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Home My WebLink About11797-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19092 Date JUNE 1, 1990. THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 1885 ACKERLY POND LANE House No. Street County Tax Map No. 1000 Section 69 Block 5 Subdivision Filed Map No. SOUTHOLD~ N.Y. Hamlet Lot 5 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 19, 1982 pursuant to which Building Permit No. 11797-Z dated JULY 14~ 1982 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 ACCESSORY STORAGE BUILDING The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 JOSEPH & ALICE CORNELL PENDING - May 30, 1990 N/A ~//t'''~/ildi~Inspect°r TOWN BUILDIN~¢ P,E~I?! (THIS PERMIT MUST BE KEPT ON ~H,E PRE~ 5 COMPL~ION OF THE WOR~ AUTHOR ZED~ ~ 'No. ~?g7 z · nission is hereby granted to: ............. ~.~.~?~. '~ .s'vd ~ri UNTIL qULL · ','"" ........ ; ................................................................ t'"? ....... ~'"~ .... at premises located at ........................ ................. ~....-t ...... ,;' ~'"~ · ~ .............. ~ ............................ ~ .......................... ; ........T'"-~ '" .,;~...~ .......... ~ ............................. ? ............................... ~,.?~ ......... ...?... COU~ Tdx Map No 1000 Section; ............ 2},..,.;~ BI~R ~Ur~u~nt tO ~pp cot on ootOo ........... ;.....)....:.~ ......... Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN I~LL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This appiication'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. B. 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. " 72. A properly completed application and a consent to inspect signed by the applicant. £ ~aasonsCertificatetherefor in of Occupancy is denied, the Building Inspector shall state the k~__~ 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~ Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building ~ $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 ...~w...l~,..199p .... New Construction ........... Old Or Pre-existing Building...X ............. Location of Property..18~ .Ack~.~ly. P~nd. I~ne ....................... . $o~khold ............ House No. Street Hamlet Jose?h and Alice Cornell Onwer or Owners of Property ................................................................. County Tax Map No 1000, Section...9? ......... Block. 5 ...Lot. 5 Subdi$ision ............................... ~ - . Filed Map ............ Lot ....... Of Appli Joseph C. Cornell Permit No ................ Date Permit ................ cant ............ required Health Dept. Approval..~. .................... Underwriters Approval ............... required Planning Board Approval. P~ .................. Request for: Temporary Certificate ........... Final Certica~e...% ....... Fee Submitted: $..~ ~ .0.0. ................. Ifof CA r'. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2e ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL DATE COMMENTS ADDITIONAL COMMENTS: T J 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~L REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ], FINAL,,- REM/ARKS: ~~/~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ...... Disapproved a/c. (Building Inspector) 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 of property must be drawn on the diagram which is part of this appli- cation. 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 permil 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 ora Building Permit pursuant to the 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 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 tc admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .................. ..................................................................... Name of owner of premises. ,Ja, Z ~.'./~1.. ~.'.. ~..~.~. ,d?.~ .{,,,/. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, 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 b~ d~o~)~ ,~/r~ .~..~ ~.~.. d.'~. ?..//4..~..~ ..................... ........................... ..... A ...................................................... House Number Street Hamlet County Ta~ Map No. 1000 Section . ...~..~.'? ......... Block .... ~ ....... Lot ................... Subdivision ..................................... Filed Map No ............... Lot ................ (Name) ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................. ; .................................................. - b Intended use and occupancy :.ff..~.q./~/~.~..~. · /~/' '~'~: ~q(~2~44~ ~ ~.~. 2. Nature ofwork (check which applicable): New Building . .' ........ Addition .......... Alteration ...... ~,~.. Repair .............. Removal .............. Demolition .............. Other Work .... 4 Estimated Cost ........... 5. If dwelling, number of dwelling units .... ~.. If ga ag numberofcars ' o 10. 11. 12. 13. I4. ........ Fee .....\~.\. ............................(Dyscripti~n) (to be paid on filing this application) Number of dwelling units on each floor ~ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... ; ............... Dimensions of existing structuies, if 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; Frbnt ............... Rear ............... Depth . Height ............... Number of Stories .......................................... Size of lot: Front .......... ~ ............ Rear ................... .... Depth ........ Date of Purchase ............................. Name of Former Owner ............... Zone~ 0r use district in which p}emises are situated ....................................... Does proposed construction violate any zoning law, ordinance or regulation: ............................... Will lot be regraded ........ !...~ ................ Will excess fill be removed from premises: ~es , .'.N.c. Narao of Owner of premises ~Y..i¢: ,('O~.~g'.~ ~ ...... Address,~/~.~f~".~.. f..~/g.P. ~/E. ~. Phone No.,~.~.'~.. ~.ff~. 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 whoth,r interior or corner lot. ,/ STATE OF NE~RK.,~ .~ ~ ~ COUNTY O~~.... ~'~ ..... ............ (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the (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 application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... d ............ ,