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HomeMy WebLinkAbout15831-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17211 Date AUGUST 19, 1988 THIS CERTIFIES that the building Location of Property. 1070 ELIJAH'S LANE House No. Street County Tax Map No. 1000 Section 108 Block 03 subdivision GREENBRIAR ACRES Filed Map No. ACCESSORY MATTITUCK Hamlet Lot 5.10 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 26, 1987 pursuant to which Building Permit No. 15831Z dated MARCH 31, 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 MOVE AND SET IN PLACE AN ACCESSORY BUILDING. The certificate is issued to FRANK C. & NANCY A TODRICK JR. (owner, }~Q{~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 TOWN OF $0UTFIOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15831~ Z Permission is hereby granted to: ............ .:: .............. k;. I lC/.~ ~ . at premises located at ...J,,....~..,~......~D,~....~,,.,~ ........ ~.~ ........... County Tax Map No, 1000 Section ..... /..,.~,,,~ ......... Block ...... ..(~......~,. ...... Lot No. ~/ ~ pursuant to application dated ..... ...,..~...~. ...................... 19.....-..., / Building Inspector. Fee ~.~,~... ................ and approved by the Rev. 6/30/80 BLOG. TOWN OF SOUTHOLD FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 Health Dept. of water supply and sewerage disposal-IS-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 informa- tion requ'red to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling.$25700, Accessory,.SI0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, ove~ 5 year~ $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 ~ Date ..~.~.k~..l.~.d..!?..~.~. .... New Cons t~uc t ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property I.~..~% (~C~ 5 (~--1 ~ ~¢~21 ('yh ~:~TT-~--"i~F-b~©L House No, Street Hamlet Owner or Owners of Property .. ~..Qr./~..': '.k~.'~.L. ..... .~. ,....~;O~ .~,').i~.~ .c,5.~...~-~ .... ~----~ 1L/©[U,]. .......... Block .......... Lot ........... County Tax Map No 1000 Section . . , Subdivision..~ .~k~.-.~.~..~..~.~.\..C3.%. :~..C~.-k7% .... Filed Map No ........... Lot No.-t.~. Permit No.'.~-.~, .~,, ,~... Date of Permit '-~[~)JI~,?.Applicant .~.~, ,~,~...C; .~.~).]~?,O, .~o Health Dept. Approval ........................ Labor Dept. Approval ............... .................... Planning Board Approval . 'i ................ Underwriters Approval .... Request for Temporary Cer]:ificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes ~nd regulations. Applicant ..... ~. ................. OU~;DATIO~ ( 1 z t ] OUI~DATtON ( 9nd 1 OUGH FRAME & PLUMBING '~USULATION PER N. Y. STATE ENERGY CODE FINAL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. 1 SURVEY TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y, 119'71 CALL ................ TEL.: 765-1803 Examined. %.~..~1;.., 19 .~.Q. Approved..~...~..~.$.., 19 .~.r{ Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT MAIL TO: Date .O).~...~.c~.t ·., 19~.0. 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. 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 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 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' ~omply with all applicable laws, ordinances, building code, housing code, and regulations, and to. admit authorized inspect0~ on premises and iv. building for necessary inspections. ~ ................ (Signature of applicant, or nan,, if a corporation) ....................... (Mailing address of applicant) State whether applicant is~ owner, lessee, agent, architect, engineer, g~neral contractor, electrician, plumber or builder. ... o.a .................................................................... Name of owner of premises ....~.e-..6~..% .C._:...~.eD., ..~. ai°.q-.~., tx~...i~ .'70.~ ¢,~.~k~....3 .lC ................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - , ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED ]tu3~ier s'Llcense No .......................... . Plumber's License No ......................... Electrician's License No ....................... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .................................................. · I .o..q.O ............. ............... ................... House Number Street Hamlet County Tax Map No. 1000 Section ...... 2.0..~. ...... Block ...... .~..~ ....... Lot . .~*../.~....: ...... Subdivision .~. g.~lcT, r,} .~tLt av~.. tqc,~ ~E5 ............ Filed Map No ............... Lot (Name) 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .LID.. ~...~,..~./~¢-~.6.L.~..'7... ~.lOl~.%.O:¢i~.,O..'7...~.~.~. O.({ Cc b. Intended use and occupancy .O.Cdet:'cb.~.~.~....~.M3.~... ~.~.*.. L/~ .[0.D..{~'~.ll.l~.. ~/~0.tt,~/?./.o.OAD...0fl.~ .~..~.~ 3. Nature ofwqr~ (check£ which applicable): New Building ..... ' ..... Addition .... i'. ..... Alteration,]./ ......... Repair ....u,. ......... Removal .............. Demolition ............. . Other Work ....~! ..... ' ...... 4. Estimated Cost....~.c~..~P. ·© ......................... Fee (2-~' .r~.e'~..t. .. .... .~. ..... .~ ............. (to be 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, sp~cify nature and extent of each type of use .......... , : . . ~ ...... 7. Dimensions of existing structures, if any: Front ............... Rear ......... : ..... Depth ............... Height ............... Number of Stories .............................. .......................... Dimensions of same structure with alterations or additions: Front .............. .... Rear .................. Depth ...................... Height ........... ! .......... Number of, S~ories ............ ~ ....... 8. Dimensions of~nttire new construction: Front ... ~f//.... .... Rear ,..~'/ . .: . Depth .. J. ,~ff.-. . . · ....... .......... 9. ' 0. t o Purchase ...OBf¥-~..~.~.~.rl,.~ ............ Name of Former Owner .~J~.l~l~..~.~..¥,., ......... 1. Zone-or use4tistrict in4~h~ch pre~ar~-situated ............... ~ .;.; ........ ~ ......................... 2. Does proposed construction violate any zoning law, ordinance or regulation: .... .~.'!~.' ................. - ....... 3. Will lot be regraded ......... 0. ~ ............... Will exbess fill be removed from premises: Yes Nmne of Architect ........................... Address ................. i.. Phone No. ~ .............. Name of Contractor .......................... Address .'...: ............ ,.. Phone No:/. .............. _5. Is this property located within 300 feet of a tidal wetland? *Yes; ..... No Y...'. · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from =roperty lines. Give street and block number or description according to deed, and show ~treet names and indicate Whether ~terior or corner lot. ;TATE OF NEW,,-YORK. : :OUNTY OF..>.~. ?.-?..ce.t,.,,,,. s.s , ... ~.~>.~..C~..~-.~..~?.c..~.. ~_~. ~, ..... (Nam e o f in dividuaI sigmng' 'contract) bove named. ......... being duly sworn, deposels and says that he is the applicant te is the ................... . ......... ' g t, corporate officer, etc.) .f said owner or ow. nets, and is duly authorized to perform or have performed the said work//~d to i~al(e and file this pplication; that all statemehts Contained in this application are true to the best of his knowledge and belief; and that the /ork will be performed in the manner set forth in the application filed therewith. ;worn to before me this · 54. _ , ,, L.. t