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Home My WebLink About16507-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16276 October 9, 1987 Date ................................. THIS CERTIFIES that the building DECK ADDITION Location of Property 800 Glenn Road Southold, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section ....7.8 ....... Block 2 .Lot 26 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 5, 1987 16507 Z ...................... pursuant to which Building Permit No ...................... dated..........° c t ob e .... r 8.. · ...........' 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 TO EXISTING ONE FAMILY DWELLING The certificate is issued to ... WILLIAM & ALICE PFEFFER of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO ............... N / A PLUMBERS CERTIFICATI'ON DATED: N/A Building Inspector Rev. 1/81 FORM NO. ft TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 16507 z Permission is hereby granted SO..' ,o..~~..~ ...... ~.:~~.....~......~~ ................................. ~, ~,~,,, ,~,.~ ~, :..~,.....~~... ~.,.~~.~ .... County Tox Mop No. 1000 Section ..... ...~....~.'.. ........ Block ..... ...~.. .......... Lot No ....... ~ ......... pursuont to opplication dated ..../...~.../..~..-~.. .................................... , 19~:i~Z...., ond opproved by the Building Inspector. Fee $....~.~.~'. ............. u~g'g Inspector 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 ~ 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-(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: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10,O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. ~ $ 50.00 ~ Date ..~..~.-~...Z~',..~..~.¢,/¢.~./_ ...... NewConstruction ...... Old or Pre-existing Building . .-T. ......... VaCant Land ............. Location of Property f~..~. ......................... ~ .......... ./: .... .,~. ¢ ........... House Street ! Hamlet Owner or Owners of Property f~.~r~/~..~../. ~..~.~..~.~?~....r~.c .~..'~.. ./.~..~..'--~... ........... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No/~. ~,~. '~.~...~' Dateof Permit/.~//~. ....... Applicant ................................ .. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and iP~r_mit meets all applicable cpde~and regulations. Rev. 10-10-78 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved...~./~. ..... , 19d77 Permit No..,f.~..O*..D..~...~. Disapproved a/c ..................................... ildin~ector) ' APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY ......... , CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: 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. applicable laws, building code, housing code, and - ~regulati°ns' and to The applicant agrees to comply with all ordinances, admit authorized inspectors on premises and in building for necessary insp~e, tions. , . ,,q [ z'Q ~ ff // (Signature of,applicant, or na~, ~ ~) .... . ............... (Mailing address of app :ant) , / ~lur~er or builder. State whether applicant is_ owner, lessee, agent, architect, engineer, general contractor, electrician, If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... LICENSED Electrician's License No ....................... 1. Location of land on which proposed work will be done ................................. ..0o ............................................. House Nmnber Street Hamlet County Tax Map No. 1000 Section . · .7.~' ......... 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 g)/0'/--~' · ./~.~.'~'~../ b. Intended use and occupancy,,x~./---&'7,~./(~.., t~.Z---,7~[~, .......................................... 3. Nature of work (check which applicable): New Building ... ' Addition ........ Alteration Repair Removal Demolition Other Work 4. Estimated Cos .................. Fee .......................... i " (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 entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Nmhber of Stories ........................................................ 9. Sizeoflot: Front .......... ............ Rear ...................... Depth ...................... 10 Date of Purchase ' Name of Former Owner 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vi01ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ i .................... Will excess fill be removed from premises: Yes No 14. Nmne of Owner of premises . 'i .................. Address ................... Phone No ................ Nme of Architect ........................... Address ................... Phone No ................ Nmne of Contractor ......................... Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... · 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 property ilnes. Give street and bloc~ number or description according to deed, and show street names and indicate whether i interior or corner lot. STATE OF NEW YORK, ~S.S COUNTY OF ................. ............................ ' ..................... 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 duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application am 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 this ................ · ~' '~' v...day NotalT Public, . ..... /~-~...~.