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Home My WebLink About15262-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buzlding Inspector Town Hall Southold, N.Y. UPDATED C~RTIFICATE OF OCCUPANCY No Z-26730 Date OCTOBER 6, 1999 THIS CERTIFIES that the buildin~ Location of Property 10450 SOO-ND AVE. County Tax Map No. 1000 Section 122 Subdivision ACCESSORY MATTITUCK, N.Y. Street Block 2 Filed Map No. Hamlet Lot 14 Lot No. conforme substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 12~ 1986 pursuant to whlch Building Permit No. 15262-Z dated SEPT. 12, 19B6 was ~esued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which th~s certificate Ks issued is ACCESSORY GAZEBO AS APPLIED FOR. * The certificate is issued to GEI~%LDINE H. WORTHINGTON ( owner ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *THIS UPDATES CO Z-14868 DATED SEPT. 12, 1986 ~ldin~ I/ns~ector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No $J. 4.~ . . Date . S.ep'q...1.2. .................. 19 .8.6 THIS CERTIFIES that the building A.ccessor¥ ...................... Location of Property .. 193.89. S.O.U.N .D..A. VE.: ........ .Y~..T.T.I. TU..C.K. ............... House No Street Ham/et County Tax Map No, 1000 Section . .].3. 7. ...... Block , 0 [ ........ ]Lot . 0.1.3 ........ Subdzwsion ............. Filed Map No ......... ]Lot No ............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated .... .S.e. iq.~ :. 1.2. ......, 19 86pursuant to which Braiding Permit No .... 152.6.2 :~ ........ dated . .S.o.p?.: 1.2 ....... 1986. ,was~ssued, andconformstoalloftherequirements of the applicable provisions of the law. The occupancy for which flus certificate is issued is ... ... A.c. cess.o.r¥ ~a. ze.bo.... ................................. The certificate is issued to .... .R.O.B?RT..&..G .E, .R~..?I.N.E..D..A.VIS .................. of the aforesaid building. Suffolk County Department of Health Approval ........ ~./..A ............... UNDERWRITERS CERTIFICATE NO... N/A Buridmg Inspector Rev 1/81 FORM NO. It TOW'N OF SOUTHOLD B01LDII'4G DEPARTMENT TOWN HALL SOUTHOLD, N, Y. BUILDING PEPJ*AIT {THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15262 Z Permtsslon Is hereby granted to' j...o..~.~..~....,~.*..;.~...***Q~...,. ........ ................................... I'~'~T~'~ .... : ............ Courtly Tax Map No 1000 Sect,on .~ Block ..~.. Lot No ....'::~.~'t~L.~.... pursuant to opphcot,on doted Budding Inspector. Building Inspector Rev Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, m~ltlple residences and similar buildl~ and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings a~ "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the appllcam If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Cert~ficate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildln¢ - $100.00 3. Copy of Certificate of Occupancy - .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 October 5, 199~ Date ..................................... ..... UPDATED New Construction ........... Old Or Pre-existing muli~zng ................. Location of Property ..... I0450 So~d Avenue Mattltuck, N.Y. House No. Street Hamlet GERALDINE B. WORTHINGTON Onwer or Owners of Property .............................................................. County Tax Map No 1000, Section.. 122 .Block. 2 ..... Lot ~4 Subdivision .................................... Filed Map ............ Lot .................. Permit No. 15262- Z .Date Of Permit. 9/!2/1986 ...Applicant .... Health Dept. Approval .......................... Underwriters Approval.. Planning Board Approval ........................ Fee Submitted. $ 50.00 F1ELD INSL~ECTION~ ~ DATE~ COMMENTS FOUNDATION ( 1 st } FOUNDATION ( 2nd ) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF SOUTHOLD Buildmg Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thru application must be filled in typewriter OR ~nk, and submitted m ~mmamm to the Building Inspec- tor with the following; for new buildmgs or new use' 1. Final survey of property w~th accurate location of all buddings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal-(S-9 form or equal). 3. Approval of electmcal installation from Board of Fire Underwriters. 4. Commercial buddmgs, Industrial buildings, Multiple Remdences and similar buildings and installa- tions, a cerbflcate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed rote plan requirements where apphcable. B. For exist.ng buildings (pmor to April 1957), Non-conforming uses, or buildings and "pre-exmting" land uses' 1. Accurate survey of p~operty 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 mspect[on of bullrings or premises, or other pertinent ~nforma- t~on required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-exmtmg dwelling $15.0 0 3, Copy of certificate of occupancy $1 00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 Date .... NewConstructzon ...... Old or Pre-existing Budding ~, J~.