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Home My WebLink About15200-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. C~RTIFICATE OF OCCUPANCY NO Z-24222 Date MARCH 19~ 1996 THIS CERTIFIES that the bulldin~ ALTERATION Location of Property ROW OFF ~UESTRIAN A~ENDE House No. Street County Tax Map No. 1000 Section 9 Block 9 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Appllcation for Building Permit heretofore filed in this office dated APRIL 24~ 1986 pursuant to which FISHE~ ISLAND~ NEW Hamlet Building Permit No. 15200-Z dated SEPTEMBER 8~ 1988 was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ~J~'£~ATION TO EXISTING ACCESSORY BUILDING A~ APPLIED FOR. The certlflcate is ~ssued to JOHN C. EVANS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - MARCH 13~ 1996 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER,AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) ~ ~5~00 Perm~ss:on ~s hereby gronted to' ~..~..~ .... / ~ c ~~ .~....~..~.- ~ -.--. -~- .......................... ~....~..~ ......... ~, ~,,,,,~,,~ ~, ...... ~~....~ ...... ~. ........................................... ................................ ~~~~ ....................................... pur, u~nt to ~ppl,cot,on d~t~ ~ ~ ~ ...... 19~ ~nd approv~ by the Budding Inspector Fee $.~~ .. Building Inspector Rev 6,/30,/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMEIqT TOWN HALL 765-t802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Thzs applicatzon must be fzlled in by typewriter OR ink and submitted to the buzldzng Inspector wzth the followzng: for new buildzng or new use: 1. Fznal survey of property with accurate location of all buildzngs, property lznes, 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 znstallatzon from Board of Fire Underwriters. 4. Sworn statement from plumber certzfylng that the solder used in system contains less than 2/i0 of 1% lead. 5. Commercial buildzng, industrzal buzldlng, multzple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the buzldmng. 6. Submit Plannzng Board Approval of completed szte plan requmrements. For existzng buildings (przor to April 9, 1957) non-conforming uses, or buzldzngs and "pre-exist%rig" land uses: 1. Accurate survey of property showing all property lines, streets, buildzng and unusual natural or topographzc features. 2. A properly completed applzcatzon and a consent to znspect szgned by the applzcant. If a Certificate of Occupancy is denzed, the Buzldzng Inspector shall state the reasons therefor in writing to the applzcant. C. Fees 1. Certzfzcate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alteratzons to dwellzng $25.00, Swzmmzng pool $25.00, Accessory buildzng $25.00, Add~zons to accessory building $25.00. Businesses $50.00. 2. Certif%cate of Occupancy on Pre-existinK Bulld%n~ - $i00.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .................... New Construction .... ~ ...... 01d Or Pre-existing Building .......... '' ogge .... .... &Aggt .............. ............. Onwer or Owners o£ Property ............................... Subdivision ................................... . Filed Map ............ Lot .................. ... . Permit No...[ .......... Date Of Permzt ............ Applicant ............................. Health Dept. Approval .......................... Underwrzters Approval ......................... Plannzng Board Approval ............... Request for: Temporary Certificate ...... Fznal Certzcate ...X. . . Fee Submitted: $...~...~.,?.0. .................. .. oq¥3 ................... .............. A~PLICANT ELD I.SI~C~ION ,UNDATION (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION FER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: / / Examined Approved Disapproved a/c 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL 765-1802 ,19~ ~' , 19~PermIt No .1 ~-~. 