The URL can be used to link to this page

Home My WebLink About14322-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMBNT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20969 Date AUGUST 25~ 1992 THIS CERTIFIES that the building 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 SEPTEMBER 12, 1985 pursuant to which Building Permit No. i4322-Z dated OCTOBER 1, 1985 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 AB 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 / B~ding I ns~e~{6r TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- i4322 Z O~e .............. ../..~../../. .............................. , w.~..y- Permission is hereby granted to: ...... .~..o..!~ ...... ~.~.ct~.,l ....... ~.~.L./..~.c..~? ........... ..s.~.~!~..~.~ ........ .~:..'(.,. ............................ co~).d ~,~'f q'k~'~- ¢~-~ . &~)...T, ........................................ at premises ocmtea ar ............I;.V.., ......................................................... ~ ............................................... pursuant ,o application dated ............................... %X/..~.. ............... , 19..~..~.., and approved by the Building 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 f~om 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 "pre-existing" land uses: 1. .Accurate survey ~f property showing all property lines, streets, bJilding 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 1. 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. Cer.tificate of Occupancy on Pre-existing Building - $100.00 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 I Bate ,ocatfon of Property:.. 3.1.~0 ....... ~z~.~...[~[0~ "' House No. ' Stro' '-~-~ ................. ~~' ~ Hamlet nwer or Owners of Property .... ~~. ~ ~ ~.~ ~ . 000, ...... ...... ~bdivision ' ' ' Filed Map Lot [alth Dept. Approval ............ ~t~ ......... Underwriters Approval.-~ ........... anning Board Approval .......... ~ ......... ' ....... . quest for: Temporary Certificate .... Final CerCica~e. .................. cO doq6 ' -' ' - · FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual naturat or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(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 compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate s~rvey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion requ ired to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 (~./%C~.~L 5. Upda~:ed C.O. $15.00 Date .. .,. ,/. .O~, ~.~..~.. ...... New Cons t ~uc t i on.. ..~... Old or Pre-existing Building ............ Vacant Land ............. Location of Property..~./.~..~.~L? .......... "~'~..~.~....................... Hou,~e No. Street Ham/et Owner or Owners of Property .~'(~/L~.~-t~', /.40.-/(~.~v..~.. ~.t~........~..~.. .... County Tax Map No. 1000 Section ........... Block ............ Lot ............. Subdivision ............ Filed Map No ........... Lot No .............. Permit No. ......... Date of Permit .Applicant . . D · · .'. · · App Health Dept. Approval ................... Labor Dept, royal ........... ..... Underwriters Approval ~ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . Fee Submitted $..~ ..... Construction on above described building and permit meets all applicable codes and regulations. Applicant . ~, ~ ~.L~/C~,,, ,~.;, .~.~,~, ,/~,:, ] , :~..~, ,~,, .......... Rev. 10-10-7a FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(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 compliance 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 April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building .,. ~ ...... Old or Pre-existing Building $15.00 ............ Vacant Land ............. Location of Property .'~.~.Z..~'.~. .~.~..~1~...~.~... .:~....~f...~., .~.~ House No, Street Ham/et Owner or Owners of Property .. ~;;~/~,~..~...~./~....~.,. ,~, .//./~./.~1~, .~,`,` .~.,(~.:~.~,,,~, .... County Tax Map No. 1000 Section ..... ~1~.~. ..... Block ....... ~. ...... Lot ...... .~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.~. ~.~Z. Date of Permit. ~, .O~/~'Applicant.. Health Dept, Approval ..... ~./~. ............. Labor Dept. Approval .... , .~/.~ ............... Underwriters Approval ....... ~/~11, ........... Planning Board Approval .... 41~..