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Home My WebLink About10427-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22325 Date MAY 13~ 1993 THIS CERTIFIES that the building. NEW DWELLING Location of Property 225 FIFTH STREET LAUREL, N.Y. . House No. Street Hamlet County Tax Map No. 1000 Section 126 Block 7 Lot 5.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permi% heretofore filed in this office dated OCTOBER 3, 1979 pursuant to which Building Permit No. 10427-Z dated OCTOBER 5~ 1979 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 ONE FAMILY DWELL/NG WITH ATTACHED GARAGE The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDER%~RITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED WILLIAM F. & RITA STEWART 9-SO-94 - JANUARY 28~ 1980 N-462653 - JANUARY 7, 1980 Building ~nspe6tor ' - ~ Rev. 1/81 FOI~M NO. ~ TOWN OF SOUTHOLD 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? 10~27 Z Permission is hereby granted to: / . : . ~...~...~:..~ .............. ...... ...................... p...an, ,o ap,,i.a,io, da,ed .... .~_~,~'~,.....~ ................... . ,,f..~.. and ep,,oved by ,~.e Building Inspector, ~uilding nspec or Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for n~w 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, buildimg 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, Aceessory building $25.00, 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 New Construction .... ~ .... Old Or Pre-existing Building ....... .~. ..... {.'~ ' '' Location of Property,..~.~.~. .......... ~..~ ........... House No. Street Hamlet )nwer or Owners of Property .............................................................. :ounty Tax Map No ~000, Section. .Block.. .. ~ubdivision ..................... Filed Map lanning Board Approval ........................ ~quest for: Temporary Certificate ........... Final Certicat ~e Submitted: $. A~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate O[ Occupancy TEMPORARY No .....Z985B ....... Date..January..~1 ................... 19.80 THIS CERTIFIES that the building ................................................ Location of Property .,... 2 .b.,5..FJ.f.%h. S~..ee~; ............................ L6~..~% ,. N ~¥, House No. Street Hamlet County Tax Map No. 1000 Section ...126 ...... Block .... 7. .......... Lot...~/.o. ~ Subdivision. G....I,. ~/u~cht~L]. .............. Filed Map No .... 86.'l..Lot No .... ~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .O.c~;ob.e.17.. ~ ..... , 19 79. pursuant to which Building Permit No .... ~ .0./~.2.7. Z. ........... dated ...0ctobex'..5 .............. 1979., 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 ......... ................ P~.iva.~.e .One..F.a~.~l,y.. D~.e. lllng ............................... The certificate is issued to ........ .W. tlliara. F~..Sgo.w. al?'l; ............................. (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval .. 9.~.81~.-9./~....'1./28/B0.. Ft....g...~.illa .... UNDERWRITERS CERTIFICATE NO .......... lxI .46265~ .............................. Rev 4/79 loq " Z ~i i,..t/% ! .... Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be figled 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. 2o 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. 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. Certificate of Occupancy on Pre-existing Building - $100.00 Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 3. 4. 5. New Construction ........... Old Or Pre-existing Building ................. Location of Property ......................................................................... House No. Street Hamlet )nwer or Owners of Property .................................................................. ]ounty Tax Map No 1000, Section .............. Block ................ Lot ...................... ;ubdivision .................................... Filed Map ............ Lot ...................... 'ermit No ................ Date Of Permit ................ Applicant ............................. lealth Dept. Approval .......................... Underwriters Approval ......................... lanning Board Approval ........................ equest for: Temporary Certificate ........... Final Certicate ........... se Submitted: $ ........................... APPLICANT TOV/N OF SOUTHOLD ' OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-18O2 Date Building Permit No. Owner Pl um~ber I certmfy that the solder used in the COntains less than 2/10 of 1% lead. water supply sysfiem S. worn to before me -______day of 19 ~;Otary Public, this County (plumber's signature; ' - Notary Public-- FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ...~..~...~/~..~... //- New Building... ?~..'~-'~. ·... Old or,Pre-existing Building ............ ~aCant Land ........ ~ .... Location of Prope;~ ........... ~ ~..,~. ~ ............ ~~e; House No. ~ Street ~ o, ....... .............. ~o~~o.~00o~j~y .... ~.~'. ..... ~,o~ ...... 7. ...... ~o~.~~.~2. Subd,vision.. ~,.~.'J ..... ~ ........... Fded Map No..~'~ .... Lot No. ~. ....... ~, . Permit No.~ ¢~ ~Date of P~mit~;~.~Applicant .... ~..~~~.~(~//~ Health Dept. Approval ...~.~.. .... z.~ ~z.~..Labor Dept. Approval Unde~riters Approval .~.~/~--.~.~.~.,lannin, Board ~,,rov,I ...................... ~equ~st ~or Tem¢orar~ Gertifieat, ..................... Final G~rtifieat* ....................... Fee Submitted $ ............................. Construction on above described building and permit m~eets all appl~cabl~-x~odes ancJ regulations. Applicant ...... ~./..~..~ ,~r..' ~ ~.~.~, .-'~.. ~.~ ................... Rev. 10-10-7S FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765~1802 19~..'~Permit No./'.(?.~.2.7 ~r~ Disapproved a/c ..... ~ .................... ./ ~ APPLICATION FOR BUILDING PERMIT Application No ................ Date ................... 1 . 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 apphcant. 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 necessa~ inspections. ~ A ......... (Signature of applicant, or name, ff a corporation) (Mailing address of applicant) State wh;~er applic~e~, agent, architect,)~~ontractor, electrician, plumber or builder. .......... ........... , ....................................... ....................................... (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 Plumbers' L~cense' No../~.. . Electrician's License No. House Number Hamlet County Tax Map I~o. 1000 S.e~on /,'~'~/ Block . .. :7 ........ ~ ..... Lot..~..t[~.y'.'~....~... Subdivision..~?.'.~.~'~.~~.'.i }}}~}~FiledMapNo..~/' ...... Lot.~ ........... (N~e) 2. State ex~st~ng use and occupancy of~em~ses ~d ~ntended ecupancy of proposed construction: 3. Nature of work (check which applicable): New Building .... .~. ·.. Addition .... ..... Alteration .......... Repair .............. Removal ............. Demolition ............. Other Work ............... 4. Estimated Cost ......... ~,x...~ ....................... Fee .. ti ..~: ~ ............................. (to be paid on filing this application) 5. If dwellihg, number of dwelling u~it~.... ~... Number of dwelling units on each floor ................ If garage~, number of cars ....~..~. .......................................................... 6. If business, commercial or mixed bccupancy, specify nature and extant of each type of use ..................... 7. Dimensions of existing structures,; if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. I · Depth ..................... ;. Height ....... ~.,.. ;, ..........Numbfr of Stories ................ ~.. 8. Dimensions ?f entire new construction: Front... ~..7. r. i i D th .~ ........ Height ...~.~. ......... Number of Stories ........ ~.~..,_~.R.~a. Z:~.':::::::..o.P..................'~ ' ' 9. Size of lot: Front g..,-~.O._ ! ..... Rear. /,~'~0. ........... ~l~.o~'~. ~ .... ~-~ ........ 10. Date of Purchase ...... q/~ ~./~..? ........... ~I~mex. qfFormer Owner .~ll~.~Z~.~-. 11. Zone or, use district in which premises are situated... ~.. gAC~ .: ........................... .~ ........... 12. Does proposed construction violate any zoning law, ordinance or regulation: . .'~':la'~ .......................... 13. Will lot be regraded .~ .... I..,..,~,ff-.,..~-4-~. · · Will excess fili_~emoyed from premises: _ ~ NO 14. Name of Owner of pre~lqlses- (-~.~../~. ~4t/~... Address .~. ~~ ..... Phone No.~:/.~..~.. · 'Z~_: ~ (~ N,,tme of Architect ....~.,..~. ~:UAddress ... ~gq~..~r~one No.7~,5-,, ,J~42~.5-.~ N,une of Contractort~ .~ ......... Address ................... Phone No ...... . .......... PLOT DIAGRAM Locate dearly and distinctly all )uildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block n umber or description according to deed, and show street names and indicate whether interior or corner lot. " ,,. ,, STATE OF NEW YQRK, . COUNTY ...... S' -m ...... .od. t4&t,~.,~ .... ~.,.... ~.~..~ ~...~.~,. ......... being duly sworn, deposes and says that he is the applicant . (Name of individual sig~ing contract) above named. I He is the ............. ....... , ...................... :. .............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfumed the said work and to m~e and file ~is application; that all statements contained ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfumed in the m~ner set forth ~ the application filed therewith. Swum to before me this .~ ..... . .... ~.} ........ day0f ...... ...~.~.2. i~a~ Public, ................ ..... ' ~.~ County~~~~ ~ - NOTARY PUBLIC, State 0t New Yor~ ~ ........... ~ ~ No. 52'4524771 ~ (Signature of applic~t) ll' ~' QUa fad in ~uttotk County I ,mls'l°n ~pIres M'rch ~' 1' ,) ,? SI-ATE., THE WATER SYSTEMS FOR CONFORM TO su~FoL~×~; SUFFOLK ' CONSTRUCFION~ DATE H. S. ~EF NO APPROVED SUFFOLK CO DIST. OWNERSADDRE~.. DEED L .:. ,t