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Home My WebLink About16116-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19879 Date APRIL 30, 1991 THIS CERTIFIES that the building Location of Property 1395 HENRY'S LANE House No. County Tax Map No. 1000 Section 74 Subdivision ADDITION PECONIC~ N.Y. Street Hamlet Block i Lot 10 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 8, 1987 pursuant to which Building Permit No. i6116-Z dated JUNE 23~ 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 ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWELLING. The certificate is issued to RANDI LACALMITA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-048104 - DECEMBER 1, 1988 APRIL 29~ 1991 .- H.SMITH PLUMBING & HEAT. Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTNIENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16116 Z Dote ......... ~ ......... ..~ ............. , 19.~2 Permission is hereby granted to: ~ ~ ~/~ , ~ ...................................... .............. at prem,ses located at .../.....~..~ .......... ~:~..C~....~.. ............ ...~..~..-~:.. .......................................... County Tax Map No. 1OO0 'Section ...... ..~...?...~ ....... Block ...... ...~...~ ........ Lot No ....... .)...~.. ........... pursuant to application dated ........ ...~. ,~...~. ...................., 19...~...~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTUOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ICATION 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). 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. 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. C. Fees 1. 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 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 ~ew Construction...~. ...... Old Or Pre-existing Building ................. House No. Street Hamlet ]ounty Tax Map NoO~000, Section .... ~.~. .... Block ...... ; ......... Lot ...... ~ . .. ............................... ~ ize~ Map ....... Lot .................. Appli . %ealth Dept. Approval ....................... · · · Underwriters Approval ......................... lanning Board Approval .................... ... . equest for: Temporary Certificate ........... Final Certicate ...... ~ .... C 0 ~ · AP~CANT ' TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HA. LL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date ADril 29, 1991 Building Permit No.. ~Z Owner Randi Lacalamita (please print) Plumber H, Smith Plumbing & Heat~g, Inc. (please print) I certify that the solder used contains less than 2/10 of 1% lead. in the water supply system ~pl~mber's signature) Sworn to befor~ me this 2~gth day of Anri~ ,' 1991 Notary Public, Suffolk County Notary Pu6Lic B~RNADETTE L. TAP!AN NOTARY PUBlIC #4844893 State of New York Residing iff Suffolk County CommiSsion Expires Sept~ 30, 19...'U. UNDATION ( UNDATION (2nd) g UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMt :NTS 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION zND [ ] INSULATION FRAMING [~]'~AL ~,~, 765-1802 BUILDING DEPT. INSPECtiON FOUNDATION 1ST [,~/]~ RO~UGH PLBG. FOUNDATION 2ND -'~INSU~TION [ ] FRAMING [ ] FINAL DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. []/FOUNDATION 2ND [ ] INSULATION / ~/] FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ F~OUNDATION 1ST [ ROUGH PLBG. FOUNDATION 2NO[] INSULATION FRAMING [] FINAL ? /' INSPECTOR ~ ~. 765-1802 BUILDING DEPT. INSPECTION BOARD OF HEALTH ....~. 3 SETS OF. PLANS .'-/-o.. 'FORM NO. 1 SURVEY . /.. ....... TOWN OFSOUTHOLD CHECK -~35.~. .... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL $OUTHOLD, N.Y. 11971 CALL ................ TEL,: 765-1803 MAIL TO: Examined ~ 21t .., 1957. ,,~ (~'0' e~c0c..~g~ , Approved .~..$ ....19~..~. Permit No / g / / G ~:_ , ~ ~ }L55 tt~ ~ ~:, ~.~ \v/! ~,~ i~'~' Disapproveda/c ..................................... I[\i , 1987 ................................ . __ (Building Inspectgr) APPLICATION FOR BUILDING PERMIT Date ................... '19... 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&reas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. rc. 