~ ............. Request for Temporary Certificate ..................... Final Certificate ..... ~ ............. Fee Submitted $ .. ,4~; 0. O. ................... Construction on above described building and permit meets all applicable codes and regulations. 'OUNDATION (~nd) '(OUGH FRAME & PLUMBING iI~SULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 0 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 'IST [ 1 ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [] FRAMING ~FINAL , ,,d-/~-~x '~ U 7"' DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... BLDG. DEPT. TOWN OF, SOUI'HOLD, Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 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 necessary inspections. · ~//'~.. d~,xr.~./... ~. ~,~. 4o~.,~. ,'.~ .... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....~..~. ,g~.t~E-~t'./~. ~ .... ~ .~.f.~t..~7~......~..t~.~..<7.~ .~.. .................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. · ..-,7. ........ (Name and title of corporate officer) Builder's License No .... ~..o~/. ................. Plumber's License No ...... . ./Y//~ .............. Electrician's License No .....~./,d .............. Other Trade's License No....~.?~ 1. Location of land on which proposed work will be done .................................................. ........ ....... ...... . ....... ................ House Number Street Hamlet County Tax Map No. 1000 Section .................. Block ..... ~ Lot Subdivision,.. ' Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ..~.~.~...~.(.~. . .~,~ ~ ............................. ~use occupancy .... -- --t~ ---- "r' /~' '~'ff~-'~"~"~' - b. Inteuded and ~..l~....~....t~..~.~.z~. ~L/~,d>~,] ' · 3/ Nature 0fwork (check which applicable): New Building .......... Addition. . Alteration l~t~i~ ~[. q~g ......... R~moval .............. Demolition .............. Other Work ............... 4.' 'Estimated Cost..~: ......................................... - 'vtf~- ,.:. , (to be paid on filing this application) $. if dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ' ,fl. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ 7. Dimensions of existing stmcfures, ifany: Front ............... Rear .............. Depth .......... Number of Stories Height .................................................................. ~ ' alterations or additions Front Rear Dimensions of same structur0 with .............................. Depth ................. ] .....Height ...................... Number of Stories ................. 8 .... Front Rear Depth .Dlmenstons of enttre new copstructlon ........................................ Height . .. ............. ,~qum~er of Stories ................ ,~ ...................................... 9. Size of lot. Front ....... ,~_,~ ........... Rear ..... ~,~. ............ Depth . .~.~." 10. Date of Purchase .... ~./.~.4 ' Name of Former O .............. . . ................... wner . i ........... 11. Zone or use district in which' premises are situated ......................... i '. .............. 1.2. Does proposed construction ~iolate any zoning law, ordinance or regulation.. ........ Ad o. ................... 13. Will lot be regraded .... &/.o. .................... Will excess fill be removed from premises: Yes ~ Nc 14. Name of Owner of premises !x$~Z,a'f-~/,e~. ~;. ~.. Address .-~f(~. ~e-~C ~:~.... Phone No. Z~0'...--.?.6.~; .~'. · · Name of Contractor .'~(0~..~' .~'~>OL~.. Address .<"~..._ .,~.. .... Phone No. 7'~d~..-/uf'~f~.-... PLOT DIAGRAM Locat~ clearly and disfinctl~i all buildings, whether existing or proposed, and, indicate all set-back dimensions frorr property lines. Give street and bl ~ck number or description according to deed, and show street names and indicate whethe: interior or corner lot. STATE OF NEW YORK, COUNTY OF . . ,~"O~ .... .......... ~.'V~.4. ~ .~..'¥.~C.~'..~ .................. being duly sworn, deposes and says that he is the applicar- (Name of individual signing contract) ' above n'amed, 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 application; that all statements Contained in this application are true to the best of his knowledge and belief; and that ti=_ work will be performed in the m~nner set forth in the application filed therewith. Sworn to before me this., Notaz7 Public ,67~..q~Jj. ~.~.. l;ounty LINDA F. KOWALSK[ NOTARY PUIBLIC, $tat~ of ~ Yo~ · . N0 52~.4524771 0ommls~lan Expires March 30~ [9~ (Signature of applicam D ~ 4~X~p