HomeMy WebLinkAbout15361-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y,
Certificate O[ Occupancy
No. z-16243
Date October 2, 1987
THIS CERTIFIES that the building TOOL SHED ADDITION
80 Kraus Road Mattituck New York
Location of Property ....................................... ' ........................
House No. Street Ham/et
County Tax Map No. ] 000 Section 12 2 .Block 0 5 .Lot 10
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
September 29, 1986 pursuant to which Building Permit No. 15361 z
dated ............................Oc t o b e r 6, 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 .........
TOOL SHED ADDITION TO EXISTING ACCESSORY GARAGE AS APPLIED FOR
HAROLD & IRENE WILSBERG
The certificate is issued to ..................... [of, n'e'r, ~{~[~o~.~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval lq /A
UNDERWRITERS CERTIFICATE NO. lq / A
N/A
PLUMBERS CERTIFICATION DATED:
~ .~3~....ff.,...~...~. ........... Bt~ing Inspector
Rev, 1/81
lVO~v NO. l~
TOWN OP $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERJ~IT
(THIS PEPu~iT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15361
Z
Date ..,(~),.~ .............................. ,
Permission is hereby granted to:
at premises located at ....'~..~ ........ ~/f .~...;~...~ .............................................. : ............
County Tax Map No. 1000 Section .... ].....~..~... Block ....~....~... ........ Lot No ..... ~...~. ............
pursuant to application dated .~~.....,'~....~, .......... , 19.?....(~.., and approved by the
Building Inspector.
Fee $ .................... .~...
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Bu ilding Department
Town Hall
Southold, N.Y. 11971
Lj)C ...... :~-~--~111 l il
765- t802
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-{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.
§, 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 property showing all property lines, streets, buildings and unusual natural or
topographic features.
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 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 ...............
NewC°nstructi°n ....... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ...~:~.O. .................... /~ ,~ ,1~.0, ~, ,1~ ~, ...... . .~../~.-T.--~.i..-~'.o..~-..t~.'...
House No, Street Hamlet
Owner or Owners of Property .~r/~ ~,~ .~,?D...c~. 1:1,]~.~.~.._ .... L~ 3./~_~ ~'~';~, ~ .........
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No./'~' .-~(~./.... Date of Permit .......... Applicant .~,~..P-~.¥~.....C~. j.~.5. ?.~."~,~-~- ........
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 permit meets all applicable codes and regulations.
Rev. 10-10-78
TOWN OF SOUTIIOLD
OFFICE OF BUILDING INSPECI'OR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1892
To whom This May Concern,
We are unable to complete your Certificate
of Occupancy because ,of the following reasons.
/~ An application for Certi
is not on file.
--/ No Underwriters Certific~
/_---_~/ The check is (outdated~
/-_-/ No Bealth Dept. Approval
/--/ No final inspection has b
Please contact our office
Thank you for your cooperation.
Building Permit t~ / ~- 3 ~ 2
Building Dept.
***/~/ No Plumber Solder Certificate on fileo
( all permits involving plumbing being
issued after April 1,1984 )
FI£LD I ,S, m~-~O~ DATE
FOUNDATION {1st)
FOUNDATION ,- (2nd)
ROUGH FRAME &
FLUMBING
INSULATION FERN. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS
APPROVED ~ NOTED
NOTIFY BUDDING OEPARTM~T AT
7~5~A802 g AM TO 4 ~ ~ ~E
FOLLOWING tN~C~ONS:
FO~
2 ROUGH FRAMIN(~ & PLUM~ING ,
ALL CONSTR~CTION
THE REQUI~ENTS
~A~ CONS~UCTION
~D~, NOT ~S~E
'OCCUPANCY OR
USE ~S UN[AWFUL
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
3'EL.: 765-1802
Examined .C>~.41~..~...., 19~.~.
Approved O.~....~....~ .... 19.~.('. Permit No?.~..~..~. I..~/.
Disapproved a/c .....................................
Beceived ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date..//}.O. .......... , 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 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 comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
( ig at ofappicant, ornam~,ifa p t' )
.... .....................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......... .o..t~. ~ V~ .~. .............................................................................
Name of owner of premises .... .~.9.~?.%.b., ..°t..~C~ .~. ~.'.0.~,...t~. 3..L.~ .~..~..~ ~ ........................
(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 ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No .................... ...
Location of land on which proposed work will be done ..................................................
..... .~.9 .......................... ~ .~. ~.~... R.~. ............ .rD ~..T.TJ.7.~. ~ t.~._ .............
House Number Street Hamlet
County Tax Map No. 1000 Section ..... ('.~..Z.: ........ Block . . ..~17 ............. Lot ..... /..o. ...........
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 ....... ~7~ .~..~.../~....4F....~/. ~..K.(k..e~...~-r .................................
b. Intended use and occupancy ..... 77?.°. .tr. .... ~..~...~!~). .............................................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition ...... .... i .. Other Work ...............
.~..~.~ (Description)
4. Estimated Cost ........ .o. 71,~ .................... Fee .......... ~ ........ ~ ...................
[to be ~aid 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 Z o . Number of Sto~es t
D~ensions of same structure with alterations or additions: Front ............ i ..... Rear .... ' ..............
Depth ...................... HeiSt ...................... Number o~ Stories ......................
8. Dimensions of entire new construction: Front ...... /. P ...... Rear ...... .~.~ ...... Depth .... ( ~ ........
ight ~
He .............. Number of Stories ........ ].... ................ , ............................
9. Size of lot: Front ....... /.qe ........... Rear ........ ( P~ .......... ~Depth ..... ~ .q ~ .............
10. Date of Purchase .... ! g.~. ................... Name of Fomer Owner .~,..Z.~ ~5.~) .............
1 1 Zone or use district in which premises are situated M3 ~ ~.~ ~. . ~
12. Does proposed construction violate any zoning law, ordinance or regulation: ...... M9 ........................
13. Will lot be regraded ........ ~.~ ................ Will excess fill be remove~ from premises: Yes
14. N~e of Owner of premises 1~ ~ .~.~.~ .... Address m ~.~ ~..~ .... Phone No. ~.~.~: ~.~., .
Nme of Architect ....................... Address i Phone No .... ; ....
Nme of Contractor .......................... Address ............... ~ ....Phone N~ ..............
15. Is this property located withinl.00 feet of a tidal wetland? * ~Yes ..... ~ .....
· If yes, Southold To~ Trustees Permit may be required.
PLOT DIAG~M
Locate clearly and distinctly M1 bufld~gs, whether existing or proposed, and. inhieate ~1 set-back d~ensions from
property Hnes. Give street and block number or description aceord~g to deed, ~d show street nines and indicate whether
inte~or or cornel lot.
STATE OF NEW YORK, S.S
COUNTY OF .................
.qP .................... sworn, ep( ses and says mat is the
(Name of individual signing contract)
above named.
He is the ......... ~.~ ~.~.~ ..................
(Contractor, agent, corporate officer, etc.~
of said owner or owne~, ~d is duly authorized to perform or have perfomed the s,~id work and to m~e ~d file this
application; that all statements contained ~ this application are true to the best of hi~ knowledge and belief; and that the
work will be perfomed in the m~ner set forth ~ the application filed therewith.
Sworn to before me this
........... ........ of
Nota~ Public, ~ ~ c ~ County
~u~n~,a in suffolk County (Signatu~of applic~t)
"