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Home My WebLink About15251-zFORM NO. 4 TO~Rq OF SOUlVHOLD BUILDING DEPkRT~NT Office of the Building Inspector Town Hall Southold, N.Y. C~TIFICATE OF OCCUPkNCY No Z19275 Date AUG~3ST 7~ 1990 THIS CERTIFIES that the building. Location of Property~ House No. County Tax Map No. 1000 Section 06 Subdivision ~DITION FISHERS ISI~/qD Street Hamlet Block 07 Lot 03 Filed Map No. Lot No. conforms substantzally to the Applicatzon for Buzlding Perndt heretofore fzled in this office dated APRIL 15~ 1986 pursuant to which Buzlding Permit No. 15251Z dated SEPT. 8~ 1986 was issued, and conforms to all of the recfulrea~ents of the applicable provisions of the law. %~ne occupancy for which t_his certificate is issued ls SCREENED PORCH WITH ROOF. The certzflcate is issued to (owner) of the aforesaid buzldlng. SUFFOLK COU~DEPkRT~ OF HE2tL~ A~PROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATFJD N/A MII/)RED V. DIXON Building ~n~pebtor Rev. 1/81 !~0~' NO. · TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING P E R./',~ IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 15251 Z Perrmss,on is hereby granted to' pursuant to opphcahon dated~ /~ ...... , 19~..,~,, and approved by the Budding Inspector. Fee ~4~..~..4~.. Budding Inspector Rev 6/30./80 Fo~m Ne. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 : APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application'must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: I. Final survey of property with accurate location of all buildings, property lines, 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 installation from Board of Fire Undez-w-riters. 4. Sworn state~ent from plumber certifying that the solder used in system cont~ns ) less than 2/10 of 1% lead. r 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engine~ responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) ~on-cenformzng uses, or buildings and "pre-existzng" land uses: 1. Accurate survey of property showing all property lines, streets, buziding and unusual natural or topographic features. °" 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additzons to dwelling $25.00, Al£eratlcns to dwelling $25.00, Swimming pool $25.00, Accessory buildzng $25.00, Additions to accessory building $25.00. Busxnesses $50.00. 2. Certificate of Occupancy on Pre-exlstzng Building - $100.O0 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 ' Upda~ud Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 · ,/ ................... Onver or Owners of Property ......... IZ~.. county Ta× pNo 1000, section ...... ..... Bloc ..... T ........ Subdivision .................................... Filed Map ............ Lot ...................... ~ermit ~o..I.~...~..~.L.'~Date Of Fe~mit ..Appncant . llealth Dept Approval ~ Underwrit Approval ~lamning Board Approval ........................ Request for: .Temp°rary Certificate ........... Final Certicate ........... ELD I~SFECTtON DnT~ ~ UNDATION (1st) JNDATION (2nd) 3GH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y 11971 TEL: 765-1802 Disapproved a/c Received ........... ,19. (Building Insp~c o~r)~ APPLICATION FOR BUILDING PERMIT Date .~.pi*,X l .tX".. , 19 ~ IN STRUCTION S a. This application must be completely filled m by typewriter or in ink and submitted to the Building Inspector, witl sets of plans, accurate pkokl!l._an_.to scale. Fee according to schedule b. Plot plan shown~o~I~l~fiI~t l~ll~'l~i~ulldmgs on premises, relationship to adjoining premises or pubhc stre or areas, and glv~Tl~etailed des~.ttati~n' of layout of property must be drawn on the diagram which is part of this cation.' " c. The workt"~red hy thru ~p~hcatlon may not be commenced before issuance of Building Permit. d Up~nap~`F`~}~J~al~ti~/~Ri~-~q~n~1~spect~rw~ssuedaBu~dmgPermitt~theapphcant Suchpen shall be kept on i~.