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Home My WebLink About16079-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z15848 Date June 15, 1987 THIS CERTIFIES that the building .......... A.d.d.i.t.i.o.n. .............................. 480 Ackerly Pond Lane Southold Location of Property h~s~ h7o~ ....................... ',.e't/e~i ....................... h[*~iol County Tax Map No. 1000 Section 069 .Block 05 .Lot p/o 13 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J u n e I 1, 1987 pursuant to which Building Permit No. 16079 Z dated June I 5, 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 ......... Deck addition as applied for. Tile certificate is issued to CLAUDE & DIANE CARLSON ..................... ................... of the aforesaid building. Suffolk County Department of Health Approval ...N./.A. .................................... UNDERWRITERS CERTIFICATE NO. N / A PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 · OR~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING ~' EP, MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne_ 16079 z Permission is hereby granted to: .~.....~...~z...~ ........ .... .f., ........ ~.e-~ ........ C~ ........... . , ...~,:~ .............................. ,o ~/.~....~...~~.....~.....~~ ........................... o,~,~,,,,,=,,~ ~,...~...~ ........ ~5~ ....... .~...,...~. County Tax Map No. I000 Section .... ~..~....~.. .......Block ...... ~.~.... .... Lot No..~../..,,~... pursuant to application dated ....~...../~... .......................... , Ig.~..Z and approved by the Building Inspector. ~lJlding Insl:~ctor Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec- tor with the following; for new bui[dings 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--(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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate o~ occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 .~//. /~.,-~ 5.Updated C.O. $ 50.00 Date ...... /. .............. New C OhS tpuc % i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~.~.0. ................. /~¢'~¢~'~e ~ '~' '~' '& ............ ' '~' ] '~' (~/~ House NO, t Ham/et Owner or Owners of Property ...~/~F4~/[.e..~....D J ~ ~. .... C6~. ~'. ~[~t~-.-~ ............. County Tax Map No. 1000 Section ............... Block ......... Lot .... /.~. .... Subdivision ..... f~' ...... Filed Map Mo ........... Lot Mo. Permit No/~.~. .~. ...... ~. Z-- Date of Permitjd~/~y..~.. ?. ......................................... Applicant Health Dept. Approval ....... ~ .............. Labor Dept. Approval . ..¢./~ .................. Underwriters Approval ........ .~../~ ............. Plannin oard roval //~ . g B App ..................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..'~. t ...................... Construction on above described building and parmit meets all aJao4icable codes and regulations. App,icant · .~.. ~~'"'/'~"T~ ..................... Rev. 10-I0-78 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ]FRAMING ~AL REMARKS: 1 DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY . .. CHECK FORM ............. TOWN HALL $OUTHOLD, N.Y, 11971 TEL.: 7654802 NOTIFY CALL ................ Examined .......... 19.·. Approved .............. ¢.6~. , 19 .~."~ermit No/~...~.7, Disapproved a/c ............... .................................... ....... '. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TO: ,,. ..... ., i~KP a. Tkis 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 tkis 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 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, ordina~nces, building corse, housinag, code, and regulations, and to admit authorized inspectors on premises and in building for necessary ins~t~ns. .... /.. ;.~z.z:~'... v.-~.~c~... ~. ........... ( ~gna~re of applicant, or ham's, if a co poration) · .~%~.:..~ .... ,%.~.~,a.:'.d./¢.,.~../p. >./. (Mailing address of applicafit) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...~. 6~. ~/e: .0C .................................................................................. Nameofownerofpremises...~../~.d~'....~..D$~n<.e .... ~.~.~./~. ~ ......................... (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 Builder's License 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 .................................................. ..... .................... d. .......... ........... House Number Hamlet County Tax Map No. 1000 Section ... ~.~. ......... Block .... (~ ..~. ......... Lot..~/~../~ ...... Subdivision ...... ~ ............................ 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 f .~/~. ~u~ ~v~J;;~ ~ ~t~3~ b. Intended use and occupancy . ~. ................ ~oo~:~ ~4~ .~. ~8~P~ ........ 3. Nature ofwork (check which a~plicable): New Building ..... ' ..... Addition ... ration .......... Repair . · ~ ........... Rempval .............. Demolition .. ~ ........... Other Work ............... ''' ~/~z2 ? 'f~..O. (Descrip~tion) 4. F, stimated Cost.. O. Fee .~ ..... : · (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 .... ! ................................................................... 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 .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ....... ~, ............. i ' ' Height .............. Number of Stories .................. -- 8. Dimensions of ~ntire new construction: Front .... ~. I. · .' ..... Rear ........ Depth .... /.~-. ........ t,t. eight ............... Number of Stories ...................................................... 10. Date of Purchase .......... i .................. .~ame of Former Owner ............................. 11. Zone or use dxstrxct m which pr~m~ses are s~tuated.../~f'~ .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..J//.O .......................... 13. Will lot be regraded ..... I(k,4C~...p../5)...Z ....... Will excess/fill b_e/~mgvcd from premises: Yes Name of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ........ , ................. Address ................... Phc .............. 15. Is this property located iwithin 300 feet of a tidal wetland? *Yes ..... ~.~_.~... · If yes, Southold Town TrUstees Permit may_ be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. (Name of individual signing contract) above named, i being duly sworn, deposes and says that he is the applicant He is the ................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have p~rformed 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~