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Home My WebLink About15913-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy . Date., 6~us.~ 14, 1987 THIS CERTIFIES that the build~ng Const.r.u. ct new entra..n.c.e..t.o..b.a.s..e.me.nt .. Locatlon of Property 475 Gagens Landing Southold, New York House No. Street Hamlet County Tax Map No. 1000 Section . 070 Block . J 0 ....... Lot.. 3.4 ......... Subdivision. ............ Fried Map No ..... Lot No ............ conforms substantmlly to the Apphcat~on for Building Permit heretofore filed In tins office dated Ap r £ 1 10, 1987 pnrsuant to winch Building Permit No 159 13 z dated Ap r z .1. 16, 1987 was issued, and conforms to all of the requirements of the applicable provlmons of the law. The occupancy for wluch tins certificate is issued is .. CONSTRUCT A NEW ENTRANCE TO BASEMENT OF EXISTING ONE FAMILY DWELLING The certificate is issued to EDWARD & DRAGICA POCINA ·row. e;,~~R ............ of the aforesaid building Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO.. PLUMBERS CERTI[ICATION DATED; N/A N825853 N/A Building Inspector Rev 1/'81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FERMIT (THIS PER~.IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15913 Z Perrmss~on is hereby granted to. ..e..~.....::.~.~ ................... ..... ~.~.~.....~.:~.~....~~ ......... ...... .~..~.~,..~.:.~.,...l..L.~. ..~. ~ ....... ~..~.~~.~..~.,..~, ~,.,..;~...~~.'......~ .................. ot premises located at ..l..~,~,~.,_.~,...c~..~. ,~.~...).....~.~-- -- , ~ County Tax Map No 1000 Section ....... .~..~....~. ...... Block ........ L.~.. ........ Lot No ......~. ........... ' ~. pursuant to application dated ............ .)...~. .................. 19..~....~., and approved by the Building Inspector. Rev. 6/30/80 Building Department Town Hal! p,.oq o,~ T Southold, N.Y, 11971 T_,.._?~/?:~?;'?~.¥ 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions q~;>~"- / ~{~, A. This applicat=on must be filled in typewriter OR mE, and submitted ~ =,=-,,=,--, to the Building lnspac- tot w~th the following; for new buildings or new use. 1. Final survey of property w~th accurate location of all buddings, property hnes, streets, and unusual natural or topographtc features. 2.Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3.Approval of electrical ~nstallat~on from Board of F~re Underwriters. 4. Commermal braidings, Industrial buddings, Multiple Remdences and similar buildings and ~nstalla- tions, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5.Submit Planmng Board approval of completed site plan reqmrements where appllcab~e. B. For existing bu~ drags (prior to April 1957), Non-conforming uses, or buddings and 'pre-ex~sting' land uses: I. Accurate survey of p~operty showing all property lines, streets, buddings and unusual natural or topographm 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 buddings or premises, or other pertinent reforma- tion required to piepare a cerhfmate. C. Fees' 1. Certff~cateofoccdpancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occdpancy on pre-existing dwelhng $ 5 0.0 0 3. Copy of cert~flcat~ of oc~upancy $ 5.00, over 5 years $t0.00 4.Vacant Land,C.O~ $ 20.00 .~ 5.Updated C.O. $ 50.00 Date . .._._.! ............ NewConatrucb~on ..... Old or Pre-existing Bu ddlng ........... Vacant Land ............ Locat~on of PropertYHob~e No. ~'¢2& ~. .~. Street Hamlet Owner or Owners of Property ............. D ' ........... County Tax Map No 1000 Section ............. Block ............... Lot ............... Subdw~s~on ....................... Fded Map No .......... Lot No ............. Permit No../... .7-Date of Permtt .Apphcant ~'..~..'~.q../? ..... .~/./,~.. ¢~ ............. Health Dept Approva{ . t ................ Labor Dept. Approval ........................ Underwriters Approval ................ PIanmng Board Approval ...................... Request for Temporary Certificate ................ Final Certificate ..................... Fee Submitted S ................... Constructmn on above de'scribed budding and permit meets all apphcable codes and regulations. Applicant .. ~.. ~--~ ..................... Rev 10 10 7a ¢ o uosf TOWN OF $OUTIIOI,D OFI'ICI: el'. I',UILDIN(; INSPECTOR P.O. BOX 728 TOWN IIALL SOUTItOLD, N.Y. I 1971 TEL 765-1802 To Whom ITnis May Concern, We lare unable to complete your Certificate of Occupancy because of the following reasons. An ap~51ication ior Certificate of Occupancy is not on No Underwriters Certificate on file, /5/ No llealth Dept. Approval on file. /5/ No ifinal inspection has been made. Please contact our office on this matter. Thallk yQu for your cooperation. Building Permit II ; S ~ ] ~ Z Building Dept. ***/--/ No Plumber Solder Certificate on file. all permits involving plumbing being issued after April 1,1984 ) OU~;DATION ( 1 st ) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]/~JLATION [ ] FRAMING [//] FINAL REMARKS: ~,~*,~ ~.~~ DAT~ r ~ / /~ ~ fl 765-S802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~INAL REMARKS: DATE INSPECTO~~~/~ BLDG DEPT TOWN OF SOUTHOLD FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL . 