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Home My WebLink About7860-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27189 Date: 07/11/00 THIS CERTIFIES that the building BUSINESS STRUCURE Location of Property: 56340 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 62 SOUTHOLD (STREET) (HAMLET) Block 3 Lot 22.1 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 29, 1975 pursuant to which Building Permit No. 7860-Z dated APRIL 30, 1975 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 REBUILD ~ ENLARGE EXISTING BUSINESS STRUCTURE AS APPLIED FOR. The certificate is issued to ALBERT W ALBERTSON (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 F~RH NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 7860 Z Permission is hereby granted to: ............ ~o~t~!~ ................................................ to r.~ D.u~.:kd...c, .. mr~!q sr. g e...exi $.t ir. g...b .~i Ldf.n~; .......... (.b~&~ ~.~ q..3,..~n...p i.o ~..g:kar~ ~. at premises located at ..~-'.2.~iLq..m~,oaxi..~-.i,o~.xl.%%..L~r~ ................................................................. ....................................................... ~o~ti~l~....~L~v~ .......................................................................... pursuant to application dated ...................... A~.i-q-....~.9. ........... , 19.~..~..., and approved by the Building Inspector. Fee $..~.~,~0 ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This applzcatzon must be filled in by typewrzter OR ink and submittec to the buzld~ng inspector with the following: for new building or new use: i. Final survey of property with accurate locatzon of all buildings, property lines, streets, and unusual natural or topographic features. 2.Final Approval from Health Dept. of water supply and sewerage-d~sposal(S-9 form). 3.Approval of electrical installation from Board of Fire Undervrr~ters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. 5. Commercial bulldzng, industrlal buzldzng, multiple residences and similar bu~ldingE and installations, a certificate of Code Compliance from architect or engineer responsible for the building. ~j-~ 6.Submit Planning Board Approval of completed site plan requirements. ~ B. For existing buildings (prior to April 9, 1957) non-conf uses, or buildings and ':pre-existing" land uses: "~ ~' ' 1. Accurate survey of property showing all property iines~i ~treeq~% ~u~l~ing and unusual natural or topographic features. ~,~. O~ A properly completed application and a consent to inspe~¥~gn~ed ~y~the applicant. If a Certificate of Occupancy is denied, the Building In~pec~ffor shall state 'the reasons therefor in writing to the applicant. ~2 ..... ~ Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, A_Iterations 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~ - $I00.00 3. Copy of Certificate of Occupancy - ~ .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $t5.00, Commercial $15.00 Date .......................... New Construction .... Jz ..... Old Or Pre-existing Building ................. Location of Property .... ............................... House No. Street Hamlet Onwer or Owners of Property...~P~..A~.~PPP .............................................. County Tax Map No 1000, Section..99~:99 ...... Bloc~..PP:P9 ......... Lot..9~:9~l ............ Subdivisio~ .................................... Filed Map ............ Lo t ..................... Permit No...?.g.~.~.~. .... Date Of Permit ................ Applicant ............................ Health Dept. Approval .......................... Underwriters Approval ........................ Planning Board Approval ........................ Request for: Temporary Certificate ........... Fznat Certicate.../ ....... Fee Submitted: $ ............................. .~.~...~..~. ~.~ .~.. :-. ..... ~0~ NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Disapproved a/c ...................... Date ' Cc~ 19 ......... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the BuiJdi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahon of lot and of buddings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed descriphon of layout ofproperty must be drawn on the diagram which is part of this applicatio~ 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 ~ssue a Building Permit to the applicant. Such perm 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 Occupan, 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 tk Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterahons, or for removal or demolition, as herein describer The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t 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 buiJde ................................................................................ .................. ........ ; ...................... ................................... Name of owner of premises ............ ~d~t~. ~.....}~..~. ~...~.... ~'1-. ........... ~ ........... ~ ........................... If apphcant is a corporate, s~gnature 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 ............................................... 1 Location of land on which propqsed work will be done Map No ...................... at No .................. Street and umber ...... ............................... ................ Municipality 2 State existing use and occupancy of ~Dremises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ...~...~..~.....,~.'~"~t'~....~~. ...................................................... b. Intended use and occupancy~...~.....~....J....~...'~.~;t~ ....... ~...~..f7 .................................................... 3 Nature of work (check which applicable) New Building ............ Add~t,on ................ Alteration Repmr ................ Removal ................ Demolmor .............. Other Work ................................................ (Description) 4. Estimated Cost ....................................................... Fee .~/..~'...~ ............................................................... (to be pa~d on f,ling thru application) 5. If dwelling, number of dwelhng units ......................... Number of dwelhng umts on each floor ......................... If garage, number of cars ............................................................................................................................ 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ..................... 7. D~mensions of exmtmg structures, if any' Front ................... Rear ................................ Depth ................. Height ........................ Number of Stones .......................................................................................................... D~mens~ons of same structure with alterations or addmons Front ................................... Rear ..................... Depth ............................ Height .....................Number of Stones ........................... 8 D~mensions of entire new construction Front ....... ~.O. ................... Rear ........ ~Q. ............. Depth ..~. Height .............. Number of Stones . .~ ........................................................................... 9. S~ze of lot Front ...~..~....~..../....7.?. ~.:. ~ .................. Rear ./.~.?~... ~//.,...~ .............. Depth .....~.....~...' ................ 10 Date of Purchase ..................................................... Name of Former Owner /.~'~:~...~.....~.'~.~:~ ............. 1 1 Zone or use district in which premmes are s~tuated . .~.?..f ......................................................................... ,2 Does proposed construct,on v,olate any Tatung law, ord,nance or regular,on .... ~ ................................. 13. Wdl lot be regraded ....... ./..~......O. .......... WHI excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of prem,ses .Z~..L..!~..~.~.7../.~..~....Z..~.~ ....... Address ...~.~,.~.~.~..~ ........Phon~ No ...................... Name of Architect ..................................... Address ................................ Phone No ...................... Name of Contractor ............ ~.~ ............ Address ................................ Phone No ...................... PLOT DIAGRAM I_oc~te clearly and d~stmctly alt butldmgs, whether ex~sting or proposed, and red,cate all set-back dimensions fron property lines Gwe street and block number or description according to deed, and show street names and ind~cat: whether interior or corner lot STATE OF N ~flt~" Z~F~)~. ~-~Z,~t~~SS % COUNTY OF ~.~ ...~ ................. ~--~/~~~ ............................ be,rig duly sworn, deposes and says that he ,s the apphcan (Nar~'e'of individual signing contract) above named. He ,s the ...................................... ..~..??.:..~....~. ................................................................................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fil th~s apphcat~on, that all statements contained ~n th~s apphcot~on are true to the best of his knowledge and behef, an. tha~ the work wdl be performed m the manner set forth m the apphcat~on~ filed there~ith~. Sworn to before me this Z.\ ~ I l "~1 ............ day of ............ ........ , /11[ / Noto Pub,,c,. .............. ........ Coun ................ .......................................... Jt -- , /'~//z~ / L"'(Signatur~of apphcant) ~' - ~ot~-y Pubhc SIgto of .... Cern~ijir~n Exp~re~ March ~0, i~ J j