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Home My WebLink About15302-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 514903 Date September 22, , t9 .B.6 THIS CERTIFIES that the budding .. Accessory Shed Location of Property 410 Woodclzff Drxve Mattltuck, N.Y. County Tax Map No. 1000 Section . .1.q7. ..... Block . 08 . .Lot . 14 Subdivision .......................... Fried Map No ......... Lot No .............. conforms substantmlly to the Apphcatmn for Buildtng Penmt heretofore filed m tins office dated .S. ep..~.e.rn.b.e..~ .1.0t .... ,19 .8 6pursuant to wtuch Bmlding Permit No 15302 Z dated .S.c.p.fi,e.m.b e..~..2 ~., ........ 19..8.6, was issued, and conforms to all of the reqmrements of the apphcable provis~ons of the law The occupancy for which tlus certfficate ~s ~ssued ~s ......... Accessory Shed Thecerttflcatelstssuedto James & Dorzs Klezn (owner, of the aforesaid binlding. N/A Suffolk County Department of Health Approval ........................................ UNDERWRITERS CERTIFICATE NO ............. .N./.A. ........................... Bmld~ng Inspector Rev 1/81 TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PER~,~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15302 Z Perm~ssron ~s hereby gront~o ..ii~..~;i~...~.~.~.~ ........................ .~.~....~..:.~.,...!..,...~.~.~ ....... 'o .-~.~.....-~.....~-~...'~ .-...~.......xr~-~ ............. at premises located at ....... - ....... County Tax Map No 1000 Section pursuant to apphcat~on dated Building Inspector. Fee Block ~ ~' Lot No '~ .)..~) ..... , 19.~L~b, ond opproved by the Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- t802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be hlled in typewriter OR ink, and submitted ~ Imm.m~a to the Building Inspec- tor w~th the following; for new buildings or new use: 1. Final survey of property with accurate Iocatmn of all buildings, property lines, streets, and unusual natural or topographm features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal-(S-9 form or equal). 3. Approval of electrical Installation from Board of Fire Underwriters. 4. Commercial buildings, industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-exist~ng" 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 condmon of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion reqmred to prepare a certificate. C, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 Newconstruction ...... Old or Pre-existing Building $15.00 ........... ......... .. Vacant Land ......... ... . Location of Property .... ./'/./..~. .... ~.~. ~. ..... .c_ ......... House No. ~ ~ Strut Ham/et Owner or Owners of Prope~ ...... CounWTax Map No. 1000 Section . .l~ 7 ....... Block ...~ .......... Lot...7.~ ........ Subdivmion .............................. Fded Map No ........... Lot No ............ Permit No ........... Date of Permit ...... Applicant ... /-f~'~ ..... Health Dept. Approval ....................... .Labor Dept. Approval .................... , ,. Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $ ........................... Construction on above dese,bed budding an2~erm~t rneets all applicable codes and regulations, Applicant .~:2--1,~'~'~,~- ....... ~..J~ ....................... ..1 R~v. 10 10-78 R. c. 3o31 FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION XST [ ] []FOUNDATION 2ND [ ] []FRAMING REMARKS: ROUGH PLBG. INSULATION [ ] FINAL DATE INSPECTOR FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y 11971 TEL,: 765-1802 Approve~.~'t-4e -'~l, 19~ Permxt No ) ~'.~O .~, ~ Disapproved a/c (Bmldmg Inspector) APPLICATION FOR BUILDING PERMIT Rece2, ved ........... ,19. Date . . ., 19~ INSTRUCTIONS a Tins application must be completely filled m by typewriter or in ~nk and submitted to the Budding Inspector, wltl sets of plans, accurate plot plan to scale Fee~¥cordnlg to schedule b. Plot plan showing location of lot ~ b.m~s cx~'l~eanises, relationsh~p to adjoining premises or public sire or areas, and giving a detmled descnp~ p ~t~'~ll~y~rnust be drawn on the diagram whmh Is part of tins ap, cation ~.~ % --'~'~ ,t'_~'~~' c.' The work covered by tbas I1~ [lcllk~l~'~c'~mmenced before issuance of Building Permit. d Upon approval of tins~a4~l]~ ~l~[~pector wall issued a Building Permit to the applicant Such pen shall be kept on the premlse~ll~b~ i~p~lli~t~hout the work. e. No bufldmg shall.