765-1802 Examined ~ ./. 4., 119 l~ '] Approved (~ . J.k. , 119~ .7 Permit No Disapproved a/c ............ BOARD OF HEALTH ...~-->.. 3 SETS OF PLANS SURVEY .......... CHECK - 0:~-' ..... SEPTIC FORM ............. NOTIFY f MAIL TO. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. T'ms application must b~ completely filled m by typewriter or in mk and submitted to the Bufldmg Inspector, wi, sets of plans, accurate plot plan ko scale Fee according to schedule. b Plot plan showmg location of lot and of buildings on premises, relationship to adjoining premises or pubhc str, or areas, and glvmg a detmled description of layout of property must be drawn on the diagram which is part of this a~ cation. c. The work covered by this application may not be commenced before issuance of Buildmg Permit. d Upon approval of this application, the Building Inspector will issued a Bufldmg Permit to the applicant Such pex shall be kept on the premises avhdable for inspection throughout the work. e. No buildmg shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occupa shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldlng Permit pursuant to Budding Zone Ordinance of th6 Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construchbn of buildings, additions or alterations, or-for removal or demolmon, as hereto desenl The applicant agrees to comply w~th all apphcable laws, or&nances, budding code, housing code, and regulations, ant admit auth°nzed mspect°rs °n premises and m budding f°r necessary Inspect~°ns C~/~ ~ (Signature of apphcant, or name, if a corporation) (NIalhng address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bud Name of owner of premises ~./~/a/~j ~/i~. f~_ ................ (as on the tax roll or latest deed) If apphcant ~s a corporation, signature of duly authorized officer (Name and title of ~orporate officer) ALL CONTRACTOR'S M~flT BE SUFFOLK COUNTY LICENSED Builder's License No .......... Plumber's L~cense No ............ Electrician's License No Other Trade's License No Location of land on Much proposed work will be done llouse Number Street County Tax Map No 1000 Section ~ 0 Subd~ Iston (Name) Hamlet Block ,! 0. Lot ~3 7 Filed Map No Lot State ex~st]ng use and occupancy of premises and ~ntended use and occupancy of proposed constructmn a Existing use and occupancy , .t~ .,f~.~- _ . .. b. Intended use and occupancy ........... 3. Nature of work (check whlch applicable) New Bmldlng .... Addition . {/ Alteration Repair ~Removal .... Demolition ......... Other Wo~,~ ...... 4 Estimated Cost ....... ' ................ Fee ............................ , ~ (to be paid on filing th,s application) 5 If dwelling, number of dwelling u,ruts .......... Number of dwelling units on each floor ......... If garage, number of cars I ............................... 6 If business, commercial or rmxed occupancy, specnfy nature and extent of each type of use ............. 7. Dimensions of existing stru?tures, if any Front ........... Rear ........... Depth ......... Height ........ iNumber of Stones ............................... Dumenslons of same structure with alterations or additions Front .............. Rear .............. Depth ......... ,.. Height ........... Number of Stones ............... -' $. Dimensions of entire new construction Front .. . Rear .......... Depth ......... Height ........ Number of Stones ......................................... 9. Size of lot Front .......... Rear .............. Depth ................ 10 Date of Purchase ........ Name of Former Owner ................... 1 1 Zone or use d~stnct in which premises are situated ..................... 12. Does proposed construction violate any zoning law, ordinance or regulation ........................ 13 W~!l lot be regraded ~ ......... Will excess fill be removed from premises Yes I' 14. Name of Owner of premises .......... Address ............. Phone No ............ Name of Architect ................... Address ............ Phone No. Name of Contractor . i ............ Address ............. Phone No .......... 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~. *If yes, Southold Town Trustees Permmt maybe required. I PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back dn~nenslons fro, property hnes. Give street and block number or description accordmg to deed, and show street names and indicate wheth. interior or corner lot. STATE OF NEW YORK, S S COUNTY OF ........ (Name of individual s~gnmg contract) above named .... being duly sworn, deposes and says that he m the apphcan PUBUC, State ~1 New Y~k 470~, ~uffolk County County (Signature of applicant He is the ..... ~ ............. (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the smd work and to make and file tin application, that all statements contained m thru apphcatton are true to the best of Ins knowledge and behef, and that th work wzli be performed in the manner set forth m the application filed therewith. Sworn to before me this