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Home My WebLink About15040-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19818 Date MARCH 27, 1991 THIS CERTIFIES that the building ACCESSORY Location of Property 2710 PRIVATE ROAD #18 House No. Street County Tax Map No. 1000 Section 54 Block Subdivision Filed Map No. SOUTHOLD~ N.Y. Hamlet Lot 14 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 18, 1986 pursuant to which Building Permit No. 15040-Z dated JUNE 27~ 1986 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY SHED AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED EDWARD OFFENHEISER~ DECEASED 'Building Inspector Rev. 1/Sl FOB, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHO~-D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15040 Z Dote ...... ...], ...................................... , ....... Permission is hereby granted~Lo: -- & . ...... ...~...':.!.~ ....... ~..0....~ ................................ .~.....~....~....~....~.:,/..:...,.,,./..?....~ ..... , ~ at premises located at.~..,.~..:.g~....:...~.....~;~~...4~......~.:.....~....~ ........ County Tax Map No. 1000 Section .... ~....~.~....~.. ....... Block ....... .,~...J ......... Lot No. to application doted .... ...~..~.J.....~. ....................... , 19...~...~., and pursuant Building Inspector. approved by the Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ~ALL 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: 1. 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, multiple residences and similar buildings 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and 'Jpre-existzng 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 applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.0gj Alterations to dwelling $25.00, Swirmning pool $25.00, Accessory Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $i00.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 / Date . ~a~t~c~][['~'.'[~d.o..~.~.~x..i~s.s~n~u,.~.~[[[[i[ ......... House No. Street Hamlet 0 Onwer or Owners of Property ~ '. . ' .. County Tax Map No 1000, Section....~.7.~. ...... Block......../ ........Lot ..... ~.~.'.............. Subdivision .................................... Filed Map ........... . Lot .................... . . Permit No..f~O. · . . ........~ . .Date Of Permit..~.~....... ~ g, .Applicant .~.~.( .~.. .,..6~7~ O..~/~? f~.~,fj CC~_.. Health Dept. Approval ........................ . . Underwriters Approval ........................ . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... ,Se. eL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ]/~JLATION FRAMING ,r./~ FINAL INSPECTOR DATE FIELD INSFECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS'. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . t Approved.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG, DEPT, TOWN OF SOUTHOLD : Received ........... ,19... Date x.%,tv~ / 9 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets · or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- · cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until 0 Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bdilding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to// admit authorized inspectors on premises and in building for necessdrv inspections. (Signature of applicant,, or na'nfe, if a corporation) ...~..~.: ./. ?...0..,,..?~.: ................... .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~'~.....~.t~. al.o(..~...~. ..... .~.~C .~..M. (~. ~-. (5.<7.../'~.. ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .ff..'?..~. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... p . ,. ,. ~ - a~" ';_~~ ~ 1. Location of land on which proposed work will be done. ~. ·. ~ .................................~ House Number Street Hamlet County Tax Map No. 1000 Section ....... ~.~. ..... Block ...~ ......................... [~-.t. .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.~ ~. ........................................................ b. Intended use and occupancy .. ~.~....~g~. · 5~.~.~.. ~ ~ .... ~ ~.. ~ ~ ~ ~.~ .... · Nature of work (check which applicable): New Building ....... Addition . i ......... Alteration ......... Repair .............. Removal .............. Demolition .......... i. - Other Work .~.74.~.+.~. .,5'~ .~. , (Description) 4. Estimated Cost ........ ?.~ ............................ Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units [~'o '~el/tM,./~-.~'14,r.~ ............... r~um,er of dwelling un!ts on each floor ................ If garage, number of cars ............ . .--TT-:.. ........................... ~ ............................. 6. If business, commercial or mixed occupancy, specffynatureandextentofeachtgpeofuse ...Tr. ................ 7. Dimensions of existing structures, if any: Front....... ~ Rear ... ~ .... Depth....~....f~7~.~ ... .... Height ...... :v~. ...... Number of Stories ...... .-w-7.. .................. ~ ............................. Dimensions of same structure with alterations or additions: Front ..: ;.; ..... [ ...... Rear .... ~... ......... De h '---' ' ~' ' pt ......... ; ............ Height ...................... Num~,~r o? Stones ............... 8. Dimensions of entire new eonstruetion: Front ...... ~. ....... Rear 9. t ....... Rear.. '"" :::::: ::::'::: : 10. Zone or use districi i; ~Ji;~'n'r;~'i;e's'ir;'sit~'ai;~ .... , ~,01 ~,~ ~'~,~ ...................... 11. . ........ ~.- . ~.~-._.¢ ,,.., ......................... 12. Does proposed constructlon violate any zoning law, o~'~r~8 ~on'~'~:~li .. . 13. Will lot be regraded .......................... ~.'~t~i~_c~ iii~;~ ~'~premises: Yes No 14. Name of Owner of premises/.2~,, .~.c~..~... 0~./.h..,~.~q~d~l~'~.~ .~..~ ~.~f. qll~one No.TJ.~.. ~. T.~.. t?...~.~. Name of Architect .......... A d~s"lJ' ,~..~..--x ..~ [ ,~:~.. Phone No ............... Name of Contractor ~.,¢..~.~. ~o.~ .~.e?.~ .P~.~.t4.~f. Addr~s~1~..~ 15. Is this property located withinl,00 feet of a t~' J~'~';'~g~'. .... N'o'..]~ ....... * If yes, Southold Town Trustees Permit may be requ~ PLOT DIAGRAM~ Locate clearly and distinctly all buildings, whether existing or proposed, anddndicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF....~..t~.. ~.~..~7. ~.. /?£.~.. £ ~ .~../~..o. ~£( .~?.~/.~.~.. .............. (Name of individual signing contract) above named. 1 FOUNi~A q[iN ~0 ~EQU~REO FO:R ~OURED CONCRETE 2 ROUG~ F~A~ING a PLUMBING ~ INSULA rlOe~ ~. FiNAL CoN~TRUCTI(')N MUST BI CUMPt-ETE flOR CQ ALL ~:ONST~UCTION S~ALL THE ~EQ¢I~MENTS O~ ~E N. ~ATE co~TRUC~ON & ~ERGY COD~. NOT ~NSffiLE m~IGN OR C, ONSTRUC~ON ~RORS. being duly sworn, depo}es and says that he is the applicant 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 tnake and file this application; that all statements contained in this application are true to the best of hisl knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before ~he this ............ /. ~ ....... day of ...... ~.~. .... ,~19.0~..-~ ' ~ ~...//-~ c~r~o ~ . / Notary Public, ~ ././'~~...~ounty/} . ] ' ,, . ~ ' : /