4Y~-., Recemved ........... ,19. (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date ..... , 19. INSTRUCTIONS a. This apphcation must be completely filled m by Wpewnter or in ink and submitted to the Building Inspector, wit sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc strc or areas, and giving a detmled description of Iayout of property must be drawn on the diagram which is part of this ap cation c. The work covered by this application may not be commenced before issuance of Building Permit d Upon approval of this application, the Bmlding Inspector will issued a Building Permit to the appbcant Such pei, shall be kept on the premises available for inspection throughout the work. e. No bufldmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupm shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Bmlding Permit pursuant to Bmldlng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmance; Regulations, for the construction of bmldmgs, additions or alterations, or for removal or demohhon, as herein describ The applicant agrees to comply with all applicable laws, ordmances, building code, housing code, and regulations, and admlt author!zed mspectors on premises and m building for necessary~ (Signature of applicant, or name, if a corporation) (Maflmg address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises ',JO ~ m. ~, ~"V'~a v~ ,T' ...... (as on the tax roll or latest deed) If apphcant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builder's License No CF, ~i' ~q'lq S3~,. .~ .~.'~C~ ~ [ ~ Plumber's License No ,N~kL Electncmn's hce~e No ~o~, e, ~[/j Other Trade's License No Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section 6~ Subdivision (Name) Block · [ ·, Filed Map No Hamlet Lot/ ·. Lot State existing use and occupancy of premises and intended use and occupancy of. proposed construction a Existing use and occupancy ~N/t~.$ ot~gt~ ?*~q~ b Intended use and occupancy ~}~ ~ ~ 3. Nature of work (check which applicable) New Budding . .. Addition .. Alteration . ~ .... ~. Removal . Repair , . Demohtlon .,,Other Work .......... ~ ~'~.. (Description) 4 EstimatedCost-W'.,~.O.~.OO.o. ..... Fee .~1~... ~.~'..~ ......... (to be paid on filing this application) 5. If dwelling, number of dwelling units . g ,, .~ ~ .,, . I~um~er of dwelhng units on each floor . If garage, number of cars ~2~. ~ . z .~.. ?./'t'? .r-~...c~t_.. ~.~--~...~.~. ..................... 6 If business commercial or mixed occupancy specify nature and extent of each type of use . . "-' ......... ~ 7 Dtmensmnsofexmnngstructures, lfany Front 3'~t 2.*/-;~... Rear ~.. '~-?"~..".. Depth .~ .fi'. t ...... Height l~k .... Number of Stones . ~,,xL~. ?hd~¢l, .~,~ ~ .fo~.~>,,, ,~4"/*qt.,d,:,~,~ .'~ Dimensions of same structure with alterations or addmons Front ~'$ ./ :~.Ya :... Rear .. B.~.'.~.'./*-." Depth ~5:'J , . Height J$.*. .. Number of Stones . ZD*x*. ..... 8. Dimensions ofentlre new construction Front .P,,J'~..q~-~ . Rear ........... Depth Height . . Number of Stones ................. 9. Slzeoflot Front lr~.~l~.~ ~'.~. ,~.,s Rear ............ Depth ........... 10. Date of Purchase .~?~'/ Name of Former Owner ~,,v~-~...~-,~-c...tt . . . 11 Zone or use district in which premises are situated ~;d~.~x~'~[. . . .. .. . . ...... .. 12 Does proposed construction violate any zoning law, ordinance or regulation JM' ~ ................. 13 Wxll lot be regraded ... fi, J'o . . .WtlI excess fill be re.re, oveO from premises Yes 14. Name of Owner of premises .4 al~ ~> ~ '.' ~'~,~.x' . Address l~o,<, 3.2~ ~.T/~ ~/..~M- Phone mafX'/.~).7~'.c 7~.. Name of Architect . ~' " Address . Phone No Name of Contractor ............ Address ........... Phone No ........... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether exlstmg or proposed, and indicate all set-back dimensions from property hnes. Give street and block number or descnptlon according to deed, and show street names and mdlcate whether interior or corner lot STATE OF NEW YORK, S.S C~-~FY O~F,..~ .,. C1J ..... (Name of individual agnmg contract) above named being duly sworn, deposes and says that he is the applicant He ~s 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 apphcatmn, that all statements contained m thxs apphcation are true to the best of his knowledge and behef, and that the work will be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this ........... ? ..... day of .._.. Notary Pubhc, ...~-.~..'.~..*. ~./.~/..~... HD. EN IL D~ VOE NOTARY PUBI. IC, $t~e of New York No 4707878, Suffolk Count~.: ~ Term Ex~irtos Parch 30, t%_~f-/ Countyt'?% (Signature of apphcant)