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Home My WebLink About13592-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. z-15711 Date April 30, 1987 THIS CERTIFIES that the building ...A.e..c.e.s.s. ?.r.y..s..h .e.d. ............................ 470 Second Sr. 6, 2625 Jackson Street, New Suffolk Location of Property h~t~s~ k/ol ....................... ~;~r'e~t' ....................... h~r~t'e~ County Tax Map No. 1000 Section 117 .Block 9 .Lot 26 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 19, 1984 13592Z ..................... pursuant to which Building Permit No ...................... dated.. N ...... ov emb. ..... e r 2..............9, I 984 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 AS APPLIED FOR ANNE POLASNOCK Th~ certificate is issued to ..................... ?o~,,'o'r,'/e~,ggrTt'~,n~X .................... of the aforesaid building. Suffolk County Department of Health Approval N / A N/A UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 13592 Z County Tax Map No. 1000 Section ....... I.~...~. ......... Block ........ ~ .......... Lot No....,,c~.~. .......... pursuant ,o application doted .... /~.~~......J..~. ....... , 19..~.~.., and approved by the Building Inspector. Fee Building Inspector 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 .~ ~ 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 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. Fees: 1. Certif[cate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 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 .......................... NewC°nstruction Old or Pre-existing Building Vacant Land Location of Property ~,~ .z~, '~,, ,, ,,,~--'~,. (.~,),_~,~, 7 t~, ~,, , , ,~,~_.~C~ ..................... ~ ~ · .. Hou~ No. reet ~mlet Owner or Owners of Prope~y ... ' ...... ~ .~ ........ County Tax Map No. 1000 Section .. l ~/~ ......... Block ..... ~, ......... Lot..¢J~i ........... Subdivision ................................. Filed Map No ........... Lot No .............. ' ~]~/~..") Applicant Permit No/~ ~t~."~,,... Date of Permit ..................................... Health Dept. Approval ., .~[~ .................. Labor Dept. Approval .................. ; ..... Underwriters Approval . .. ~J J~'. ..................................... Planning Board Approval . Request for Temporary Certificate ..................... Final Certificate ......................, Fee Submitted $.../.0.,.0.~. r .................. Construction on above described building a/~/e~ perm_ it.~mys ~//~ble_ 7es and ,r_~u lations. Rev. 10-10-78 Applicant ~¢*¢~ '~ ............. CO:i ]5')11 F1EtD ef]$SPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL COMMENTB ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ?,O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no. 13592Z issued to Anne Polashosk on 11/29/84 for Accessory is completed and a final inspection has ( ) has not ( X ) been done. 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 $10.00 payable to the Town of $outhold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. Please help us to clear up this matter so that legal action does not have to be taken. Thank you for your prompt attention. Victor Lessard Executive Administrator VL:gar encI. 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 :~xamined./~.~..~.~-., 19 ~.?. ~,pproved .k).~ .a..q.., 19~.~.. Pe~rnit No./.a.~Y.~ .~. Received ........... ,19... )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 issued a Building Permit to the applicant. Such permit ;hall 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 ;hall 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 3uilding 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. l'be applicant agrees to comply with all applicable laws, ordinances, building code, housiA~g code, an~d regula, t3ons, and to admit auth°rized inspect°rs °n premises and in building f°r necesi~~. ' .~.~..~~ ......... ~e~,,licant ' 5~;~~ (Marling address of app~c~tit) State whether applicant is owner, lessee, agent, architect, engineer, general, contractor, 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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ..................... ~9~ ~/F9 ~',/~ /9 ~._~ Location of land on which proposed work will Im do~3.~. ·....... . i. ' ' . . .............. · .... .................. , ..... House Number Hamlet County Tax Map No. 1000 Section ...' ..... /./. 2 .... Block ........ ~. ........ Lot....':~...~ ...... . ...... Subdivision ................ (iq'a~) ................ Filed Map No ............... Lot ............... 2, State existing use and occupancy of premises and intended use and °c.cu~panqy °f pr°p°sed c°nstructi°n: a. Existing use and occupancy .~ ~¢~.~. · .-~--~- · · · · ... ~. ........ ', .............. ; ........ <77' b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Alteration , Repair Removal Demolition ' Other Work i (D ripti ) 4. Estimated Cost ~. ..... ,'~..t¢~. ......... Fee ~" (to b~ paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars i 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ 7 Dimensions of existing structures if any: Front '>'~"-' Rear ~T. .... Depth Height .... ' .... ·.. f~.~. ..... Number of Stories.. - -~---' . Dimensions of same s.t~ cture with alterations or additions' Front R~r Depth .................. Height ...... ~.TW. ............. Number o'f Stories/ ................... 8. Dimensions of entire new Construction' Front ~-?. · .~.~ Rear ~I~'./.~.- no,,+h ~q r~ r' ' ' Height .......... Number of Stories... ~~. . i ................. 9. Size of lot: Front . ~,~O .............. Rear.. ~, epth ...Y 10. Date of Purchase .............. Nmne of Foimer Owner -J~ffM · ~~ff~... 1 1 Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ...[ ............................. 13. Will lot be regraded ...... ~ ................. Will excess fill be removed from premises Yes N~ fp 14. Nme of Owner o remises .................... Address .............. : .....PhoneNo ................ Nme of Architect Address ' Phone No Nme of Contra~or[~ .......................... Address .............. . .....Phone No ................ PLOT DIAGRAM Locate clearly ~d dist~ctly ~1 bufld~gs, whether existing or proposed, and. i~dicate ~1 set-back d~ensions from property ~nes. Give str~t ~d block number or description accord~g to deed, and sh6w street nines ~ [ indicate wh~ther interior or corner lot.. ...... ~ ....................... ~)~ .................................... ~ ............... ~ ~ vO~LOw~N~ tNSgeCr .vor T~V 1. FOUNDATION . T~SREQUiRED FOR P~[/R~D CONCRETE ~'4 ....... ~ 2. ROUGH _ FRAMING & PLUMBING 3. INSULATION 4, FINAl ' CON'STRI, IC~'ION MUST 8E r'~,~4pI t--T-g FOR C. O. ALL CONqT~t~CTiO~ SHALL MEET THE REOtu~rAqVNTS OF TH~ STATE CONSTRUCTION & ENgRGyN' Y, CODEs. NOT RESPONSIBLE FOR ~ DESIGN O~ CONSTRUCTioN ~R~S' (Name of individual signing contract)t-~t; d h, ":}:" :t~: qg h ' ["I ~ { ~i~} }j/~'~ E1 (Contract6r, agent, corporate officer, etc. >f said owner or owners, ~d is duly authorized to perform or have performed the ~aid work and to m~e and file this pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the cork will be performed in the m~ner set forth in the application filed therewith· ;worn to before me this .... J ~ .day of T ......... 19 : lotaw Public ............... County HELEN 8 []E VO~ " ' · ' ....... NOTARY PUBliC;, Slat0 of New Y0r~ ~ ~ x (Signaturetof applicant) ~0 4707878, &dlolk C rune ~ Term ~p~res Malch 30. 19~S now Or £O. rrn~rly Howard Parker ALS$, ! Pt'ED 150') C KSO/V NOTE .' · -- MONUMENT FOUND 0 = PIPE FOUND [] = MONUMENY SET REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVEEHEA[ ALDEN W, YOUNG SURVEY FOR: JOSEPH POL A$HOCK AT NEW SUFFOLK j GUARANTEED TO: