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Home My WebLink About15272-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z~20316 Date OCTOBER 29~ 1991 THIS CERTIFIES that the bulldln~ ADDITION Location of Property EAST END~ PRIVATE ROAD FISHERS ISLAND~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 5 Block 2 Lot 10.9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this offzce dated SEPTEMBER 10r 1986 pursuant to which Building Permit No. 15272-Z dated SEPTEMBER 17~ 1986 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certmfmcate is lssued is DECK ADDITION TO EXISTING ONE FAMILY DWEJJ,ING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Bulldlhg In~ec'tor' ' J Rev. 1/81 FOW'M' NO. J TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15272 Z Map No 1000 Sechon /, Block ...... County Tax ~. ........ Lot No ..~...~., pursuant to ~pphcahon datecl.-r'/~ //~' ... 19. ~lr'(~and approved by the B u ~ ~.~1 Inspector uilding Inspector .Rev TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUT~OLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ..'(. .... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND HOUSE NO. STREET HAMLET Cnumty Tax Map No. Property ........................................ lO00 Secglon o Block .~'~. Lot .. % Subdivision ....................... Filed Map ........ Lot .......... ~lth Dept. Approval ..... V./.~ .......... Uode=~ri=e~ A~ro~o~..~./.~. ....... Planning Hoard Approval ..~3.~. .......... Request for Temporary Certificate ....... Final Certificate rev. I0!14/88 FORM ~0. 6 TOWH OF so[ri'HOLD BUILDING DEP/dl'I'HE1T~ TOWN HAL~ 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS This application must be filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: ]. 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). 3. Approval of electrical imstallation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that solder used in system contains less thau 2/10 of ]Z lead. 5. Commercial buildings, industrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the Architect or Engzneer 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 and "pre-existing" land uses: I. Accurate survey of property showing all property lines, stxeets, buildings and unusual natural or topographic features. 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, ]957. If a Ceztificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or ocher pertinemt information required to prepare a certificate. For Vacant Land Certificate of Occupancy: I. Aa application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior to April 9, ]957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. FEES: 3. 4. 5. 6. CERTIFICATE OF OCCUPANCY - New Dwelling $25°00, Additions to Dwelling $25.00, Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - Businesses $50.00. Certificate of Occupancy on pre-existing dwelling - $100.00. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00 Vacant Land Certificate of Occupancy - $20.00 Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - $25.00 Residemtial $50.00 Commercial er. ELD I~;SUECTtON CO,I,i~,,'~ ...... ~ ,UNDAT!ON (1st) UNDATION ( 2nd ) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: NOTT'~ ~NG DE~AET~,,+~T 7~5-]802 9 AM TO ~ ~M FOR FOLLOWING IN~ECTION~. L FOR ~OURED ~ON~RETE 2. ROUGH . FRAMING ~ PLUMDING ~. INSU~T~ON 4. FINAL ~ CON'STRO~Ti~'N Mus~ BE COMPL:TF F~R C, 0 ALL CON~T~UCmlON ~HALL MEE¢ THE REQUIDEMEN~ OF THE N Y ~A~ CONSTRUCTION ~ ENFRGY ~OD~ N~ ~P~'mONSID[ E FOR D~IGN O~ ¢:GN~fRUCTION ~PPORS 17' 'FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y 11971 TEL 765-1802 Examined ......... 19 Approved , 19 Permit No D~sapproved a/c ......... ! TO~ ~tN OF $" J", ' ~ ~ ~ Received ........... ,19.. (Bufldzng Inspector) A['?LiCATIOhl ,"OR BUILD!.~JG PE~.~IT INSTRUCTIONS a This application must be completely filled m by typewriter or in ~nk and submitted to the Building Inspector, w~th 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 streei or areas, and g~vmg a detmled description of layout of property must be drawn on the d~agmm which ~s part of tlus appl catmn. c. The work covered by tlus apphcatmn may not be commenced before issuance of Bufldmg Permit d Upon approval of flus application, the Braiding Inspector will issued a Budding Permit to the apphcant. Such perm shall be kept on the premises available for inspection throughout the work e. No building shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmldmg Permit pursuant to tl Buil&ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmances Regulations, for the constmcQon of buildings, addttmns or alterations, or for removal or demohtion, as hereto describe, The apphcant agrees to comply with all apphcable laws, ordinances, bu$1dzjag~code, housmg code, and regulatmns, and admit authorized inspectors on premises and m bmldmg for neces~ /,J(Slgnature of~phcant, or,,namff, if a corRolatlon) (Maflmg address of apphcant),"~ ~m, State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber~o~b~ul~ · .......... .... If apphcg~.t ~s a)zorporAt~on~slgn~gg, r~of duly)3uthonzed officer (Name and title of corporate officer Builder's License No " ... Plumber's LlcenseNo Electrician's License No Other Trade's L~cense No Location of land on which proposed work w~l be done House Num~-er Street County Tax Map No 1000 Section . / ... Block Hamlet ..... ot. /c7 .......... 4 Subdivision, ...~,tNa~ ..... Filed Map No .. Lot ....... State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy .~..7~.. ~.../~....~_~.i, ...................... b Intended use and occupancy ..... 3. Nature of work (check which applicable) New Braiding ... Addition .......... Alteration ....... Repair .. Removal ........... Demohtlon . .A/ ...... Other Work ......... ~.~. o ~..~,, ~..~. (Description) 4. EsUmated Cost..'Y-I ..~. C) C~ O Fee (to be paid on filing this apphcatlon) 5. If dwelhng, number of dwelling units ......... Number of dwelling units on each floor ............ If garage, number of cars ................................................. 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structures, if any. Front ........... Rear ........... Depth .......... Height ..... Number of Stones ......................................... D~mens~ons of same structure with alterations or additions. 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 .............. Nam of Former Owner ..................... I 1. Zone or use district In wh,.ch prom'.sos are situated ./Z~. . ~ ................................ 12. Does proposed construction violate any zomng law, ordinance or regulation' .. 13 Will lot be regraded .... .~ ~' .......... Will excess fill be removed from premises. Yes N 14 Name of Owner of premises .......... Address .............. Phone No ............. Name of Architect ................ Address ........... Phone No ............ Name of Contractor ............... Address ............ Phone No ........... PLOT DIAGRAM Locate clearly and chstmctly all buddings, whether existing or proposed, and, indicate all set-back dimensions frot property hnes. Give street and block number or descnpt]on according to deed, and show street names and mdmate wheth. interior or corner lot STATE OF NEW ¥OKK, S S COUNTY OF ....... .... being duly sworn, deposes and says that he is the apphca~ '~Name of individual s~gmng contract) above named. He is 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 th apphcatlon, that all statements contained m this application are true to the best of his knowledge and behef, and that tk work w~/1 be performed in the manner set forth m the application filed therewith. Sworn to before me this ........... ?....dayof . , NotaryPubhc, ... ~. ~. ~.~.~.~..'::: "~:3nty '~>: ~/~I fA' " ........... ~o llo~I& s~7 (S~gnature of applican