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Home My WebLink About15607-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCcumANCY No Z-2412.4 Date JANUARy 23~ 1996 THIS CERTIFIES that the buildin~ Location of Propert~ 1780 HENRY'S LANE House No. County Tax Map No. 1000 Section 74 Subdivision i ACCESSORY NY Street Block 2 Lot 4 Filed Map No. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore f~led in this office dated DECEMBER 29, 1986 pursuant to which Building Permit No. 15607-Z dated DECEMBER 31~ 1986 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 AN AC~ESSORY BUILDING AS APPLIED FOR. The certificate is issued to DONALD & LORRINDA STARON of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 /~uil~ing ~nspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FERJ~IT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15607, Z Permission ~s hereby granted to: ' .... .t. ~..~..~......~....~ ............ ~~:~.~....~ !. ~..~ ~ ~t premi~o~ I~at~ ~t ...I.~.~.~ ....... ~ ........................... County Tax Map No. 1000 Sect,on ~)"J ff . Block ...................... Lot No .... ..~)....t~. ......... pursuant to application dotedr.....~...~...?-..~ ..., lO~.(~e., and approved by the Building Inspector Building Inspector Rev. 6~30~80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Th~s applmcation must be f~lled zn by typewriter OR ink and submitted to the building ~nspector wzth the following: for new bumldmng or new use: i. Final survey of property w~th accurate location of all buzld~ngs, property l~nes, streets, and unusual natural or topographic features. 2. F~nal Approval from Health Dept. of water supply and sewerage-d~sposal(S-9 form). 3. Approval of electrmcal installation from Board of Fmre Underwriters. 4. Sworn statement from plumber certmfy~ng that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, ~ndustr~al building, multiple residences and s~m~lar buildings and znstallat%ons, a certmf~cate of Code Complzance from arch%tect or engineer responsible for the building. 6. Submmt Plannlng Board Approval of completed s~te plan requirements. For exmstzng bumld~ngs (prior to April 9, 1957) non-conforming uses, or bulldmngs and "pre-exmst~ng" land uses: 1. Accurate survey of property showing all property lines, streets, buzldzng and unusual natural or topographmc features. 2. A properly completed application and a consent to ~nspect smgned by the applicant. If a Certificate of Occupancy is den~ed, the Building Inspector shall state the reasons therefor In wrltmng to the applicant. G. Fees i. Certificate of Occupancy - New dwellzn§ $25.00, Addmt~ons to dwellzng $25.00, Alterations to dwelling $25.00, Swlmmzng pool $25.00, Accesaory buzldkng $25.00, Addmtzons to accessory bumld~ng $25.00. Businesses $50.00. 2. Certzfmcate of Occupancy on Pre-exist~n~ Buildinm - $100.00 3. Copy of Certzf~ca~e of Occupancy - $20.00 4. Updated Certmficate of Occupancy - $50.00 5. Temporary Certmfmcate of Occupancy - Resmdential $15.00, Commercial $15.00 C Date ~.. %.~.~ /~?~ .. New Construct~on.~.~..~.[~..t'Old Or Pre-exmstmng__ _-Buil~2~g,_ ..... [iiii].].iii~7 _ ~ .................. Location of Property ....... Jl~ .... [ ..... ~ .AJ.f~.%. /.~:. ~ ........... ~C~/~ ............. House No. Street Ha~et Onwer or O=ers of Property .... PC~[~ + t-orrt~d~ Y~t~ ooo, ......... ........... ~o~ .... ~.~.~..tS~x ......... ~a ~.._~.0 t..~o~ ..................... Health Dept Approval.. .. .. . .... . ....Underwriters Approval ..... Planning Board Approval ........................ Request for: Temporary Certificate ........... Fznat Certzcate...~. ...... Fee Submitted: $...2~..I.I.~?/.~...{~.r..~'~'~.%~I ~ ~, ~ . ....... ....... 765-1802 BUILDING DEPT. INSPECTION OUNDA]'ION. IST, [ ] ROUGH PLBG. ~~o~f.~ [ ~ ,.SUL.,O. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBO. FOUNDATION 2ND [ ] INSULATION [~J~RAMING [ ] FINAL INSPECTOR ~ 765-1802 BUILDING DEPT. iNSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING FIREPLACE & CHIMNEY REMARKS: ROUGH PLBG. INSULATION DATE INSPECTOR OUNDATION (1st) OUGH FRAME & PLUMBING NSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Appr~ .