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Home My WebLink About13719-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou(hold, N.Y. Certificate Of Occupancy No. Z15776 Date May 21, 1987 THIS CERTIFIES that the building ...a.c.c.e. ,s.sg.r.Y...s.t.o.r..ac~.e. shed Location of Property ,. ,1, 7, .0 ............ pp.l.t? .h.i.n.. D..r.i.v.e. .......... G.r...e?.n.p.o..r.~ ......... House No. Street Ham/et County Tax Map No. 1000 Section .... 5..6 ......Block ........ .7. .....Lot 6 Subdivision.. ~.o.u..fi.hg.~.d...S.h.°.r. 9.s ........... Filed Map No...3.8.5..3..Lot No .... .1.5. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ¥.e~.¥ug~:/~,. ~- ~.,.. 1..98 5 pursuant to which Building Permit No ..... .1~.~ t:. ~._ .g :f. j.. ~ ? ~,.d.. dated ..... MArch. ~5.,...1.9.8.5. ........ 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 ......... .... kcc e s $.ql~y. s.tor~g.~. $h.e.cl, -. ................................................ The certificate is issued to ................... .~.L,I¢.E' .&., .C.H.A.R.L..E,S, ,T..E..S.T.~. .............. (owner, of the aforesaid building. Suffolk County Department of Health Approval ............. .NJ.~. ......................... UNDERWRITERS CERTIFICATE NO ..................... NJ.~ ......................... PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13719 Z Permission is hereby granted to: /~ _ ~ . ~......~...o...~.....~.~..~. ....................................... ....~..~.~....~.:.~.,...~.~..~.~: .... . .... ~. ~, ~m,,, ,La,ed a,.. ~.~..~ ..~ ~.~ ..... ~ ......... County Tax Map No. 1000 Section ....,~...~c? ....... Block .,....~.. ............. Lot No....~..~, ....... pursuant to application dated ..~~ ].,~, ~ .................. , 19~...~.., and approv~ by the Building Insp~tor. ~ Building I~tor Rev. 6/30/80 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 am mmmmmmm to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topographic featu res. 2.Final approval of Health Dept. of water supplv 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" iand 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 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. Additions $25.00 C. Fees: I. Certificate of occupancy New Dwelling $25.00, Accessory '$10,00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~..b~..) 5.Updated C.O. $ 50.00 Date ................... New C o n s t ~ u c t i on ...... Old or Pre-existing Building ............ Vacant Land ....~.. ....... Location of Property ..... i .~.0..% 0.1 .~.~.;':¥.%..t~..~.... %~ V.~.~. 0.~ &.., .............. House No, Street /Cam/et Owner or Owners of Property ....................... County Tax Map No. 1000 Section . .~.%.~ ....... Block....".~. ......... Lot....~ ........... · Subd, ,,,on ................................. F,,ed Map No. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ..~. .................. Fee Submitted .¢. .... Construction on above described building s end regu lations. e.0. ~i~-~: ~-l'~(o Applicant. ~..~. .... .' -~-~<~..'~/J'[~ ........................ Rev. 10-10-78 FIEL'D INdirECTION FOUNDATION COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no. 13719g issued to Charles Testa on ~/5/85 for _ Accessory is completed a final inspection has ( ) has not ( X ) been done. and In order to complete this file, it is necessary tibet a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $10.00payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. Please help us to clear up this matter so that legal action does not have to be taken. Thank you for your prompt attention. Very truly ~, Victor Lessard Executive Administrator VL:gar 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . .~...of~...~'...., 19~. C Permit No..)..~?. !.~ .~... Disapproved a/c ..................................... ................................ i ..... (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 necessa~j~t,,,~n~~~ (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. ....... .~.k~-~ .vx..%.X7 ............................................................................. Name of owner of premises .~-~ ~ ~-'h'~:~.~'~i~ .4~~.~-~.~'(~,'~. ...~. L~.~.~5. .................................... (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....~. ~ ~¢~[~. ........... Plumber's License No... N O.h.~.-...N O. ,¢.~.~[..h\ \~ %Th¢~FD Electrician's License No.. }~. [6..t.V.~, .... !}., .~ B Other Trade's License No....~. G.~.Q~ .~. ........ 1. Location of land on which proposed work will be done .... [.~.'~..~...*.~...Q5.~'-.6~3.~.~3.~.\ .~..{.~ ................... · & .......................................................................... House Number Street Hamlet '"-7 Lot JC County Tax Map No. 1000 Section . . . ~.~. ........... Block ..................................... Subdivision..~.Q~.~.~.O.\ .c~, ~C5~t\%¥'.q.£5 ............. Filed'Map No..'~,~C~ .~.~..~ .... Lot..l :~.~. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .a. Existing use and occupancy ... ~'3.~. f~ IL. .~..~. 9. 10. 11. 12. 13. 14. . property lines. Give street and bloct interior or corner lot. Nature of work (check which applicable): New Building ........ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............. ' (Description) ~ (t ' ' gth' ppl' ' ) ,: r~ ' o be paid on fihn is a ~cation .If dwelling, nt~mb.e~ Of d~v,ell~g u~n~... ;,.~'~..~. ~4 ;,.~,q.,Num~ ber ~of d)ye~ling units oga each floor ....... ......... 'If garage, number of cars .. -&,!;.%,.r? !%.. % O .t~..~. ~).1 .q,.'q .... tNB 9~...~.~-ro)c'.0~.. ['~,(3 .O. ~ .................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dimensions of existing stmctu/es, if any: Front ~ (~tx[ .~.. Rear ....... Depth Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ,.. Height ...... ~ ~t' i .......... Nu~l~rj~f Stories ......... ~.~..~ ........ Dimensions of entire new construction: Front ... ~1 ........ Rear . ~ .......... Depth ........... ~,,-. Height .. I . .~w. .... ~Nun~ber of Stories ....... ~ .............................. ./. ....... Size of lot Front ~ "x~ i ~ Rear ~ .~ O De-th ~.~ ~'~.'7. q " Date of Purchase ....... (~. !'.~. · J .~,~..~. ~ ..... ,~ Nam~2~f Former Owner . .C,,.~ ~ .~2;.'...t~..~ ........ Zone or use district in which pfemises are situated...I.~,¢,~... ~,.~ ........................................ Does proposed construction v~91ate any zoning law, ordinance or regulation: .. J~) ........................ ~ Will lot be regraded ....... ~.e,) ................... Will excess ~11 be, removed from premises: . ?_es, .. ~(~) Name of Owner of premises .~.~gg.'"~."~.~ .... Address ~,'l,bx~.~*..~... Phone No..'~ ~. ~..~.~'."fi. ..... Name of Architect ......... . .................. Address ....... .~ .......... Phone No ................ Name of Contractor : Address Phone No ~i c/qg- 00?O i PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate ail set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, 1 COUNTY OF ................. i S.S ............................ ' ..................... being duly sworn, deposes and says that he is the applicant (Name of m&wdual signing contract) above named. He is the ..................... ~ ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 mann ~r set forth in the application filed therewith. Sworn to before me this ......... · ..].~1 ....... day of .... .4A~.. ........... ,19 . . . County Notazy Public, .')_ HELEN ~. D~ YQE '"~ ..... ' .... NOTARY PUBLIC, State ct New York N0. 470'1878, Suffolk~ C0unt2. ~ ' ....... ' Term EalI, os March i0, 191~5 (Signature of applicant) RODERlCK VAN TUYL, P.E. LICENSE~ LAND SURVEYORS STATEMENT OF ~NTENT THIE WATER SUI~aLY AND SEWAGE I:IISPOSAL SEAL