The URL can be used to link to this page

Home My WebLink About15510-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N Y. Certificate Of Occupancy Z-15691 No .. Date. .3PI*) .2~! .1~7 ......... THIS CERTIFIES that the budding Locatlon of Property .3435..L.e. sli.e Road ... House No County Tax Map No 1000 Section 086 . .Block D~ck.~.G.azebo 5q~.i.q~9n .. P.e c.o..n.i.c.: . .N.. Y... .......... Street Hamlet 04 ........ Lot.. 9.8 .......... Subdlvlsion ........ Filed Map No. . . Lot No .......... conforms substantially to the Application for Building Permit heretofore filed in ttus office dated N o. y .e m.b e .r..1.7. ,..I .9.86 pnrsuant to winch Braiding Permit No .. J .5.5 1. 0. Z ......... November 19~ 1986 dated .... was issued, and conforms to aH of the requirements of the applicable provlmons of the law. The occupancy for Much this certificate is zssued is ..... DECK AND GAZEBO ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR THOMAS & The certffmate is ~ssued to ....... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO PLUMBERS CERTIFICATION DATED: FELICIA GEIGER "id~#e;,~~x ............ N/A N/A Budding Inspector Rev 1/81 FOB,,I~ NO, e, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT ('FHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15510' Z Permission ~s hereby granted to: .... .......... ~.~.......~..:¥.,....~L.~.~.-~... ........... to ...~.m....~.....~....~....~¢ ...%..~.~.....~.....~ ...... at premises located at .....;~..~..:;~L~-~~...~ ............................................................ County Tax Map No 1000 Section . C~ ,~.....~, ..... Block ........(~.,~ ....... Lot No .....,O,..~. ...... pursuant to application dated .... J~/. ~.,.~ ....... 1,~ .., 19.~°.,~, and approved by the Budding Inspector. Fe~ $.,~.~.:.. ~ Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewmter OR ~nk, and submitted ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. F,nal survey of property w~th accurate location of all buildings, property lines, streets, and unusual natural or topographm features. 2. Final approval of Health Dept of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical mstallatmn from Board of Fire Underwmters. 4. Commercial buddings, Industrial buddings, Multiple Residences and similar buildings and installa- tions, a certffmate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed site plan requirements where apphcable, B. For existing buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property hnes, streets, buildings and unusual natural or topographm features. 2Sworn statement of owner or previous owner as to use, occupancy and condttion of buildings. 3. Date of any housing code or safety inspection of bu dd~ngs or premmes, or other pertinent mforma- t~on required to prepare a cert~fmate. C Fees: Addztzons $25.00 1. Certff[cate of occupancy New Dwellzng $25.00, Accessory ,$10.00 Buszness $50.00 2. Certificate of occupancy on pre-exmtmg dwelling $ 50.00 3 Copy of cert~fmate of occupancy $ 5.00, over 5 years $]0.00 4.VacanL Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ..... .r:~.~./C NewCons t. ructzon ...... Old or Pre-existing Building ........... Vacant Land ............. Locat~on of Property ...................................... ,.............. ....... House No. Street Hamlet Owner or Owners of Property /r~'~l/~ '~ ~-6( C- / ~t County Tax Map No. 1000 Sect,on ~'~ Block .~. Lot .... Subd~wmon ...................... Fded Map No ......... Lot No .............. Permit No. I.$~;.I. 0 :~. Date of Permit It~l.~lf~o...Applicant .................................. Health Dept Approval ..................... Labor Dept. Approval ........................ Underwmters Approval ....................... Planning Board Approval ...................... Request for Temporary Cert~fmate .................... F~na[ Certificate ....................... Fee Submitted S ......................... Construction on above described building and permit meets~pphcable codes and regulations Apphcant ......... ~' '~'~.~..~.~.. ~.~' ./~...' ............... Rev 10 10-78 OUNDATION ( ls t) OUNDATIO:I (2nd) OUGH FRAME & FLUMBING NSULATION ?ER N. Y. STATE ENERGY CODE ADDITIONAL FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLD, N,Y. 11971 TEL,. 765-180:3 Examined 10 &t,Ev~ ./,el , 19~° Approved tk) ~ ~ ) ct , 19 )*~ Permit No Dmapproved a/c Received .......... ~19.. (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This apphcation must be completely filled m by typewriter or in ink and submitted to the Budding Inspector, with 3 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 pubhc streets or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of this apph- cation. c. The work covered by tbas application may not be commenced before issuance of Bmldmg Permit d. Upon approval of this apphcatlon, the Budding Inspector w~ll issued a Bmldmg Penmt to the apphcant. Such permit shall be kept on the prermses available for mspectlon throughout the work. e. No bmldmg shall be occupied or used in whole or m part for any purpose whatever tmhi~a Certificate of Occupancy shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmldmg Permit pursuant to the Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as hereto described. The apphcant agrees to comply with all apphcable laws, ordinances, bmldmg code~mg code, and regulations, and to admit authorized inspectors on premises and in bmldmg for necessary inspections // 7/ ,3/ (Signature of applicant, or name, ff a corporation) · ............ ....... ....... (raa~l~ng addrffss of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premlses (as on the tax roll or latest deed) If apphcant is a corporatmn, signature of duly authorized officer (Name and title of corporate officer) Builder's hcense No Plumber's License No Electrician's License No Other Trade's License No Location of land on which proposed work will be done. [louse Number Street County Tax Map No 1000 Section .~FO . Hamlet Block .4. Lot. a Existing use and occupancy b Intended use and occupancy Subdivision Fried Map No Lot (Name) State emstmg use and occupancy of premises and intended use and occupancy of proposed construction 3. Nature of work (check which applicable) New Budding .. Addition.. w'...... A/teranon .. Repair . . Removal ..... Demohtmn ......... Other Work ............ ~ 0~0 (Descnphon) 4 Estimated Cost .· l, dod, Fee (to be paid on f'flmg this apphcation) 5. If dwelling, number of dwelling units ..... Number of dwelling units on each floor ............. If garage, number of cars ................................................. 6 If bumness, commercial or mixed occupancy, specify/nature and extent of each type of use .. 7 Dimensions of existing structures, if any. Front Rear ........ Depth. .. Hexght .... Number of Stones D~rnenslons of same structure with alterations or add~hons Front ...... Rear .......... Depth ..... Height ..... Number of Stones .............. 8 Dimensions of entire new construction Front Rear .......... Depth ............ Height ..... Number of Stones ................................. 9 Size of lot 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 violate any zoning law, ordinance or regulation 13, Will lot be regraded ................... Will excess fill be removed from premises Yes No 14, Name of Owner of premises ....... Address ...... Phone No ....... Name of Architect .............. Address ......... Phone No. Name of Contractor ............. Address ............. Phone No ...... 15. Is this property located withinl00 feet of a tzdal wetland? * Yes ..... No ~ '.~.. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back dtmenmons from property hnes. Give street and block number or descnphon according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK' ~2/'z'~'zA"mn-, S.S COUNTY OF. .. ........ .~-/~.//f//~. /~] .... d~7~--/~. .. . .. .. . being duly sworn, deposes and says that he is the apphcan (Name of individual mgmng contract) above named. He is the ..... (Contractor, agent, corporate ofhcer, etc.) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file th, application, that ali statements contained m this application are true to the best of his knowledge and belief, and that th work will be performed in the manner set forth m the apphcataon filed therewith. Sworn to before me th~s