~..~.. .... Vacant Land ............. Location of Property../.O...3..~.~. ....... ~-:~...~,......~'~....~ ~-~ ....... I'./ou,~e ~ street ,_ Hamle Owner or Owners of Prope ....................... ''' County Tax Map No. 1000 Section ... } 2-z.- Block ~- Lot. Subdivision ............................... Filed Map No ......... Lot No ............. Permtt No./~.'I.~..D-..~.. Date of Permit . .},...~..Apphcant .. ~ .......... Health Dept. Approval ...... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ~ F mai Certificate Fee Submitted $..~"- ~ ................... Construction on above describedApphcant~, ,~ build,ng and permit ~ts all apphcable codes and '- ./- .~-.~ ................... rlgilatlons. Rev. 10 10-78 Exam~ned~~ ~'1~ FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approve~.gO~z[?.,~O-a~ I::1-., 19 g~[ Permit Noa/ Dmapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Rece!veO ........... ,19. Date . .. INSTRUCTIONS a. Tins apphcatlon must be completely filled in by typewriter or in ink and submitted to the Bmldmg Inspector, wit sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of bufldmgs on premises, relationship to adjoining premises or pubhc sir, or areas, and glvmg a detailed descnptmn of layout of property must be drawn on the diagram which is part of tins ap cation c. The work covered by this application may not be commenced before issuance of Budding Permit d Upon approval of this apphcatmn, the Building Inspector will issued a Budding Permit to the apphcant Such per shall be kept on the premises available for inspection throughout the work e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certfficate of Occupa. shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Buildmg Department for the issuance of a Building Permit pursuant to Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construcbon of buddings, additions or alteratmns, or for removal or demohtlon, as hereto descnk The apphcant agrees to comply w~th all applicable laws, ordinances, bmldmg code, housing code, and regulations, an,. admit authorized inspectors on premises and m bmldmg for nece~ ~/~ ~,~ . (Signature of applicant, or name, ff a corporation) State whether apphcant ~s owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or Nameofownerofpremlses //~~'~-~~~'~' ~~ ................ .' (as on the tax roll or latest deed) If apphcant ~s a corporation, s~gnature of duly authonzed officer 2 (Name and t~tle of corporate officer) Builder's License No Plumber's L~cense No Electrician's License No Other Trade's L~cense No I Location of land on which proposed work will be done House Number Street County Tax Map No I000 Sechon ~'~ Hamlet Block ~ . Lot. Subdivision Filed Map No . Lot (Name) State exmt~ng use and occupancy of premises and intended use and occupancy of proposed constructmn a Ex~stlng use and occupancy )-'~ .o~ ...... b Intended use and occupancyC-~t'~j~ / ~'3%4[~. .................. 3. Nature of work (check which apphcable). New Budding .. Repmr ...... Removal ........ Demolition 4. Estimated Cos~'-~'// ~ ....... · Addltmn ....... Alteration ....... ........ Other Work ........ (Description) .. .. .. . . Fee. .. .. . .. .... ....... . . ... .. (to be pad on fihng this apphcation) 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, speckey nature and extent of each type of use ............ 7. Dunenslons of exmtmg structures, if any. Front ......... Rear .......... Depth ........... Height .... Number of Stones .................................. Dumenslons of same structure with alterations or ad&t~ons. 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 .................... 11. Zone or use district in which premises are situated ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation 13. Wdl 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 thzs property located withlnl0O feet of a tidal wetland? * Yes ..... No ..... · If yes, Southold Town Trustees Permit may be required, PLOT DIAGRAM Locate clearly and (hstlnctly all bufldmgs, whether existing or proposed, and. indicate all set-back dnuenmons from property hnes. G~ve street and block number or descnptlon according to deed, and show street names and indicate whether ~ntenor or corner lot TATE OF NEW YORK, S S OUNTY OF .... (Name of individual sigmng contract) ~ove named ·. being duly sworn, deposes and says that he is the applicant is the .......................... ..... . (Contractor, agent, corporate officer, etc ) smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file thru ~phcat~on, that all statements contamed m this application are true to the best of his knowledge and behef, and that the ork will be performed in the manner set forth m the application filed therewith. vorn to before me this ....... ..... of... (S~gnature of applicant) / / t