or 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 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 cadet and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~ // ............... . ......................... (Address of appllcant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... 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 ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: .......... ./~. ....................... Lot ~qo..:~.~. ................ Street and Number ..... .~r~,,~ .............. ,~..:r¢,~.~........~.....~¢... ....... .-~_.~,~-~,-r). ~.~.. ..................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.~...~--~-~...~ .................. -;. ............................................. b. Intended use and occupancy ............ 10. 11. 12. 13. 14. propert whether Nature of work (check which applicable): New Building'. ................. Addition ...... ~ Alteration ..~ Repair .................. Removal ...~ .... Demolition .................... Other Work .................................................... ~ o ~ ~cr~ (Description) stimated Cost ....................... ............ Fee ............................................. (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 ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, Jf 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 1at: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchese ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from lines. Give street and block number or description according to deed, and show street names and indicate nterior or corner lot. ST/VFE OF NEW YORK, t c c /~,,~ ~ c~ COUNTY OF .... ,~tt ~'O.'1 .~ ........... ................. 7: ........... ';'~:i'..~"¥;'~-~:~.e:~o~o~'iT'~T~.,~' ................ being duly sworn, deposes and says that he is the applicom tmame aT ma~waual s~gnlng contract) above named. He is the ~ontractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work oq/J to make and file this application; that all statements contained in this application are true to the best of his know~dge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /7~ J/~ .......... ........... .................... Notary Public,. .......................... .~.,, ~ f'a.'l .~ ........ County ............... .~/~'.. V.../. ~,ZJ(.//gld~....~:.....J. .................................... ~ ~.~ ----,_-~- , ~(Signoture of dpr~icant) ELIZABETH ANN NEVILLE NOTARY PUBLIC, Slate ol New York No 52*g12585fl, SuffolkCou~U~l~y,ty