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Home My WebLink About12442-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22286 Date APRIL 28~ 1993 THIS CERTIFIES that the building Location of Property 900 ROGERS ROAD House No. County Tax Map No. 1000 Section 66 Subdivision kLTERATION SOUTHOLD, NEW YORK Street Hamlet Block 2 Lot 38 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 1983 pursuant to which Building Permit No. 12442-Z dated JULY 26, 1983 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 ALTERATION TO EXTEND LIVING ROOM INTO Fi4ISTING PORCH AREA The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMEN~ OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PATRICIA H. SYMONDS H-034285 - APRIL 12, 1993 Rev. 1/81 · ' I~sp~ctor FOE~ NO. ~ TO~N O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12442 Z Permission is hereby granted to: ........ .............. ........... ....... ,o ....... ~~.~ ...... /-/...~/.~..~. ...... ~.~.F~..._z~/..~...~...~.~ .............. ...... ~ ~, ~,,, ~, ~z~ ............ -~.~.........~4z~.. ~. ~...../Z:... ~ ~ ~. ~z~' at premises located at .........~....~..~ ............ ~..~.4~.....~.~..¢~:1..-~... ........................................ ................................................................................................ ; ............ .~..o..~ .~.~.c~?....~....~ County Tax Mop No. 1000 Section ...~.~/~. ......... Block ....~..~. ........Lot No...~.,~....~... ........ pursuant to application doted ..... ..~..~.~/~/'.~.. ....... ...~.....~.... ............... , 19..'..~..~., and approved by the Building Inspector. Fee $..~......~......~ Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTbIENT TOWN [~LL 765-1802 APPLICATION FOR CERTIFICATE OF~occUPANCY k /~ ~. 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 residencos and similar buildings and installations, a cer~ificate of Code C,~pliance frem archiuect 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-ex~sting" 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 tbe reasons therefor in writing to the applicant. :. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, SwimminS 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 Occuphncy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ........ /. . .................... ew Construction ........... Old Or P~e-existing ~ui~ing.. , ............ House No. U Street Hamlet ~wer or Owners of Property ....... ~. . ~. ~.. ............ mary Tak Map No 1000, Section ......... Block ...... d. · ..... Lot .................. .? · · · ......... Filed Map ..... Lot .............. :rmit No.. . ~ .... Date Of Permit ......... Applicant . t ..... · alth Dept Approval ' · ' .................. ' Underwriters Approval arming Board Approval ............... ~.. quest for: Temporary Certificate ........... Submitted: FORM NO. 6 ,TOWN OF SOUTHOLD · Building Department Town Hall Southoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling q/r land use $/3-/$5.00 3. Copy of certificate of occupancy $1.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ............... ............... b.:. Location of Property .. ?. ,/.~, ....... ~¢~ fl~ . _._.__._ . . Street arelet Owner or Owners of Property ........... County Tax Map No. 1000 Section . .~. ~.-~. ........ Block . .~..~. ......... Lot...~.~...~'. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./f~';P- .~..~.. Date of Permit ..~./.../...Applicant2'6 ~,,~ . ~.~..~:.~..~ ...... Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .. "'~2 ............... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~.. · .'~'. ..................... Construction on above described building and permit meets all applicable codes and Applicant ................. ..~.~r .~.. Rev. 10-10-78 FIE~D INSPECTION 1. FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: OCC ROU,.: - ~] INSU! Aa-!( ~, FINAl- BE CGMPI 7~LL CONS1 [ THE REQUIR STATE CON' CODES. Ix DESIGN OR JCTION SHALl- MEET MEN-I'5 OF THE N. Y, ~-RUCTION & ENERGY RESPONSIBLE FOR )NSTRUCTION ERRORS, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 E×amined. ~X~'..~...., 19 .:..-: ' A~proved Application No.. t/~-'.q.~..~.'. ...... Disapproved a/c ....... .,-: :':'::W~Z-7..-'TL~.. ....... _. ...., .... ..... APPLIGATION 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 fo adjoining premises or public streets or areas, and giving a detai/ed 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 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 in buildings for necessary, inspections..~ (Signature ofoppli r n ~ion) · . l.~.~.:'. ..l.~ .... ~:.. ~.~:~..!~: 7. ~.!.~ " [t (Mailing address of applicant) State whether applicant is owner, 1,~e~, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ .................................................. N~eofowne,'of~ren',-ises ..... .n. .~. ::. . ~./. ~ ( ~. . . . .:. . ~ . . .,.:. .7 .~.~.~'. '. ....................... (as on the tax r611 or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No ..... ~. ?. ................ Plumber's LicenseNo ......................... Electrician's License No ....................... 1. Location of land on which proposed work ~11 be done.. ~ .............................................. , House Number C;unty Tax Map No. 1000 Section ..~.~ ...... ,... Block .... (Name) 2. State existing use and occupancy of premises and intended use a~d occupancy of proposed construction: 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition .......... Alteration . .[~.. i.. Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) Estimate Cost ........................... e .................................... ~ (to be paid on filin~ 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 usd ..................... .... ' ' '?.'r Dimensions of e~lstlng structures, if any: Front ............ Rear ......... :. Depth ........... Height . ~,, ~. '. ........ Number of Sto. ries .... ~ ................................................. Dimensions of same structure With alterations or additions' Front 7 ~. , . Rfear Depth ............... ~.. Height .................. Number of Stories ~ .................... Dimensions of entire new construction: Front Rear ' Del~th !?,eight ............... Number o~LStories ..... ~.. ~ .................... : ,.-.'./-'~ ~. 2~.. :f.] ~7;~. ..... bize of lot: Front .......... id .~ ........ Rear ....~ .............. Depth ...... .,. Date Of Purchase ~ Name of Former Owner Zone or use district ~n which premises are situated ................................. , ..................... Does proposed construction violate any zoning law, ordinance or regulation: .... ,.A~. _~?..:. ............. Will lot be regraded ........ i .............. ~... ~..,Will excess fill be removed~from premises: Yes Name of Owner of premises ./~.~ .72'.~..(<-(.~. .~q.~(..~.a.'~d~ess .... ~'2~/~.. ~.~... Phone No ................ Name of Architect.:: ~..,.~.. :~ -~.'::::::::: Address Address ~ . .77. ~;..~-~q,. ........... Phone No .............. ~.. ~.....~ Name of Contractor .... Phone No. ?. ,~...__~2____ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether, interior or corner lot. ~S, TATE OF N~.~ - l '-/ ff"~--'-%f'~ ' ~ ~ ' says thee ....... ~. , ~.., ~ .- ....... , .............. .... being duly sworn, deposes and 18 the applicant ~ ~q f individual signing contract) above name~ ~ ~ .... ................................................... (Contractor, agent, corporate officer, etc.) of ,said owner or owners, ~d is duly autho~zed to perform or have perfomed the said work and to m~e and ~e this application; that all statements contained ~ this application are true to the best off, ledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ~OT~RY PUBLIC.t6 ~ ~eW VO~ ~ ~ ~ ~ ~ignature ofapp~c~t) ~o. 52-8125850; Suf~lk Co~. /~ ff ~ . // ~ ~ [~ ~ .~/~ ' : .. . 7 . I