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Home My WebLink About15767-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22057 Date DECEMBER 23, 1994 THIS CERTIFIES that the building. Location of Property 8200 MAIN ROAD House No. County Tax Map No. 1000 Section 31 Subdivision ACCESSORY EAST MARION~ N.Y. Street Hamlet Block 7 Lot 1 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 12, 1987 pursuant to which Building Permit No. 15767-Z dated MARCH 16, 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 ACCESSORY SHED IN REAR YARD AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JAMES & JOAN ROGERS Rev. 1/81 ~'0~1~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15767 Z Permission is hereby granted t~ ~ ......... ...'. .............................. ........ ~""~r~'"'"".:' ............... ~'._^ ,~l ,~-- ._.. ,. ................ : ................... ': ................................... ~' ..................... o, premises lOC' v cited cit ...~7...~...~'.....~. ........ ~.~...~...~...........~:~...........*~:....~...~:.......~...~.~.~.):...~..:..~ .... J County Tax Map No. 1000 Section ..... ..~.....~..} ...... Block ...... ..~....~. ........ Lot No......~...~ ............. pursuant to application dated ......~.~.~...~...%~.. ................... , 19.~....~.., and approved by the Building Inspector. Fee $..~.~.....:...~ Building Inspector Rev. 6/30/80 " DEC 2 21992 ' :' Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 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). 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. For existing buildings (prior to April 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 Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions {o 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4.. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . New Construction Old Or Pre-existing Building ................. Location of Property..,~.'~ ¢~..~J~--,.: ..... ~ ..... House No. Street Hamlet p~ ty Onwer or Owners of Pro r .................. County Tax Map No 1000, Section....~..~ ...... Block ..... P[~ ........ Lot .... Z2.f .............. Subdivision .................................... Filed Map ........... . Lot. ..................... Permit No .... ~. ~..~.~..~.Date Of Permit..~.~f~/~.Z...Applicant .......................... Health Dept. Approval .......................... ~ Underwriters Approval ......................... Planning Board Approval ......................... Request for: Temporary Certificate ........ ...· Final Certicate ........... Fee Submitted: $''~'~' ................. ;'i' '? 0.,4.o. q532. ................... CO ~ o~0,5'7 / APPLICANT OUNDATION ( ls t) OUNDATION (2nd) OUGH FRAME & PLUMBING . ADDITIONAL COMMENTS: ~NSULATION PER N. Y. STkTE ENERGY CODE FI:JAL 765-~.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGN PLBG.~ FOUNDATION 2ND [ ,] . · ION FRAMING [~/FINAL DATE ~////~Z-~ INSPECTO~~-~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,; 765-1802 BI.DO. DEPT. TOVVN OF SOUI'HOLD ..... I ..... ,',' i ' ' <3b; : Al~oroved . M I:~¢ .~. ........ ,19.., ~e~t ~o.,. ,. ~ ........ ....................... },,: 5:q ~ :~ ~ ~; .'...~.~. ~ ...... -. ~(Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19... Date ................... 19... INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter or in ink and submitted 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 tins application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wilt issued 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 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 regu!ations, and to admit authorized inspectors on premises and in building for necessary in.~ ~ (Sfgnature of applic/cht, or name, if a corporation) .. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. of premises .... Name of owner '/~'~'~'' ...... ('a;~i ;; i~t;;t' fi;;a') ......................... 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 ...................... I. Location of land on which proposed work will be done .................................................. .... ................ ............. ......... ftouse Number Street Hamlet County Tax Map No. 1000 Section ... ?7./. ........... Block ..... 7 ........... Lot ..... /t. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy . Repair f (Description) 4. Estimated Cost ..................................... Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number of dwellil~uCli~[~n each floor ............... If garage, number of cars .... - .~-~&~[~..~.~.. 6. If busaness, commercml or maxe¢ occupancy, specify na~l~e~o'~each t.vl~a 7. Dimensions of existin structures ifanv' Front . ..,~...~v--~l~a~ ~l~,~.~'~N~'~l~,,,h Height Number of Stories . ~ %.(~..L.~.~ .~.~.~ Dimensions same structure with alterations or ..,~.,. ~.. [3.~,,~,~I[.~.~ 1184~ .' ............. Depth .................... I.. Height ............ ~1 t'~f~ b~ff'~S['drie s ...................... 8. Dimensions of entire new const/uction: Front ......... ,~1~ ~ .~.~1 l~e~a; ...,~,~.~..~... Depth ........... 9. Size oflot: Front . ..i ........... Rear ~[..~.*q..% Depth ......... 10. [)ate of Purchase ........... .................. Name of Former Owner .................... 11. Zone or use dastnct an whach pr~m~ses are satuated ..................................................... 12. Does proposed construction vio!ate any zoning law, ordinance or regulationi ................................ 13. e~'''" Yes ,--N° Will lot be regraded ........ ~ .....// ............. Will excess fill be ~moved from premises: 14. Name of Owner of premises . ~0 .~....~ .... Address .... ~r~. '.~....oOt~. Phone No..c~.~...~.O.4.z'. Name of Architect .......... ~i ................. ~ Address ................... Phone No ................ Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, an& indicate all set-back dimensions from proparty lines. Give street and block number or description ac~cg..rding to deed, and show street names and indicate whether interior or corner lot. ' STATE OF NEW YORK, COUNTY OF ................. S.S (Name of individual signihg contract) above named. ~ being duly sworn, deposes and says that he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said own'er 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 manne~ set forth in the application filed therewith. Sworn to before me this ........... (~. .......... day of ............... 19.. NOT'ARY rUOtlC' "~U"' °f N*w'Y~ // (Sig~{ature of applicant) no. 47078'18 Suuolk Term £xoire,q Match 30