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Home My WebLink About12576-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of OccuPancy No. Z-15367 Date March 18, 1987 THIS CERTIFIES that the building Accessory Shed Location of Property 300 Marion Place East Marion, N.Y. h/d ........................................................ Street Hamlet County Tax Map No. 1000 Section 3 1 .... Block 8 .Lot 12.5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated August 19, 1983 12576 Z ...................... .,. pursuant to which Building Permit No ...................... dated September 6, ! 983 ............................. 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 SHED The certificate is issued to HENRY & DOROTHY ST. GEORGE ..................... ?o¥.'d-, X .................... of the aforesaid building. Suffolk County Department of Health Approval N / A N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FORM[ NO. ~ TOWN OF SOU?HOLD 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? 125~6 Z Permission is hereby granted to: ..~....~....i...~Y~~.;...~.~t ~,....~. ................ ..Z..~......~.~.~'~ ' ...... ~.,~ ?~:~ ........ I ....... ~... at premises located at ,~.~ ............................ County Tax Mop No 1000 Secti ............ Block ........ ~ .......... Lot No....[ ........ ,~. ........ Building Inspector. Fee $.1.....:. .............. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ 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 featu res. 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 New Dwelling $25.00, Accessory ,$t0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date..~.¢.~..2(~.~.~.~'.7 .... NewC°nstruction ...... Old or Pre-existing Building ............ Vacant Land ............. House No, Street Hamlet or Owners of Property .g .... ..... Owner County Tax Map No. 1000 Section .... '~, .I, ........ Block .... ~' ......... Lot.. J.~-, ,t. ~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant..[-~ ~, Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... 9. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no, 12576Z issued to Henry St. 'George on 9/6/83 for Accessory .... is completed a final inspection has ( ) has not ( x' )'"been done. and in order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $lO-OOpayable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with thi~ office for an inspection date Occupancy or nsc is nnlawful wlCllout a Certificate of Occupancy. i'lea~e, help us to clear up t'ht~ m~tter so that legal action does not have to be taken, Thank yon for your prompt attention. Very truly yo~, Victor Leseard Executive Administrator VL:gar encl. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C DE FINAL 'DATE ti COMMENTS ADDITIONAL COMMENTS: , I FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765-1803 Examined....~. ~..~....(q...., 193.~. Approved ..............~.~.'~. ~. , 19'~..~. Permit No.~..~..~.~ .(o..~.. Disapproved a/c ..................................... Received .......... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typew~ter or inink and submitted 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 s{reets or areas, and giving a detailed description of layout of property m:nst 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 ~issi~ed 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 whate'gOr 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 hou~ng code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessaIy-x~s~e.c~i.°ns~'~xA ~ ~--~'X~' at,, ' - '~f ap~ '"~li*d,,ant, o' '~-~; ~me, ifa c~'''-'~''-' ~ ;~) .... , ~x ~addressofapplicant)X "1 ['~ I~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. USv.o ul~ ............................ .................. dk · ~-O f~G~ ............... Name of Owner of premises ~} ?. ' ~r.' ~" .'+' "~' 0'¢ ..... ~' ........................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (N.a.me 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 proposed work will be done..~/~.~..'~(~:R ~..I.0..Kd. ............................ ....~..o..o ............ bs. .a. ?. .~. .o. ~ .... .'¢..c.: ........ g. ~,5. ~. . .~.g.e.~.o. .,,.~ . . . ~. :J... 1! House Number Street Hamlet County Tax Map No. 1000 Section ...-.~..I ............ Block . ..~. .............. Lot .... ! .~..'..~. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy . .'~...~...~. ?..*..~. ~ .... ~ .~...~.!~ .[..~... ~..,.~, .O. [ ~.....(..S.~.C.4 ....... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work ............... ~ (Description) 4. Estimated Cost.. ..... . ....~.~O.....O:..........g'"O .......... Fee.. ................................ . ... : (to be paid on filing this application) 5. If dwelling, number of dwelling t~nits ............... 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 existing structure~, if any: Front ............... Rear,. ............. Depth ............... Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ........... Rear .................. Depth ................... .. i...Heigh,,t . .. .................... ~ Number, of Stories ............ i ......... 8. Dimensions of entire new construction: vront ...... ~o.: ..... Rear .. ~ ........... Depth ... ~ ........... Height ............... Number of Stories ........ _,/.,~_: ~; .... ~ ....... ~ .............................. 9. Size oflot: Front...........,.........,,~O~c 2.00 .,~-l~r ........... ~....~ ....... Depth. ~ ................ ¢,.~5,.._~ , 10. Date of Purchase .... ~o~'[.!,'...Iff.ff..Lw. ....... Name of Former Owner .~,..~.~.~)0 I I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violhte any zoning law, ordinance or regulation , ~ .................... 13. Will lot be regraded ......... ;...0 ............... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ' Address Phone No Name of Architect .., ....... i ................. Address ................... Phone No ................ Nmne of Contractor ......... ~ ................. Address ................... Phone No ................ property lines. Give street and block interior or corner lot. PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing br proposed, and~ indicate all set-back dimensions from umber or description according to deed, and show street names and indicate whether 6'-0. "']D o 15o.5 D STATE 0V NEW ~0-'~RK. , /.~ o o · .. ,~[-,/-~ ..... ,/~,...~-~'. ~.. 'being duly sworn, deposes and says that he is the applicant ,~am~ of inffivl~ual sig~ing contract above named, j He is the .................... ~: ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du~y authorized to perform or have perfo~ed the said work and to m~e and file ~is application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfo~ed in the m~n6r set forth in the application filed therewith. Sworn to before me this .............. ~~.da, o .. , ~ ~ol~?~[ .... ~., .~,. PONL_IG -: ERST ~Ard''~ ' TO'WN OF ,.,w~,, HW~ D KI,,Y, STATEMENT OF INTENT THE WATER SUPPLY AND ~WAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO T~ STANDAR~ ~ THE SUFFOLK CO DEPT OF HEALTH A~LICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OFi CONSTRUCTION ONLY DATE: j, ', APPt~OVED: , ,, ~UFFOLK OB. TAX MAP DESI~AT;~: ~ ': OWNER~ ADD~: 1D A~LE~Y