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Home My WebLink About14782-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20968 Date AUGUST 25~ 1992 THIS CERTIFIES that the buildin~ Location of Property 51750 MAIN ROAD House No. County Tax Map No. 1000 Section 63 Subdivision ACCESSORY SOUTHOLD~ N.Y. Street Hamlet Block 6 Lot 4 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 14, 1986 pursuant to which Building Permit No. I4782-Z dated APRIL 24, 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 THREE CAR GARAGE AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ALEXANDER KOKE & WILLIAM RUSCH Rev. 1/81 BuJ~g InspeCtor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PER./~41T CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLk-TION OF THE WORK AUTHORIZED) N? 14752 Z Date .... .~¢u-,~..~ ................................. Permission fs hereby granted to: .... ~.~...¢.....~.~......:...~....,. ................... ..~..~&......u...:~.:..).).~ ~..~ .......... ,o at premises located at ....~:~,.~..L...~...~..~.. ....... ...~...~.....~..: ........ ~-~.~ .................... ,I County Tax Map No. 1000 Section ..... ..(~.....~...,.~. ...... Block ....... ..~...~ .......Lot No. '~ pursuant to application dated ..... . .~.......!...~. ......................... , 19.~..(~, and approved by the BuiJdJng Inspector. Building Inspector Rev. 6/30/80 Form No. 6 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 Underwriters. 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 '.'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 an~'~ 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 i. Certificate 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 Building - $100.00 3.Copy of Certificate of Occupancy - $5.00 o~er 5 years - $10.00 4..Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .. . ................... ~ew Construction ...... ~.... Ol'd Or Pre-existing Building. ", House No, Street Hamlet ounty Tax Map No I000, Section...~'~5 .... Block ...... qB Lot.~.~. .............. ubdivi.sion . , , .................................... Filed Map ............ Lot.. . ~alth Dept. Approval ........ .~.l~. .............. Underwriters Approval ..... ~./~ .............. [anning Board Approval ................... ~quest for: Temporary Certificate ........... Final Certicate ......... FIELD/IN S_~E C T I ON FOUNDA'TION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL Ye ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... Date ........ ~'~.. 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building 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 constrdction 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 necessary inspections. ~ ... M..~.a.,~..~.l;Je~,...~o,to~.. ~. (Signature of applicant, or name, if a corporation) ~¥~7..c.o. to,,t.,~.¢....~.~.... ~..~....t~.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~.$*r~d~.<....~o~...~...OJ. tl/rn~.../.~e:~c~. ...................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . -&trna, ............. ........ (Name and title of corporate officer) Builder's License No... Plumber's License No.. Electrician's License No. Other Trade's License No ..... ~//~ ............ 1. Location of land on which proposed work will be done .................................................. ...~"/J'. ~.O ................~/..~../.,~....~..r9 ....... (.~...z.~. ............ ~ o. ~/~0 t-tg. ........ House Number Street Hamlet County Tax Map No. 1000 Section ..... b. 5 ........ Block ....... .~. ......... Lot... 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 ..... .~..~.~... F4~.. ?..~_....P~(~; .............................. b. Intended use and occupancy . ~ ............. ~ ~ ~.~~~'~?~;~i~)/~~., ~ ~ ~ ._~,~.,~_~ ~..,~:.,~~ ~ . .~ ............ 3. Nature of work (check which ~pplicable): New Building ..... ' ..... Addition ...... Alteration .......... Repa~,~M,.;.I.~ .~[~ ..... Removal .............. Demolition .............. OtherWork ............... (Description) i~:i~:E.;t:~.~ at;d Cost ...... /t~.,.~ ......................... Fee,~, ...................................... (to be. paid on filing this application) · I ell ng, number Of dwe'lli g units ............... Number of dwelling units on each floor ................ If garage, number of cars ...... 3. · .~..~ ......................................................... 6. If business, commercial or raised occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nttmber of Stories ........................................................ - Dimensions of same structure with alterations or addmons: Front ................. Rear .................. Depth Height Number of Stories 8. Dimensions of entire new con~tmction: Front ..... ~.~. ....... Rear .... ;~.~. ........ Depth ...~-~. ......... Height ... / ........ U~ber of Stories ....... /. ......... ; .................................... 9. Size of lot: Front ...... .~..O. ............ Rear .......... ~.~ ......... Depth ... ~...Z:. ~-~ i~. ......... 10. Date of Purchase ......... : .................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does pr0Posed construction violate any zoning law, ordinance or regulation: ............ ,4d.O ................ 13. Will ldt be regraded ..... ~.g}. .................. Will excess fill be removed from premises: Yes P(. No 14. Name of Owner of premises .: ................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ............... PLOT DIAGRAM Locate clearly and distinctly 11 buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK - - " COUNTY OF..v._~_ (~--/'~ "7"D (~ I ......... ......... (Name°findividualsi~ninac°nt,, ' '' g ' g 0ntract) above named· He is the ..................... ! ......(~.~J~. 0~..Z~......~.~'..~'.~..~.~:..~. .................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dOly authorized to perform or have performed the said work and to make and file this' application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manffer set forth in the application filed therewith. Sworn to before me this [ ............' ~..../. ~....day 6f ....... ~. t~.. ( .~. ..... , 19 ' (d L~IT..~]ETH A Ye~k ''' 7'-T':~" ~" "' .................... ~l~-.~.8~[~O~,8*su~t~ ./' (Signature of applicanQ No. 82, 81 Term Expire, O~tob4r 31 WITHOUT CERTIFICATE OF'OCCUPANCY ·