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Home My WebLink About10907-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20041 Date JUNE 28~ 1991 THIS CERTIFIES that the building____ Location of Property 2500-20JMAPLE LANE House No. County Tax Map No. 1000 Section 38.01 Subdivision ADDITION GREENPORT~ N.Y. Street Hamlet Block~ 1 Lot 20J Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 7, 1980 ~ursuant to which Building Permit No. 10907-Z dated OCTOBER 7, 1980 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 & ROOF ADDITION ENCLOSED WITH SCREENS The certificate is issued to MARTIN LIEBERMAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL_______~_~ UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A -Building Inspector- Rev. 1/81 SOUTHOLD, BUILDINGi PERi, iT - (THIS PERMIT MUST BE KI~PT ON ~H,E p~,£/~lSi:S UNTIL ULL COMPLETIOiN OF THE WORK AUTHbRIZED) N°. 10907 ~Z flote 19...~ Permission is hereby grafted to: BOX ~3 Build ~eok ~d ~oof enalo~ed w~th' ~o~ens ....................................... ~ ..................................... ....~ ........ ~.. ~ ~. . .. ~ .... ..... : ~ ~o - m~ ~.~ ...~ ..................... o~,o~ ~.~. ~.~ ~....:. . ...................................... ~ .............................. ..~ ........ ....................................... ~ ........................................ C~un~ l~x ~op ~o. ~00 S**tion . B8 .' Sl~g ~ ...... e.~kot ~o ......................... ................... ~ Oe~*B~ ~ ' ~ 19 .... and opproved by the pursuant to application [ dated ............................ Building Inspector. Fee $ .......... ............ IhspeCtor Form No. 6 TOWN OF SOUTIIOLD 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: 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 certifyzng 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 C~pliance from archizect or engineer responsible for the bullding. b.~ 6. Su mzt Planning Board Approval of completed site plan requirements. ,. For existing buildings (prior to Aprzl 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 Build~ng Inspector shall state the reasons therefor in writing to the applicant. ;- Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to d~elling $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-existing Building - $100.00 3.Copy of Certificate of Occupancy - $5.00 over 5 years - $I0o00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ew Construction ........... Old Or Pre-existing ~uilding.. ocation of Property. ~ .~.~.~. - ~ ~- .~.~ ~ House No. Street Hamlet ~wer or Owners of Property ..~.~K<.'~. ~/ ~f~..f~.~/Q/ ,unty Tax Map No I000, Section..3~?~/ .... Block ..... / ........ Lot .... ~:'~.~?....~. ~bdivision .............................. Filed ....... · ' Map Lot ,rmit No. · ...... Date Of Permit ................ Applicant ............... ,alth Dcpt Approval · ' ...................... Underwriters Approval .......... arming Board Approw~l ....... quest for: Temporary Certificate ........... Final Corticate ........... 120J - ' ..... · .................. Al) DITI(2N/AL. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 E×amined ....... :/. . .7, Approved ....... :., mermit.o, .... 0 7,. --Z-----. Disapproved a/c .................................... ~ :~':" '~ z (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.. :().::: ...... Date ................... 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 Budding 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 Budding 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. ........... (Signatur~of applicant, or name, if a corporation) .,--e.. 4:,~.,) .- .~ .././..~..?..~/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name(Jof owner of premises .t~ f4-~t/~...QA~. ~(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 ..................... 1. Location ofland on which proposed work will be done. ~.'L.~,,~.c.,2~'c~- ~e.~-~ ~Z'--rt~Ygc ~ ................... .... ............... ': ..... House Number Street Ham[et County Tax Map No. 1000 Section ....~..~.q .0 ......... Block .... ~..7'..~.O. ....... Lot...~..~. ............ Subdiwsmn (~. -.~...-.~d~.,~.....~.~..-~-~. Lt,' .......... Filed Map No ............... Lot ~ ~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ . .~.~...:. ~ .-n~.... ...................... b. Intended use and occupancy . ~:~....~. ,~.~',M~.,~....-~.4~. ~.~.~./. 3. "N'atCtr¢ of work (check which applicable): New Building .......... Addition .......... Alteration .... -.~.. Repair ' Removal Demolition Other Work .~. t/~ d~ .O ,,/.~.,, (Description) 4. Estimated Cost ................................ Fee ..................................... (to be paid on filing this application) ' &. 5. If dwelling, number of dwelling hnits ............ Number of dwelling units on each floor ................ If garage, number of cars ..... i ................ · .................................................. 6. If business, commercial or mixed occupancy, specify natu, re and extent of each type,of use ..................... 7. D~mensmns o[ ex,sting structures, ~f any: Front... ~ .~...~. ..... Rear .3 ?....~ ....... Depth . ./~. :~.. ........ 8. Dmlens~onsofantirenewconstruct~on:Front Ii- . . Rear../~.. J~e'p'th ~.'~: ....... Height .. / ~ t .. Number of Stories .... ./ ................................................... 10. Date of Purch.ase .... ~t.'/.'7.~jd'~O' .............. ....... Name ;~'o'r~e'r'(~v~;}'. Depth .. 11. Zone or use dlstrict in ffhich~r~mises are situated . Yg/.:-.! .... ~ .. ? 1 2. Does proposed construction violate any zoning law ordinance or regulation: ~'~ 13. Will lot be regraded ............ ~,~,~ ............ Will excess ~11 be.remov~ from premises: Yo, s,~ , No 14. N amc of Owner of premises .~?ff.. ~',',~.~ Address Oq.~. { ,/[. ~.~...~-J2~.. Phone No. ~."(7.'..77,./..~.. Name of Architect .......... ~. ............... Address ..... ~h~. Phone No.. NameofContractor ~/. ~.,,9~-d,~,~ ...Address~l~6°~'~,'~i~,.~,";. PhoneNo ~'~'-'~'/-'~'~>"' 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 humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW !~RK, / /y ,~ S S ........ ~ ...... Y-,,.,4 ........ l,'~. being duly sworn, deposes and (Na/ne of individual signing contract) above named. He is the ..................... says that he is the applicant ntractor,~ent, corporate officer, etc.) authorized to perform or have performed the said work and to make and file this :ined in this application are true to the best of his knowledge and belief; and that the of said owner or owners, and is du applicqtion; that all statements cont; work will be performed in the manne'r set forth in the application filed therewith. Sworn to before me this ......... ~ ......... day of, .... -..., 19J2Z.D Notarv~ublic, ......... ~ ..... ,' County i ,EW t '" ' "'"'2. ' ' ' ' ' .............. N~ie'F~'~}~¥^,~ ~/ (Signature of applicant) i .' 5228125850. Suffolk; ,merm r. xp)res March 30,