~_~.esgaqh~b'l'~)fSr t~trOl~nlllsl~ughout the work. e. No bmld~t~-__l~lt~l~l~c~[~{1Cff~,(i~lfilr~,( m whole or in part for any purpose whatever until a Certificate of Occupm; shall have been gtl~mUo~r~l~dmgTlRf~i~ed~UlRED FOR'POllER 'POURED CONCRETE APPLICATI~NEIgtI~i~IiBc~]i[~ t~ ~,_~ Department for the issuance of a Bmld~ng Permit pursu.ant to Building Zone O~d~t!kNTown of Southold, S~ffolk County, New York, and other applicable Laws, Ordinances Regulations, for4thEli:~t~Etruct~l~btl3t~/l~ aqitI~Ktotns or alterations, or for removal or demohtmn, as hereto descrlN The apphcant agredlEt~O~t~rl~b2T~ilto~lll~p~licalSl~"liqvs, ordmances, building code, housing code, and regulations, and admit authonzedklntipat, Oit~l~ ai~tp~bulll~ul~ for necessary ~rIOectlons. ~ RE~ .. . ...... / STATI~ CON'q'~UCT~ON & (~tgn, at,.u,r,p~o f applicant, or name, if a corporation) CODEr3 ~NOT RESPONSIBLE FOP ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electnc~an, plumber or bmld.: (as on the tax roll or latest deed) If apphcant Is a corporation, s~gnature of duly author]zed officer (Name and title of corporate officer) Bm~_~r's License No. ~ Plumber's License No Electrician's License No Other Trade's License No Location of land on which proposed work wdl be done [louse Number Street Hamlet County Tax Map No I000 Sechon ~" ?'~'-~ . Block Lot Subdivision Fried Map No Lot (Name) State existing use and occupancy ~f premises and intended use and occupancy of proposed construct]on a Exishng use and occupancy/jl'~eJ'~e~'t'~'.L''r . . b Intended use and occupancy 3 4 5. Nature of work (check which apphcable) New Building Repair ... Removal Estimated Cost ~ I/ 0dO.? ....... If dwelling, number of dwelling units · Addition -)( Alteration ..... Demolition . . . Other Work... ~/~.O~ .~.' (Description) .... Fee ..... ~ .~. ................ (to be prod on filing this apphcatmn) ....... Number of dwelling units on each floor. If garage, number of cars .............. If bus]ness, commercial or mixed occupancy, specLfy nature and extent of each type of use .... D~rnens]ons of ex~stmg structures, if any Front ...... Rear ....... Depth Height . . Number of Stones.. Dunensmns of same structure w~tk alterations or additions. Front ............ Rear . Depth .... Height. 2~.' ..... Number of Stones .......... ~ ..... 8. Dunensmns of entire new constructmn Front . . . Rear . .Z.2't. ...... Depth .. Height ./~tf .... Number of Stones . / .. 9 Size of lot Front .. Rear ............. D,e, pth ,. 10 Date of Purchase 2~t~."('~'.~.~" . ...... Name of Former Owner ..P/~¥ ~'~'r~.ii' 11 Zone or use district in which premises are situated ........ .! .................... 12. Does proposed construction violate any zoning law, ordinance or regulation ................... .h/.~ 13 Will lot be regraded . 3/~, ....... Will exc_,~,.ss fill be removed from premises. Yes N, 14 Name of Owner of premises fh;.J~. ~. ~; T.~/ , . Address ~;r~.4r ~tr.~/q.~.. Phone No. ~:7,~,¢ Name of Architect ............... t~t~ Address ....... Phone No. Name of Contractor ..... /[/¢.a/~.. ....... Address ............ Phone No .... PLOT DIAGRAM Locate clearly and dlstmctly all buildings, whether existing or proposed, and~ indicate all set-back dnnenslons fron property hnes. G~ve street and block number or descnptmn according to deed, and show street names and indicate whethe interior or corner lot 'S~IO~J~t3 NOI-LDFI~JLLSNOD ;JO NDIS3Q ~10=1 ~'IS[~NOdS3~ J-GN S3OOD ADkt3N3 ~ NOIJ-~fl~_L'/.NOD 3~..LS 'A N 3H J_ :I0 01D ~10.~ 3±= ldWbD 28 .LSFIW NCI~Df'I~J-LSNOD - qYNM NO~JV'IDSNI ~J-~]~NOD (]3~]fflOd ~O=l ~NOI/~$N] ~HJ_ ~10=] Wd¢ O& WV 6 ~0~[-~/ -I-Va-I-i~3WJ-~tVd3C] DNICI-IIn8 AzII/ON IJIlON $9' (lZ2,0~lddV /,4./ STATE OF NEW YORK, S S COUNTY OF ......... (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the apphcan He is the ............... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the smd work and to make and f~e application; that all statements contained m this apphcation are true to the best of his knowledge and behef, and that th. work w,ll be performed in the manner set forth m the apphcatlon filed therewith Sworn to before me this Notary Public, ~ (Signature of apphcan~