~. l , 19~ Permit No Disapproved a/c ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Recezved ........... ,19. INSTRUCTIONS a Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, w~tl sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public stre or areas, and g~vmg a detmled description of layout of property must be drawn on the diagram which is part of tins apl cation. c. The work covered by tins apphcatlon may not be commenced before ~ssuance of Budding Permit d Upon approval of this application, the Bmldmg Inspector will issued a Bmldmg Permit to the apphcant Such pen shall be kept on the premises available for inspection throughout the work e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Bmld~ng Permit pursuant to, Bufichng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances Regulations, for the construction of bufldmgs, additions or alteratmns, or for removal or demoht~on, as herein descnb. The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized mspectors on premises and in bulldmg fo r necessary lnsp~c ~~/~q.~O.,r.,..~ .. (Signature of applicant, or name, if a corporation) · . ................ .......... ff. .e. .qo. . .,,e. ). . . . j./. (ma~ling address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or build. Ov2toe_ r" .. Sameofownerofpremlses '"~/OCI-Ic) /]-]'JC~d} ~'-O~"{~[./[d~OjO''' 57i-/~1QO.A'/ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of c~rp~raJe Builder's License No Plumber's L~cense No officer) Electrlcmn's License No Other Trade's License No Location of land on which proposed work will be done House Number t County Tax Map No 1000 Section 7 t-/ .. Hamlet Block ~2~ Lot Subdivision . .. Filed Map No Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction '· " aEx,stlng use and occupancy / )flje- Fa, ,Icl,d ..elhc' . b Intended use and occupancy .~ ~j~O[ 0~ ~ ~Vl.'t~['Oq C?~.te ). ,/ 3. Nature of work (check which applicable). New Budding ~ Add,tlon Alterat,on Rep:ur .......... Removal .......... Demohtaon ......... Other Work ....... ~ .~.~? (Description) 4. EstnnatedCost .s~=,~%r~....· .~ .......... Fee .'. ~ ....................... .AJ.~ (to be paid on t'fling this applicat,on) 5. If dwelling, number of dwelhng un,ts.. . Number of dwelling umts on each floor ......... If garage, number of cars . . .O70.~-- .................................. ,./,. ...... 6. If business, commercial or m,xed occupancy, specify/tature and extent of each type of use ..... /~.~///3t7... . 7. Dnnenslons of exmtmg stru.ctures, if any Front. ~{~ ~ ..... Rear .~.~.. ~.. .... Depth . j2..~.... 0-9 .... Height . . [~ t ..... Number of Stones . . .OtJ ~ ............................... DLmenslons of same structure with alterations or additions Front .~ ..... Rear . ~ ..... Depth :~:t~. ......... Height . 'Te~:~.. ...... Number of Stones . .~..- ......... 8. D~rnensions of entire new construct, on Front .. ,2, g'~' Rear .~> ." Depth ~ C) He,ght . . ./~. . . . Number of Stones . . . C} .A~..~. ............................ f-~. Size of lot Front I ...... Rear .............. Depth ................ 10 Date of Purchase j .......... Name of Former Owner .......... I 1 Zone or use d,stnct in winch premises are situated.. 12. Does proposed constructmn vmlate any zoning law, ordinance or regulatmn ......................... 13 Will lot be regraded .... ~..~... ...... .~.. ./Will excess fill be remo3{ed froth premises' Yes 14 Name of Owner of prem,ses l~.O7~.O~/¢)..¢'~./J~0:Cddress .~CrA g.5'~l, ff.¢c.o.,dz~PhoneNo Name of Arcintect - .. ~A~O.-6/.q ..Address ................ PhoneNo ........ Name of Contractor ........... 6t.(~ .~- Address Phone No 15. Is this property located withinl00 feet of a tidal wetland? * Yes ..... No .''.~. '' ~ If yes,, Southold Town! Trustees Permmt may be required. PLOT DIAGRAM Locate clearly and dmtmcti~ all buildings, whether ex,sting or proposed, and~ intimate all set-back dxmensmns fro property hnes. Give street and block number or description according to deed, and show street names and indicate wheth interior or corner lot / STATE OF NEW YORK, S S COUNTY OF .. .............. being duly sworn, deposes and says that he m the apphca (Name of Individual slgnmg 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 f'de tt application, that all statements contained m thls application am true to the best of his knowledge and belief; and that tl work w,II be performed in the manner set forth in the application filed therewith. Sworn to before me thru ...... . dado,. ..... Notary Pubhc, . ~. ~ ...~.~..~.~'~ .... County No 470787S, Suffolk .Ce)mTy~ / (Signature of apphcaz