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Home My WebLink About16200-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. zi6710 Date . March 16, 1988 THIS CERTIFIES th{tt the building .... .C.r.e.e.n..h 9.u.s.e. ................................ Location of Property 35095 Rt. 48 Peconic House No. Street Ham/et County Tax Map No. 1000 Section 069 .Block 04 . .Lot 1. 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .J .u.l.y...1 ,.. 1. 9. .8.7.. pursuant to which Building Permit No .... 1.6. 2..0.0.Z. ........... dated .... J. u..17.. I. 0. ~..1.9. 8..7 .......... 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 ......... Construct greenhous,e as appled for. The certificate is issued to Kevin Knob 1 och ..................... ?o¥.'o;, ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... N. {.A ................................ UNDERWRITERS CERTIFICATE NO ..... Iq/A PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 it"ORAl b~O. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NR 16200 z Permission is hereby granted to: .~..~....,,~..~..t ............................................. ............. at prem,ses' located at .~'~ ............................................. ~.~ c:} ~ ~ ...~.~ .......... ~~ ............................................. /. pursuant to application dated ........... .~ ....................... , 19.~...~.., and appro¥od by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 ' BLDG. D!::: T, / ~T WN OF SOU]'HOI D APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 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 features. 2. Final approval of Healtb 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 inform+ tion required to prepare a certificate. C. Fees: Additions $25 .00 POOLS $25,00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 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 ...!.~.~£~...I.~ ........... New C on s t r uc t ± on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..R)~' ..... ~)~j ..................................................... House No. Street Nam/et Owner or Owners of Property ' 0,q l 7._ County Tax Map No. 1000 Section ............. Block ............. Lot... , ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~'Z.,OC;)... Date of Permit .......... Applicant . . . ¥',4t_t~z.~ o . .'~.v>~l\~.c~.~. ......... Health Dept. Approval ~--. ' . .LaborDept, Approval ................... Underwriters Approval ._.~....,,<~ . .F'lanning Board Approval ........'~ ........... Request for Temporary Certificate ..................... Final Certificate Fee Sub[nitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. .................. d,O. z UNDATION (2nd) UGH FRAME & FLUMBING SULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: ?65-~LSG2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~] FINAL G~/,~P~.r'~,~ REMARKS: ~/~ '~ ~_,0 DATE ~ [ INSPECTOR BLDG. TOWk~ O!,. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY ....~. · ~ TOWN OF SOUTHOLD CHECK -"¢':- ~ -'- BUILDING DEPARTMENT 8EPTI,e FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 ~2~ TEL.: 765-1803 CALL ~("~- ....... MAIL TO: Approved . . I.O.., 19~.'/. Permit No. J..~...~..O~...~ J Disapproved 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 sets of plans, accurate plot plan to scale.~ee according to schedule. b. Plot plan showing location o~'~nd q~ buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed 4af~ip~ -.o~ka~3~t of.,~a~gperty must be drawn on the diagram which is part of this appli- cation. ~,~~7[~,~)~'~,~'.)'~ ~,~"JTt ~"~ c ufldm Prm~t c. Theworkcover~~~~commencedbeforeissu~ eofB ' ' g e '. d. Upon appro~X~~~--~ ,~[~,~g~~ Inspector will issued a Bufld~g Pemit to the app~cant. Such pemit shall be kept o~s~ ~~n throu~out the work. e. No buil~~ [up~ ~hole or in p~t for any purpose whatever until ~ Certificate of Occup~cy shall have been gr~h~ ~ In~h ~PLICATION m ~ ~o~e Bulldog Dep~tment for the issuance of a B~lding Pe~it pursuant tote Building Zone Ordina~] ~ Southold, Suffolk County, New York, ~d other applicable Laws, Ord~ces or Regulations, for the co~/t~l ~)~ld~gs, additions or alterations, or for removal or demolition, as here~ described. The applicant agrees to ~ y with all app~cable laws, ordinances, bufld~g code, houses code, and regulations, and to admit authorized inspecto~h premises and ~ bulldog for necessaw inspections. ... ........ ; ........... (Signature df applicant, or name, if a co potation) ;., .... ........... (Mailing address of applicant) State whether applicant is w~ lessee, agent, architect, engineer, general contractor, electrician, plumbe'r or builder. Name of owner of premises ...~. ~,.<:x,... ~.v3OhlO'.C.~.. ....................... VIt*I $'¢' [¢'~'*'' .I. G ~. ~ (as on the tax roll or l~[~eed~-- '' If applicant is a corporation, signature of duly authorized officer. F~E' ~ ~~BY' ~ ~.L. (Name and title of corporate officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's, License No ....... ~x~' ............... Plumbers ~icense No ......... .kX,~,i,.. ........... NOTIP/ IBOtLDING O[/PARTMEiNT AT 76~,1~2 ~ A~ TO ,~ ~ ~R THE FOLLOWING {N~CTION~: FOB ~)U~O CONCRE'¢E Location of land on which proposed work will be done; ................ ~,?;~6~LO~.LCC~G%~UCT~Q~ .......... .... ..... [ ....................................... House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision .......... ~.~. ....................... Filed Map No. ~..~. ........... Lot...~ ./.°..~... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~...I,fi~..o.'... ~..'5,'~ .................................. .' ............. b. Intended use and occupancy ....~ ..... ~C~.e...~,~-,~.. ~5.~...'T ..... ~.O.,:X:..~.g .... :~i:'.. ................ 3. Nature of work (check which applicable): New Building , . Addition Alteration Repair .............. RemOval .............. Demolition .............. Other Work ............... 4. Estimated Cost ............ %.. ~::~0. 0 ................. Fee ...................................... ' (to be paid on filing this application) 5. If dwelling, number o f dwelling!units ............... Number of dwelling units on each floor ................ If garage, number of cars .... : .................................... :~ ................ · .............. 6. If business;'qo.¢mercml~or ml,xe~d occupancy specify nature and extent of eac e of use ..................... 7. Dimensions of existing structures If any: Front ...... · .......... Rear ...... ~ ......... Depth..", .......... Height · ~ ~ '~ Number of Stories ' ' ' ' ' Dimensions of same st~cture with alterations or additions: Front ................. Rear ................. : Depth Height Number of Stories ' Dimensions of entire new const'uction: Front .......... ' ..... Rear ............... Depth .............. Height ............... Nur tber of Str)ries ................. · .... · ................................... 10. Date of Purchase ............................ Name of Former Owner ............................. 11. Zone or use district in which pr .~mises 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 No 14. Name of Owner of premises ................... Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No ................ Name of Contractor .......................... Address .... ; .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... · If yes, Southold Town Tr~ stees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exist~ng,,gr 'pi6p6~ed, hnd,~hdi,cote all set-back dimensions from property lines. Give street and block number or description a~O3d'~n'g~td'de~,O ,~aild sl~o~it:reet names and indicate whether STATE OF NEW YORK, S.S COUNTY OF .................. ..... , .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... ; ................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............../..~/~. ~ .. day o'f ~ PUBLIC, State of N~w Yolk ' Tm'm Expires fbrch (Signature of applicant)