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Home My WebLink About26430-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27023 Date: 04/06/00 THIS CERTIFIES that the building ACCESSORY Location of Property: 670 GROVE RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 51 Block 6 Lot 26.1 Subdivision Filed Map No. -- Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 3, 2000 pursuant to which Building Permit No. 26430-Z dated APRIL 4, 2000 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 STORAGE SHED IN REQUIRED REAR YARD OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR "AS BUILT". The certificate is issued to ALBIN V. CZELATKA & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A N/A PLUMBERS CERTIFICATION DATED Rev. 1/81 Authorizedfgnature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT ~UST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26430 Z Date APRIL 4~ 2000 Permission is hereby granted to: ALBIN V. CZELATKA & ORS. 607 GROVE RD. SOUTHOLD,~NY 11971 for : CONSTRUCT ACCESSORY STORAGE SHED IN REQUIRED REAR OF EXISTING ONE FAMILY DWELLING AS APPLIED FOR "AS BUILT" at premises located at 670 GROVE RD County Tax Map No. 473889 Section 051 Block pursuant to application dated APRIL 3~ 2000 SOUTHOLD 0006 Lot No. 026.001 and approved by the Building Inspector. Fee $ 35.00 ~/~ature Rev. 2/19/98 ORIGINAL 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 qccupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - , .25~, 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .... ................... .... · ............. New Construction ........... Old Or Pre-existing Building ................. Location of Property ........................................................ House No. Street Hamlet Onwer or O~ers of Property..~ ............... ~ ............ '..% ........................... County Tax ~p No 1000, Section.. ......... ock ...... .. ... ...Lo . .............. .... · .. Subdivision · Filed Map Lot .................. Permit No ................ Date Of Permit ..... Health Dept Approval · .. Planning Board Approval .... ........... Applicant ............................. Underwriters Approval · · Request for: Temporary Certificate ........ Fee Submitted: $ .......................... 5 7706 co z oA3 ... Final Certicate ........... APPLICANT FIELD INSPECTION REPORT DATE COI~IENTS FOUNDATION ( IST) FOUNDATION (2ND) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE II II II [I ADDITIONAL CO~IENTS: FORegO. TO~NOF SOUTHOLD BUILDING DEPARTI~ENT TONS HALL SOUTHOLD, N.Y. ]]97! TEL: 765-1802 Disapproved a/c. ..................... ..... ..... . · 0 (Building InspectS) APPLICATION FOR BUILDINd PERHIT INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ~URVEY ........................ CHECK ......................... SEPTIC FORN ................... NOTIFY: CALL .................. IqAIL TO: .................... Dato ~%/°° a. 'fhis application n,,-qt be c~npletely filled in by type~iter or in i~ and suhnitted to the Building Inspector wit 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 deacriptian of layout of property m~st he dr~an on the diagram ~dsh is pert of this applicat ion. c. lhe work covered by this application may ant be eerareeced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pemit shall he kept an the premises available for inspection throughout the ~ork. e. 1~o, building shall be occupied or used in ~hole or in part for any pu~T~se ~hatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATI(I~ IS ~ ~ to the Building Department for the issuance of a Building Pemit pursuant to the Building Zone Ordimmee of the Trna of Santhold, Suffolk County, 1~* York, and other applicable La~s, Ordinances or Rngulations, for the constraction of buildings, additions or alterations, or for removal or demolition, as herein described. Ihe applicant ng~a to eonply with all applicable la~s, ordlnafl~s, building code, housing code, and on premises and in build' g for necessary inspections. regulations, and to admit authorized inspectors n heil~d~'.