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Home My WebLink About9976-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. C~RTIFICATE OF OCCUPANCY No Z-25442 Date DECEMBER 19, 1997 THIS CERTIFIES that the building Location of Property. 2105 BAYSHORE ROAD House No. County Tax Map No. 1000 Section 53 Subdivision ADDITION GRKENPORT, N.Y. Block 4 Filed Map No. Street Hamlet Lot ]3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 12, 1978 pursuant to which Building Permit No. 9976-Z dated OCTOBER 12, 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 AS APPLIED FOR. The certificate is issued to JANE SCH~MACHER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Build~g Inspec~ Rev. 1/81 FO~ ~0. ~ TOWN OF SOUTHQLD 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? 9976 Z Permission is hereby granted to: · .~./c ........ ~.~ ....... ~.e~.a...u....~!.~.~..t.!)-.~..!,~ ........ TOWN OF SOUTHOLD BUILDING D EFARTME~NT 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: i. 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 cer=ifying 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 c6mpleted 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 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-e-xisting Buildinm - $t00.00 3. Copy of Certificate of Occupancy - ~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00~ Commercial $15.00 New Construction ........... Old Or Pre-existing Building._/.'~ Location of Property ~ J .~.. ~ .~.~.. ~.~h.... '~.. ~.~.( .~.. I?.'1...IJ:.]: ...... House No. Street Hamlet 0n er or 0=ers of ............................... ooo. ........ ............ .............. S ubdivisio~ [~..(~-. ,~.. ,~. J..~.. J~..~. ~.~ .~... Filed Map ............ Lot ............... .~ ...... .Permit No, .~ .~..~"~. ~ ...... Date Of Permit. [ .~ .~..lZ...~.~..App lican t .~ .~..~-~-~. ~ .~-(~ · '~' ' Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request fo[: Temporary Certificate ........... ~Vin~rticate-.~. ...... ~ee Submit-ed: $ ............................. FO~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .................... ................. App,,eat,on No ............... Approved ................... u.~.~.;, ........... , ~ ........ e mit No. Disapproved a/c ............... ~~ .......................... ............................................... ~ ......... ~'"'7~_,z?~.~ .................. ~.~:......~....v...~~ ....... (Building InspectorY APPLICATION FOR BUILDING PERMIT Date ..../~././..~ .................... 19.2..1~... INSTRUCTIONS a. This application must be completely filled in by typewriter oe 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 ir~ buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................... ~.~.~..~......~,z~...:..~~ ......................................................... Name of owner of premises .......... 3..".......?.~T...~..~...h~...~../.~rf,~ ................................................................................. If ~can, is a cor~por~.~gnotu~of duly/:th~,/z~ ,cer. ....................................~e and title--of ...... '~,e~~officer) Plumber's License No ....... ./~..~.~.~,~... .................... Electrician's License No ...... ..~.../..9./...~.../'.~.,~.. .................. Other Trade's License No ......... .~..f~.J...~[..[?--. ................ ,. ,ocot,on of,and on w~,oposed work wi" Street and Number ..~.....~..~..~.-.~/../~.Z.,.~........~....~.~....r~......~.....L'.....L~..~./ ............ ~-..~,,.,~.,..,~"~,. ..................... .(... ........ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exislting use and occupancy ........ ~...l~,~4~..l~7.,x~..A~Lt'.,..(~.... ................................................................................. b, Intended use and occupancy ........... .~....?.../~./..,.,..p,..~.~....c::,.~.(,~. ......................................................................... 3. Nature of work (check which applicable): New Building'· ................. Addition ............ Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~/~'--~ r..) ~'~ ~ ~ ~ (Description) 4. Estimated Cost ............... x.~¢ ....................................... rea .......................................................................................... (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 nature and extent of each type of use ....... ~ ...... 7. Dimensions of e~isting structures, if any: Front ....... ~..'~.., ......... Rear ......... ..'~...~ ............ Depth .....~J'..~. Height .....~,.~.. ............. Number of Stories ....... .~....~.£~..-z~z.,. ........................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Sto~des ........................................................ ~ .......................................................... 9. Size of lot: Front .................. .~.~.. ............................. Rear ........... ,.~...~... .......... ~Depth .~.,.~.. ~ i0. Date of Purchase ..... /..~.....~.. ...................................... Name of';orm~r O~ner"ii~...i.~.iiii~/.~.';~iill 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... 4~..~...O.. ....................................... 13. Will lot be regraded .....~....O~.~ -- ............. Will excess fill be removed from~__~.~_t~preq~es: ( kYes (~ No 14. Name of Owner of premises ...~..,..~...~?..~.~-~d!, .............. Address .~.,~...~..~Phone No ....................... Name of Architect ..... ~...., .......... ,,~ ..................................... 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. ~,:._~:..~...L~...~.~ .......................................... being duly sworn, deposes and says that he is the applicam ~/ (Name of individual signing contract) ............................................................................................................. (Contractor, 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 app cat on; that all statements contained in this applicat)'on are true to the best of his knowledge and belief; and thor the work w~l be perforv ~d in th~~ f~h in th~pplication filed therewith.