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Home My WebLink About13789-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20295 Date OCTOBER 21~ 1991 THIS CERTIFIES that the building. Location of Property HEDGE STREET House No. County Tax Map No. 1000 Section 10 Subdivision ADDITION FISHERS ISLAND~ N.Y. Street Hamlet Block 7 Lot 17 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 22~ 1985 pursuant to which Building Permit No. I3789-Z dated MARCH 26~ 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 SUN PORCH ADDITION TO EXISTING ONE FAMILY DW~TJ.ING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FRANCIS T. DOYEN N/A '- B6ilding ~nspector Rev. 1/81 I~OB~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13789 Z Permission is hereby granted to: ..~.~.~ ~. .....~..~...~.~.~ ............................................ ...~.....~....~...~. Co~n~ Tox MM No. 10o0 S~ct~on ..... .~..L.O.. ....... B~o~k ........ ~ .......... ~ot ~o ...... 1....'7. ........... eursuont to application dated ...... ..~.~.....,~-~..~. ................, 19...~...~., and approved by the Building Inspector. Fee $..~..'~.....:...'~.... .... Building In,q~ctor Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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. 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 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. 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. 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 ......... ?/J.~./~. ~ .................. ... New Construction....~.. ..... Old Or Pre-ex/~_ting Building .............. Location of Property...~.~ .......... ,--.~. ................ [[[ .... ~. ~.~...~- House No. Street Hamlet Onwer or Owners of Property ..... ~....~..~. ~ ~....~..% .~..~.~.. ........................... County Tax Map No 1000, Section...~.~..~ ..... Block ................ Lot ...................... Subdivision ............................ ... .. . .. Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ....... Applicant.. ~ ~.~.. . ~ Health Dept. Approval ........................ Underwriters Approval ............. Planning Board Approval ....................... . Request for: Fee Submitted: Temporary Certificate ........... Final Certicate ........... FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ODE FINAL ~.7 ,, ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..¥)~ .o,/¥.~..~...~..., 19~(. Approved ...~...O4k-..~...&..b.., 195.~. Permit No..}..~..~. ~..~..~. Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 pumuant 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. /fl · ......... (Signature of applicant, or name, i~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 ...~..~t~r-,/.G/~ .... . .T... .... ~.~ .,)/~.x,,/ ..................................... (as on th~ 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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .............................. · .................... ........................ .... .......... ............ House Number Street Hamlet Map No. 1000 Section ..... .(~.l ..O. ..... Block ....... '~7 ......... Lot ..... l..~ .......... County Tax 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 ..... ]~)./~. ~ I J2./~.~J .'~.../../t L ......................................... b. Intended use and occupancy ..... :..'.~· .'°r..t~.~. .....~...~...~. 'O&C~ ............. : ........ 3. Nature ofwoik (check which applicable): New Building .\...' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work J~.~-~. ~ .t4. i..i-.b.. (Description) 4. Estimated Cost~. .~...o..o.o.: .o.~. ......................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units 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 existing structures, if any: Front. ,5.)/./. ........ Rear . ~.~..~ ....... Depth . ...~U-/D../ ....... Height . 2~. (~. ( ........ Number of Stories . .~ .................. ., ................................. Dimensions of same structure with alterations ~r additions: Front ... ~ .~../ ......... Rear . .~ .~./. .......... Depth . .-..~- 0.. ./ ............... Height .. ~ P../ .............. Number of Stories .... J,~ ................ Dimensions of entire new construction Front .... I.D. f ....... Rear ..... /.0.( ..... Depth .. ~.~.../ ........ Height ............... .N/umber of Stories ..... J. ..................................... ~ ........... Size of lot: Front .... /'/~. · ~ ............ Rear ..... .~O .r. ........... Depth .... /~,~/'~ ............. Date of Purchase ....~./././,_577 .............. .~4Name of Formor Owner . (,~.:..~.4/./IJ, Q,~,~./) ........... Zone or use d~stnct in wh~ct/premises are situated.../[<! ~5 ! ?).~/,/75.,~G~. .... ._.~ .......................... Does proposed construction vi~)late any zoning law, ordinance or regulation: ../.~//~. ......................... Will lot be regraded .... v,~.. ·: ..... ~ ......... Will excess fill be removed from premises: Yes Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate 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 coruer lot. 9. 10. 11. 12. 13. 14. STATE OF NEW YORK, COUNTY OF .~, c.,~T./-~(./C.. S.S ...... ~.~.,/(~..~.1.~......"~.....,~.~/.~'.~. .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...... .~../~..~..er~'.~.. ......................................................................... (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 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 manner set forth in the application filed therewith. Sworn to before me this ........ ~.."~.. .......... day of...~'t..~...~. .......... , 19~.~I~. Notary Public, ...~,~. 'r-., ....... /~J..~' .J~. -~ ....... County ...... N01AR¥ PUOU0, STATE 0F NEW ¥0RI( (Signatflrb of applicant) WO. 52-8267{B0 - SI~FFOt. W 600W'{~ COMMISSION EXPIRES MARCH 30, 19~'& ~ATE: B.P. ~ .... FEE: BY: NO~I~ .......g')}LDING DEPARTMFNT 765-1809 9 AM TO 4 PM FOR ]. FOU~P-.*'d~'q - TV.,'O R~QUIRED FOR -~ ~ ,,, ~ .:.~ CONCP. FTff 3. INSUI 4. g]k,~l r ..... ~ , ] ~AUST - · ALL C~ ~' u)~d 5 ~,-~1I MEET