~l~c"~pt~l' ~ ~t~hll~'~ part for any purpose whatever untd a Certfficate of Occupm shall have been granted t~l~t~ J~d.~ APPLICATION IS HE~i~ f~.~n?dmg Department for the issuance of a Buildmg Permit pursuant to ' Building Zone Ordmance of t~_~ [,~t~'~ld, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the constmct.~! 1~, ad&huns or alterations, or for removal or demohtlon, as herem descnb The apphcant agrees to comply wlt~ a~phcable laws, ordinances, budding code, housing code, and regulations, and admatauthonzedmspectorsonpremt~ hndm bmldmgforneces~mspectmns.. , . q~_ (Slgn~ure of applicant, or name, if a corporahon) ................ tmai±~-ng address or appz±can~) State whether applicant ~s owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or bmld, .C)~ ~v' ......... , - ovm OTW Ifapphcantlsacorporatlon, slgnatureofdulyauthorlzedofficer ~(. / gy~ ~ L, NOT~ BUI~ING DEPARTMENT AT 705-1~2 9 AM TO 4 ~ ~R ~E FOLLOWING IN~C~ONS (Name and title of corporate officer) Builder's License No . Plumber's License No .... Electrician's License No ...... Other Trade's License No Location of land on which proposed work will be done House Number County Tax Map No 1000 Sectmn . . J ~.~ 3. INSULAfIOr; 4 FINAL CCt*,LOTRUCI'K'~N MUST BE COMPrElL FOR C O ALL CONSTRUCTION S~cL MEET THE REQUW~ENTS OF rile N,Y Hamlet Block ..... ~.~ ....... Lot. /.~. ......... 2 Subdivision . Filed Map No Lot (Name) State existing use and occupancy of premises and il!tended use and occupancy of proposed construction a Existing use and occupancy ~/4,t, '/G~ //o O'd~. .. b Intended use and occupancy ~'7'~o*/ ~-~O~*.. ~'~d ....... 3. Nature of work (check which apphcable). New Budding ..... Addition .... Alteration ....... Repair ....... Removal ........... Demohtlon .......... Other Work~o/r -/~] .~o,~t~O (Description) 4. Estunated Cost .............. Fee ........................... (to be paid on fihng this application) 5 If dwelhng, number of dwelhng units . .' .: ..... Number of dwelling umts on each floor ~ If garage number of cars ---- 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use -- ~ ~ ~,', ...... 7. Dimensions of exmtmg structures, if any Front . ,C,~ . .. Rear ~-2, ... Depth ~, ..... Height . .26, ~'... . Number of Stones .... / .... Dunenmons of same structure with alterations or additions Front --" Rear ~ Depth . '-7. ..... Hmght . ~ ~ Number of Stones. /. ............. 8 Dm~enslons of entire new construction Front . /O. / . . Rear . Jig>." ..... Depth ...~. f. . Height .8 ....... Numb~r~of Stones / ..... ~,., ................ ~, ........ 9. i~laZ~eOof/~tucFt~aOs~t . ' ...~T-..:. R~7 ......... ~,~ ......... 10. r ~. ~-' ~.' . . Na/.mTof~er Owner De .,~/~i~.~. 4~ ..... I 1 Zone or use district in which premises are situated .................................. 12 Does proposed construction violate any zoninglaw, ordinance or regulation' ...~.~ ................. 13. Will lot be regraded .... /1/~ ........ , .. Will excess fill be remoYed from premises: Yes 14. Name of Owner ofpremmes ,Ja4~e~ j/,/, ~/~.. Addressf.~ ~ /. ~X.~.,-C?~Phone No.~¢~.-~<~ .~.. Name of Architect ............. Address ........... Phone No .......... Name of Contractor .......... Address ......... Phone No ............ 15. Is this property located with~nl00 feet of a t~dai wetland? * Yes ..... No ~P~.. · If yes, Southold Town Trustees Permzt may be required. PLOT DIAGRAM Locate cleazly and d~stmctly all bufldkngs, whether exlstmg or proposed, and, indicate all set-back dnnensmns from property hnes Give street and block number or descnphon according to deed, and show street names and indicate whether interior or comer lot. TATE OF NEW YORK, S.S 'OUmq'OF ..... . · ~/ (Name oflndimdual slgmng contract) vove nimed being duly sworn, deposes and says that he is the applicant is the (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )phcation, that all statements contained m this application are true to the best of his knowledge and belief, and that the ork will be performed in the manner set forth m the application filed therewith. ~orn to before me thru ..fl~ ........ , 19 Ot~. Coun (Stgnature of applicant)