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 issue~d a Building Permit to the applicant. Such permit shall be kept on th.e premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for~ony purppse whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. ' ~ APPLICATION IS HEREBY MADE to the Building Department for the .is~uanc~ of a Btdlding 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 b'Uildings, additions or alterations, or'for r~mova! or demolition, as herein described. The applicant agrees to comply with ill applicable laws, ordinances, building code, hi)using code, and regulations, and to admit anthorized inspectors on premises and in building for necessary inspe~jLn~.~ ~.. ~~ (Signature of applicant, or name, if a corporatj7n) State whether applicant is owner, lessee, agent, architect, engineer, general1 contractor, electrician, plumber or builder. ......... .......... ........................................... Name of owner of premises .'..././.~ · .,~. ~~. · .~.~ .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · Builder's License No .....................'~.~.~9. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ~.~...~.... I. Location of land on which proposed work will be done .............................. House Nnmber Street,~qq ~ Hamlet County Tax Map No. I000 Section . . ~..~ .... Block . . ~.,v~,.'.x-...r: ... Lot .... [ ~ ..... (Name9 2. State existing use and occupancy of premises and intended nsc and occnpancy of proposed construction: b. Intended use and occupancy . 3. Nature of work (check which applicable): New Building ' Addition . .1..,~. ..... Alteration .. ~ ..... Repair .............. Rembval .............. Demolition .............. Other Work ............... ' (Description) · 4. Estimated Cost........ . ' ............. . ... Fee. .............................. . . ..... ' · (to be paid on. filing this application) 5. If dwelhng, number of dwelhnglunlts ............... Number of dwelling units on each floor..'.../ ........... If garage, number of cars .... : ....................................... ,, ~ ......................... 6. If business, commercial or mixed occupancy, specify na}!~re and extent of each ty4~ of use'. ......... . ........... 7. Dimensionsgfexistingstructur~s, ifany Front..,.(.[/. . Rear . ..:~.~/. ...... Depth/~.~.~.d~../:/../a.~(/.~. ~ Height .. ~. ' . Number of Stories ~ · ' , ' ......... '. ....... .~../-~,. ...... Dimensions'of same st.rgcture ~ith alterations or additions: Front . .'. ~..~.. ~. ....... Rear .. ~...J...~. ......... Depth/.~ e~.'~-~g~[~.~.'~.Hei t . ~: . . Number of Stories /' . ~r'---8. D~menmons of entire new construction. Front .... ~...5...' ..... Rear .... ~ ......... Depth ....~e~ ........ Height ...... o ........ Numb~L,o f Stories ...... .~ ................................................. 9. Size of lot: Front ../. }~r~/~.. ~.'.~.,- ...... Rear.:,..,Z .~..,./. .~ .......... Depth .. ~..~..~..gff ......... 10. Date of Purchase ~/(.../. ~.]s:~... ,,/.~.7.$ ........... Name of Former Owner ............... i .............. 11. Zone Or use distriot in which pr~miSes are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: /~.~'.r. :-;~...tP.q/~..lf~.a..~d.,.~.E4~.. 13. Will lot be regraded 0At4-~. ~..,~.0.~.~. :~. ~.~....~.o.,y.s. ,.~'. Will excess fill be removed from premises: ~ No 14. Name of Owner of pr~emlses//.~?.x, [~.l..a_.l~..,, ..... Address /~t~...~..~..~.~.~./.~:..oM/P. hone No..~.ff ~-'-~.~.~.:. Name of Architect /{.:/;{{R. lJ.~.~. (3.. [~..,cfi. ~ .5.q~ta,~.t~. ,iddress /~/. ge..ZZ.W..~:,:,:,:,:,:,:,:,~..~..~.,,.~. Phone No. ff..~ 7 ?. fl.. ~.a.?... Name of Cgntractor lfl~.~Nqet4/..t4JAgN(gr. .... '... ~.ddress .~ ./~,~.,¢//~ rid.,..fl(. Phone No Jif S"-tT,.*gO 15. Is this property located lwithin 300 feet of a tidal wetland? ~.~;~'22... ~o 'r'~:: ........ -:'' ~If yes, Southold Town TrUstees Permit maybe required. -- ~ ~,' ~ Locate clearly and distinctly all buildings, whether existing and, in~t~cate all set-back dimensions from and show street names and indicate whetKer property lines. Give street and block number interior or corner lot. STATE OF NEW YORK, ' S.S ' COUNTY q~F..: .............. . ........ /~ ...................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dully authorized to perform or have performed the said work and to make and file this application; that all statements contal¢ed in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this Notary Public, ..... (Signature of applicant)