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Home My WebLink About22975-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~TIFICATE OF OCcupANCY No g-23850 Date SEPTEMBER 5, 1995 THIS CERTIFIES that the buildin~ ALTERATION Location of Propert~ 105 PRIVATE RD. ~31 SOux~OLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 77 Block 3 Lot 25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 15, 1995 pursuant to which Building Permit No. 22975--Z dated AUGUST 29~ 1995 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 ENLArgE OPENING ON EXISTING GARAGE A~ APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 ROBERT & SUS~I N/A N/A N/A ~ Build~n'~ ? FORM NO.3 TOWN OF $OUTHOLD BUIt. DING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT Mu$'r BE KEPT ON THE PREMISES UNTIL FULL COMPLE11ON OF '[HE WORK AUTHOREED1 ............. .............................. N? 22975 Z Permission Is hereby granted to: //.~~....~...~....~....~.~,~ .~...~...~.~....~ ............... .~~..,:,.,,,,~y:...../..~ez ...................... to .~..~_~.~, .......... ~ ....... .~.~ ~ ~ ~ ........... ~,~. . .~..~. . . . , . .~,~,,~. ................. OountyTax Map No. 1000 Section..., .~..Z ........... Block ....... ..~.~,,. ........... LotNo ...... ..~...~ .......... pursuant to application dated .................... .~..//t/~-'~,, ,'~. ..................... 19.,,..~.~., and approved bythe Building Inspector. ~e~ ~....~ ..... Building Inspector Rev. 6/30/80 TOWN OF SOUTUOLD BUILDINC DEPARTMENT TOW 765-I802 A?PLICATION FOIl CERTIFICATE OF OCCUPANCY Au 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/~0 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 Occupaucy is denied, the Building Inspector shall state the reasoos 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 b~ilding $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existinR Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00-, Commercial $i5.00 Date New Construction ........... Old Or Pre-existing Building ..... ~... ........ Location of Property...~..~.J~, ..... .~..~...~f..~ ,'~. ~../~.'...(~.~ ..... .......... . .~.~5~.~.~ '.~. ........ House No. Street tlamlet Onwer or O~ners of Property ........... ~...?/ ........... ~..~_~.~ ............................... :ounty Map 000, Soetion.... .¥2 ...... ..... ......... .............. Subdivision .................................... F:iled M:U~ ............ Loc ...................... ?er]nit No ................ Date Of Permit ................ Applicant ............................. iIealth Dept. Approval .......................... Underwriters Approval ......................... 'lan.lng Board Approval ........................ ~{equest for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN~TION [ ] FRAMING [ ~J FINAL [ ] FIREPLACE & CHIMNEY REMA _. INSPE~ FORM NO. 1 ~ I 5 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT.. rOWN IIALL SOU]HOLD, N.Y. 11971 TEl..: 765-1803 Ex,m,i,,ed.... d~A.? ..... , 19 9~"- Disalq~roved a/c ................................... : , APPLICATION FOR BUILDING PERMIT BOARD OF IIEALTII ......... OF PLANS ......... SURVEY .................. CIIECK ................... SEPTIC F 0 IH'I ............. I!OTIPY: ~/,.) ~z.~_~ _~ HAlL TO: Date ............... 19 q47- , INSTRUCTIONS a, This ~pplication must be completely filled in by typewriter or in ink and submitted to the ]:luildlng Inspector, wilh 3 sels of pMas, accurate plot plan (o scale. Fee according (o schedule. b. Plot plon showing location or lot and of buildings on preoiises, m[afionshlp to ~djoining premises or public sfieeis or areas, and giving a detailed description of layou[ or property muh[ b~ dr~wn on the diagram which is part or this ~ppli- cation. c. The ~vork coverer] by this application may not be comolenced before issuance of Building Permit. d. Upon approval of Ufis application, the Building Inspector willigsued aBuildingPennlt to tbeapplicanL Sucbpermit shall be kepi oa the inemises available for inspection lhroughotd Ille work. e. No building shall be occupied or osed in whole or in part for mW purpose whatever m~til a Certificnte of Occupancy shall have been graMed by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Deparlment for the issuance of a Building Penoit pursuant to II~e Budding Zone Ordinance of tim Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance~ Regulalioas, for tlle constmclioo of buildings, addHions or nlleraUons, o~ for ~emoval or demolition, as herein described. qbe npplicant agrees Io comply with all applicable laws, ordinances, building code, housing code, and regulations, ami to admil authorized inspectors on premises and in boildiog for necessa~ inspections. .... ........ ........ (Signat~e of applicant, or name, if a co l o , Ii ......... (Mailing addiess of applican0 Slate whether applicant is owner, lessee, agent, architecl, engineer, general conh'aclor, eleclrician, phlmber or builder. (as on the tax roll or latest deed) If applicant is a colporalion, signahne of duly autholiied officer. (Name and title of cmporate oflicer) BuihleCs Lice.se No. ' I lumbel s l.icense No ......................... ElecHic'an s License No ....................... 0 he~ Irades .~ce se No ...................... Location or hind o,, which proposed work will be done..~7~. ~.~..C.~.C~d ........................... ............ [lOUSe Number Street Ilamlet Cotmly Tax Map No. 1000 Section . .O.' ~. ~ .......... Block , .~ ' Lot .~ ............. Subdivision .................................... . Fi}ed Map No ............... Lot ............... (Name) Si;He cxisling use and occupancy of premises and intended use and occupancy of proposed construction: a. ExislJng use and occupancy ..~~*~,.. ' 3. Naluleolwoik(checkwhichapplicable): New Building .......... Addition .q.'~...,.... Alteration .......... Repair .............. Removal .............. Demolition .... : ......... Other Work ............... · /'~,~-:~. #v ' - (l)cscrii~iion) 4. Eslimated Cost......~.~.t:2.. .... : ..................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Nulhber of dwelling units on each floor ................ If garage, n)lmber of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensionsofexistingstmctures, ifany: Front ............... Rear ............. , Del>Ih ............... 1 teight ............... Number of Stories ........................................................ Dimensions of samesh'ucture with alterations or additions: Front ................ . Rear .................. l)cptb ...................... lleight ..................... ; Number of Stories ...................... 8. Dimensions of entire newconslruclion: Front .............. : Rear ....... · ........ Depth ............... lleight ............... Number of Slories ........................................................ 9. Size of lot: F~ont ......... . ............ Rear ...................... Depth ...................... 10. I)ale of Purchase ............................. Name of Former Owner ............................. I 1. Zone or use district in which i)temises are situated ..................................................... 1 2. Does p~oposed coostruclioo viol;lie any zoning law, ordinance ol. regtllafion: ................................ 13. \Viii lot be cegraded ....... '. .................... Will excess fill be removed froth premises: Yes No l~J. Name of Owner of premises .................... Address ................... Phone No ................. Name of Architect ........................... Address ................... Phone No ................. Nallle ()l' (~ollJlaclor , ......................... Address ................... Phone No ................ 15. Is this prolmr~:y ~,,Ithln 31)0 feel_ of: a l_J[dal vel_land? *Yes ........ No ......... ~[f yes, Soul:bold 'ro~..m Trostees PermiL nlay be required. PLOT DIAG IL4. M l.ocale clearly and distinctly all buihliogs, whether existing or proposed, ami. indicate all set-back dimensions l'rom prope~ ty lines. Give street and block number or description according to deed, and show street names anti imlicate whether iatc~ior or corner lot. APPROVED AS NOTED DATE: .~.~9/~J'"~ .B.P.# 765-1802 O AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. ~NSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ;"FATE OF NI~\V YOI>,K, S.S :()UN'FY OF ................. · ' '~'~'~g~:~'(Name .......................... ~ing conhacI) being duly swoin, deposes and says that he is the applicant is ......................................................... .............. (Coolractor, agent, corporate officer, elc.) I' said owner or owners, and is duly authorized to perform or have performed the said work and to make and hie this [)plicalion; that aU statcmenls contained in this applicalion a~e lrue to lbe best of his knowledge ami belief; and that the 'o~k will be per£onned in the manner set forth in the applicalion filed lberewith. worn lo be£o~c me this ap[llicant) 'Farm Expires June 12,1 ~,?)