The URL can be used to link to this page

Home My WebLink About16654-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23234 Date SEPTEMBER 19, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 525 WILLOW TERRACE LANE ORIENT, NY House No. Street Hamlet County Tax Map NO. 1000 Section 26 Block 2 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 27, 1987 pursuant to which Building Permit No. 16654-Z dated NOVEMBER 27, 1987 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 AN AGRICULTURAL ACCESSORY STRUCTURE AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED NANCY R. DOUGLASS N/A N/A N/A Rev. 1/81 FORM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted ?: ~ ~ (I ~.~ ....... ~...0.~....~... ..... · .~.~ ...... ~.~H..: ....... )..I..~..~...1 ............ ,o .~~..~..~~....~.~.~....~~.......~. ....... ~e~....~.:......_......~ ............... ; ............. ~ ............................ ;..: ~.t prem,ses located at .~.. ....L~. ~.... ~.......c:~,.........~....~. ............................ County Tox Map No. 1000 Section ...~J~..~ ....... Block ..... ..~)..,e~m ...... Lot No ...... J../~ ............ pursuant to application dated ...~.~.~f~........~...~. ....... , 19..~...~.., and approved by the Building Inspector. Fee *..~.:....~ Building Inspector Rev. 6130/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOI~N I~LL 765-1802 APPLICATION FOIl CERTIFICATE OF OCCUPANCY Ao 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 lihes, 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-exlstzng 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. C. Fees i. 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. 2. Certificate of Occupancy on Pre-existing Buildinm - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5, T~mporary Certificate of Occupancy - Residential $15.00, Commercial ~15.00 Date ~..Z~ ~./~. ~ ' New Construction ........... Old Or Pre-existing Buildin ..... Lo ation of House No. Street Hamlet Onwer or Owners of Property..~t~:~7~.~/~...~Z),..-~.~. ~.Z~ ................................. County T~ Map No 1000, Section..~ ......... Block ..... ~ .Lot... /~ ...... Subdivision .................................. Filed Map ............ Lot ...................... Permit No.~.~..~...Date Of Pe~it.~Z. .... Applicant~...~. Iealth Dept. Approval .......... ................ Underwriters Approval ................... ~lanning Board Approval .................... [equest for: Temporary Certificate ........... Final Certicate...~ ...... ee Submitted: $ ......................... FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENEROY CODE FINAL - ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. J0.~ .&.~, 19~..~ Approved J0.~..~'.'1., 19~-/.. Permit No. ).(P.(~ .~..~...~ BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MA~L Disapproved a/c ............................... ...../- ) . (Building Inspector) APPLICATION FOR BUILDING PERMIT a. This application sets of plans, accuraj~t~'~' b. Plot plan sh~, ~ or areas and giving a d~e~ cation. c. The work covet%"d d. Upon approval shall be kept on the prerrtt, e. No building shall shall have been granted by~ . I%~ INSTRUCTIONS k~t~e, tetl/,{ilit~ ~¥'ty_p,~l~iter or in ink and submitted to the Building Inspector, with 3 ,,c~ ~ ~ ~n premises, relationship to adjoining premises or pubic streets }d~rgj ,~ ~ property must be drawn on the diagram which is pa~ of this appli- ~, :tio~ i[~ be commenced before issu~ce of Bu~d~g Permit. [~a~ ~ ~i~g Inspector will issued a Buitd~g Pemit to the app~c~t. Such pemit av~['~ ~s~ection throughout ~e work. ~c~: used in whole or in p~ for any purpose whatever until ~ Certificate of Occup~cy 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 building for necessary }n, spec~tions ~,,'fi-~ ,~., (Signature of appd~ant, or name, j3~a corporation) · ' ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....~4'. ~ ...................: ............................. ":t 't ?.r: :'"Y. :7:'. 7.~.: :'y... v Name of owner of premises .'~..~.~,*~"~, .~.~ ~.~. ~-7.~.!'55:. ~]'.. [.,' .~T..'~..'7.~.' .-- (as on the tax roll or If appl'~/9~l*r~ofat~n, signat~e of duly/~thorized officer. · t~ / (Name an04itle of corpor~/e officer) . ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No... ~. .................. Other Trade's License No ........... t'~;:;.~r; -' ', :3%~ .~'* h ~3C~ '~ !~[IOfl$. 1. Location of land on which propos~ ~vork will be~~.~~ ~ ..... ..... ..... ...... ~ouse Number 0 Street Ha~et County Tax Map No. 1000 Section ...... .~.&~ ..... Block .... ~ ~J ........ Lot..~.~. .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intend~se apoccupancy of proposed construction: a. Existing use and occopancy ....... . .~__/~b~4~.~ ................ ~ ....................... b. Intended use and occupancy ..... ~ ~.~~.~.. ~.~.~ ~..~ ~ +./~ r.~ ..... I 3. Nature of work (check which applicable): New Building .... Addition. ~ ......... Alteration .~ ......... Repair .... Removal Demolition I Other Work ~ .,~,~.~. ~. ~.~. ~. (Descrip~tion) 4. Estimated Cost , '~ ~} 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 ...... 1 Depth Height ............... Number of Stories ........................... ........ 1 ..................... Dimensions of same structure with alterations or additions: Front ........... i ...... Rear .................. Depth .......... Height ............ Number o.f Stories ............. ,.. .... 8.Dimensions of entire new construction: Front . . ,,~..~...~, ..... Rear . ~ ...~.: ........ Depth ..~'.. ~..~ ...... Height ./.t~...',~.,P..~... Number of Stories ...... ~/.~ .......... ! ............................. 9. Sizeoflot: Front ..... ,.~..~. ~.~ ......... Rear ..... ,~,/~. ¢Q...' .......... i Del~th ...~?. f...j ..... 1 0. Date of Purchase .../...~.,,~'..~". ................ Name of Former Owner .~o~-~....~. ,,..'~...~. 11. Zone or use district in which premises are situated /~[..'-r../~. .... I~,~.. 12. Does proposed construction violate.~an~zCning law, o~nance or regulation: ... '.. '13. Will lot be regraded Z~.~.~. i Will excess, fill be r,r,i~ov~d from premises: ' ~ No 14. Name of Owner of premise~l/~,,;~-~ ~4~oev4Address ~~.. Phone No.,.~'.~,.~.--~,,,,~'.~./. Name of Architect ........ ~.. · .z.. :,~ ........... Address .... K:~.~. :.. Phone No ...... .. ........ Name of Contractor ...,,.~~--... . Address .... : ......... 15. Is this property located wi~fhin 300 feet of a tidal wetland? *Y~s ~.. · If yes, Southold Town Trustees Permit maybe required. PLO'T DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ifidicate all set~b~ck dimensions from property lines. Give street and block number or description according to deed, and sho~w street names and indicate whether interior or corner lot. STATE 0-~ ~-I~ ¥-{J)~K, - --- .... ~(Name '~~ ......... being duly sworn, dep, ~ses and says that he is the applicant above name i He is the of said owner or owne~, ~d is duly authored to perform or have performed the s~aid work and to m~e ~d file this application; that ail statements contained ~ thi~ application are true to the best of hi~ knowledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this * i MhRY ANN C~BUL8[~ N~IR~ PUBLIC, State 01 ..... ~ ............ day of..~~ ..... , 19~7 ~ ~%g ~'~0%°uat~ umc st ,, ........ ' '