~for~ ~..~......._........ (Signature of applicant, or name, if a corporation) (Nailing address of applicant) State ~tmther applicant is o*~er, lessee, agent, architect, engineer, general contractor, electrician, plmber or builder ~ of mr of premises.. ..................................................................... .... ... .......--- -- --- (an on the tm~ roll or latest deed) If appllcm~t is a corporation, signature of duly anthorized officer. (Name and title ofonrperate officer) Builders License l~ .......................... Plumbers License Ro .......................... Elactricians License hlo ...................... Other Traders License Na .......... I. Location of land on ~aich proposed ~ork will he done .............................................................. llanse Number Street Haxtle t oq\. oo 0~.o~ Coanty Tax Nap No. I000 Section ..... .... ....... Block ................ Lot ............... Subdivision ...................................... Filed ~ No ................ l,t ~ .............. (~e) 2. State existing ~ arid Ix:olpa~ of promises aed lntend~ ~ ar~ occtlpar~ of a. ~ast~ng use a~ occupancy .................................................. .- ...... ':>' ? ~ ','" L;,;' '~ ....... b. Intended use and occupancy ............................................................................. ~mm property lines. Give street and whether interior or corner lat. ..... ,-, ......... ,. ,,~w ,~*~iUlL~8 .......... ,~lltlon .......... Altera,tion .......... IMpair ............ Rc~val {~ripti~) Esti~tnd ~st ' f~ (to ~ ~id m fili~ this a~li~tim) If &~lli~, mml~r of ~lli~ mlts ............ ~r of ~lllng onits m ead~ ~mr ................ If ~rage, ~t~r of cars If I~i~msa, ~rclal or ~[ ~, s~ci~ ~mre ~ ~tent of e~ ~ of ~ ...................... Di~mnsi~s of ~isking stnmm~, if a~: ~t ................ ~ar ............... ~pth ................. l~i~t ......................... ] ~r of Stories ..... Di~sai~s of. ~ stnmmre ~rb alterati~s or ~itiosa: ~nt ............... ~ar ............... ~ptl ~ .................... ~ .................... ~r of Stories ..... ......................... ] ~r of Stories ..................... Si~ of lot: l~t ..- q~...~ ...... ~ar ... ~te of ~rd~a~ .............. ~ of Four ~r ........................................ ~ or u~ district in ~aid~ pr~i~s a~ si~tM ~a pro~ c~s~ti~ viola(e any ~i~ 1~, o~i~e or ~la~i~: .... ~. ................ ~ll loE lm r~r~ ........... ~s of ~r of ~s ..~ ~resa ~ o Ardut~t .............. .................... ~ress......... ........ .. .... . . . .... H~ ~ ............... ~ of Cxmtr~tor ............. ~ ..................... ~ress ............................... M~ ~ ............... . ............ ...... ls ~ rty wltiun ~ ~ PI.OT DIAGRAM I~ate clearly a~ dlsti~tly al~ ~ildi~s, ~mHmr ~isti~ or ~, ~ i~i~te all ~t-~ di~nsiosa .1~ ~r or ~scrlpti~ ~on~i~ to ~, a~ ~ strut ~s ~] i~i~te (Name of i~llvidual signing contract) I ............... hemg duly ~m, deposes and says that he is the appl. icant above na~d, lie is the .............................. ] (C~trsetor, agent, corporate officer, etc.) of .~.id owner or ~wners, slx! is duly authorlz~d to contat~ne~ i, this perfom or have performad tim said ~s~t4~ awl to make ar~l file this Sat application are tiara to tile hest of his kn~ledge m~l hehef, and that the work will he perfomed in the maturer set forth in tile application filed therewith. ~rn to before ma this ~ ~ N~ York BUILDING DEPARTMENT TOI~NOF SODTHOIa) LOCATION: HOUSING CODE INSPECTION REPORT (number & street) (municipality) LOT(s) SUBDIVISION MAP NO. AD14ITTED BY: d/~ ~; ~~7~'~ ACCONPANIED BY: j~ KEY AVAILABLE SUFF.CO. TAX NAP NO/~- SOURCE OF REQUEST: ~- ---- DATE: D~ELLING: ...~. oP CONSTHUCTION_ ~ ~ ~~ , STORIES ~', EXITS TOT~ ROO~S: ]ST FLR. ~ 2~ FLR. ~ 3~ FLR. ~RO0~ (~) ~ ~O~r ~OOS is) B~EZE~AY ~- FI~P~CE BO~STIC HO~A~R ~ 'rrFg ~A~R ~ ~PE ~AT ~// WA~ AIR Acc~sso~ S~UC~S: ' , S~I~G POOL ~ G~ST~ ~E CO~ST. O~flltR: VIOLATIONS: CHAPTER 45 N.Y. STATE I~IIFORM FIRE PREVEI~flON & BUILDING CODE LOCATION DESCRIPTION · ART. SEC.