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Home My WebLink About9902-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19871 Date APRIL 26, 1992 THIS CERTIFIES that the building ADDITION Location of Property 4860 ROCKY POINT ROAD House No. Street County Tax Map No. 1000 Section 21 Block 3 Subdivision Filed Map No. EAST MARION, N.Y. Hamlet Lot 23 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16, 1978 pursuant to which Building Permit No. 9902-Z dated AUGUST 18, 1978 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to KESTUTIS E. ZAPKUS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FOR~ NO. 3 TOWN OF $OUTHO!~D BUILDING DEPARTMENT TOWN CLERK'S OFFicE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIsES'UNTiL FULL COMPLETION OF THE WORK AUTHORIZED) ~ N? 9902 Z Permission is hereby granted to: ........~'- ,-----~,, ~- ~ ~..~z=~:~..~.~.~:~...:..:...,.~:.~ t~ ~. ................... ~ ..............................................................~ ~ ~ ................. ~ ........ .... ·, ,,.,, ..... ,. ............... , ', pursuant to application dated Building Inspector. Fee $....,(.~ ..... 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. 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. C. Fees i. 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 Build~ng - $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 Date... ,~./.. .... .~...~. ...................... New Construction... ~.. ..... Old Or Pre-existing Building ................. Location of Property..~.~..~?..~..~.. ~.... ~..~...~.~. .... .~..~ .......... House No. Street Hamlet Onwer or Owners of Property ........... ~ .............. County Tax Map No 1000, Section .... .~.~ ....... Block., .~.~. ........... Lot..'~..~. ................ Subdivision ................... Filed Map Lot Permit No...~! ~. ..... Date Of Permit..~ ~-I,~./~ .~..Applicant..~.~..~. 5....~..~.~..... t%-~ ~ Health Dept. Approval ......................... . Underwriters Approval .................... ..... Planning Board Approval ..................... .. . Request for: Temporary Certificate ........... Final Certicate..~ ..... Fee Submitted: $ ~ ...................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................... ~.~./....../(...c~,, 0..~......~. Permit No ............. .~0....]~...~-~ Disopproved a/c ...............~.~ ]]].]] ~ (Building Inspector) ^PPLIC^TION FOR BUILDING PERMIT Date ............... .~/..j..~.. .................. , 19.~Zc~..... 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 Iot 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 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 Deportment 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 lows, ordinances, building code, housing code, and regulations, and to adm it authorized on in r~inspectio~/,~_____.,~__ / inspectors premises and buildings fo~,,..../~,~,~ ..... (S'~~, ~'~ ~'~'~'ii~'i ........ State whether applicant is owner, lessee, agent, architect, engineer,~'crh'~~ectrician, plumber or builder. ............. ............................ : ............................. ....... ........ ......... Name of owner of premises ....... ~.~., ....... ~...~J..f..,~ ](-~..~.. ............ .Q .~....~....¢R.~...~...~.. i.h ~...c.i.....~..~..~ .......................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) . r Builder's License No ...................~,~.~/~.~.,....~... ........ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License N~o ............................................... Location of land on which proposed work will be done. Mop No.: ........................................ Lot ~:~_.~ ............... Street and Number ......... ~.~.~:.~__ ........ ....... ~.~.,..: ......... ~...~.~......~.:~]~ ............. ~ ~S~ ~ ~ ~ t/,~ipali~ State existing use and occupancy of premises and imended use and occupancy of proposed construction: a. Exisiting use and occupancy ............... b. Intended use and occupancy ............... ~.~.~./~...~:.~.~.;.~..~ ........ ~.~.~.,.~,..~ ................................ 3. Nature of work (check which applicable): New Building .................. ¢L~,~,LS~,...~,,..~..~,.. Alteration ................ Repair .................. Removal .................. Dernolitior~ .................... Other Work ................................................ (Description) 4. Estimated Cost ........... ~.....O....~....~. ........................... Fee .................... ./'...~.,..~.~ ..................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Nurnber 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 ........ ..,~.....O,. ............... Depth .......~....~ ....... Height ......... I..,~.. ....... Number of Stories .............. .~. .............................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Nurnber of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10; Date of Purchase ....~..:.,.~.:..~..~..r~.,~.....~.~, ........... Name of Former Owner 11. Zone or use district in ~vhich~'~remises are',4situated ...... ..~'... .......................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........ ...J~.~,,l ...................................... 13. Will lot be regraded .....~'.;~ ........... Will excess fill be removed from premises: ( ) Yes ( ~'~ No ! 14. Name of Owner of premises ........ ..~...~. p...~.9...~. .................. Address ................................ Phone 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 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 NEW YORK, l ¢ ¢ ............. , ........ , ......... r . ......... ~..~,...~..,rT.......~.~.g.~..-C.~...c:t..~....~.. .................... ~.... being duly sworn, deposes and says that he is the applicon, (Name of individual signJng~contracO' above named. ~i' ff~, ~0 ,.~ ... ............................................................. He is the ............................................. ~'~ ...... ~ .......................... (Contractor, pgent, 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,, bII statements contained in th s, application are true to the best of his knowledge and belief; and thor 'the work will be performed in the mariner set forth in the application filed therewith. Sworn to be~gre me this ~.~ ~ ~ ~ ............. .~..~...... day of ......... , 19 ........ :" Notary Public, . .............. ~.,~r~.z~z.~_..':z..:~. County .~,../.~<-~~1.(,,4q4~<.,...~.~...~ ....... .,// ............................ · ~' ~ ~-~ / ~'-~(Signature of applic, a~f)J ~ ~ B~tBETTtl C, COI~Oy I~OTARy PUBLIC, State of l%w York Suffolk County Ilo. 52-5792800 Commission tlxplro~. March 30, Iii ffi