HomeMy WebLinkAbout23637-z t
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24590 Date SEPTEMBER 6, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property 400 LONG CREEK DR. SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 4 Lot 23.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 2, 1996 pursuant to which
Building Permit No. 23637-Z dated AUGUST 19, 1996
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 BRIDGE OVER DRAINAGE STREAM IN REAR YARD AS APPLIED
FOR "AS BUILT".
The certificate is issued to WILLIAM & ELLA MOSHER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspecto
Rev. 1/81
"am NO. f
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)
1°
23637 Z Date ........... .......... ..../....`1.................., 9..�`.�
Permission is hereby granted to•
......� 1...... ...�... . .........
.....
.........Ya........ .... ,4:.:
........ . .. P.........../. .;.........-r.....
,aR.. .. . ......:::. ..105�. ....: ... . .........................
atpremises located at .......... ........ . Q.?.? ..-..........................................
.................................................................................................................................................................
County Tax Map No. 1000 Section .......... ......... //
��.. Block ........... Lor No. ...�.��!.1.....
pursuant to application dated ............ .. ......Z- ............... 19.&,, and approved by the
Building Inspector.
Fee 5.. ..
.. ..` ... ............. ..........
Building Inspector
Rev. 6/30/80
Form No. 6
TMgN OF SOUTHOLD
BUILDING DEPARTMENT
Z 9 ` :') TOWN HALL
765-1802
Ye LDO.yDEP'T.
a ..TOWN OF S06 THOLD
PLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the buildin'z
inspector with the following: for new building or new use:
I . Final survev 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 fromplumber certifying that the solder used in system contains
less than 2/10 of 17 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 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 525.00,
=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 - $100.00
3. Copy of Certificate of Occupancy - .25c.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
/ Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre
,-exist'n g Building. . . . . . . . . .VI-An . .
Location of Property. . . .��6C�. . . . .1- . . . . . .���. . . . . . .�.m('C'. . . . . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
l,.�
Onwer or Owners of Property. . ) . .�. .�. . . . .C /LC-1 S' . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . . . . . .Block. . . . Iq. . . . . . . . .Lot. . A`. f. ! . . . . . . . . . . . .
Subdivision. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot
./ . . . . . . . . . . . . . . . . . .I. .n /
Permit No. . . �? .�. . Date Of Permit. . . � .`. piicant.
CuG . . . le�.5 ."
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .UnderwritersApproval . . . . . . . . . . . . . . . . . . . . . . . . .
Manning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . i
Reauest for: Temporary Certificate. . . . . . . . . . . Final Carticate. . . . ... . . . . .
Fee Submitted: . .Y: .V.w .". . . . . . . . . . . . . . . . . ,
`'�`'u't . . . . . . . . . . . . . . . . . .
-�-e , sr8y) .
�DT.TC Ai1T
T65-1802
BUILDING DEPT.
INSPECTION
[ j FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 CATION
[ ] FRAMING FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
Ca, (f-?
DATE INSPECTO
'V
R911ORT DATE COHM 'NTS
I( w
_l UVJ
it
-- __.- ._ .. --- --.. H V
POIINIIAT 1 ON ( 1 S'I') 4 1 ~ ,
I - II
FOUNDATION (2ND)
II
I-
If
ROUGn FRAME &
PLUMB I NG I IIII
II (
NSI)[.A'I'T ON PER N_ Y.
STATE I?NI?RGY
CODE
I
-FI NAY.
II
U
ADDITIONAL COMMENTS:
t�
dl ^�
�• HOARD OF HEALTH . . . . . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . .
TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN MALI.. SEPTIC FORM . ... . . . . . . . . . . . . . . . .
SOUTIIOLD, N.Y. 11971
TEL: 765- 1802 NOTIFY:
CALI.. . . . . . . . . . . . . . . .
I: mined.. 19 MAIL TO: . . . . . . . . . . . . . . . . . . . .
A1.4woved.-C�� ...............................
Disapproveda/c ............................ ............. ...................
.......................................... ...........
y Building Inspector)
P ,_ P
RL►G ^ 2 199 ea t A .KATION FOR BUILDING PERMIT
zs, T 6,,.�.i.;G. :_;�1. Dare... . - ..3.I . . . , 19
INSTRUCTIONS
a. 11iis application must be completely filled in by typewriter or in ink and submitted 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 prpnises, 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 application.
c. 11w work covered by this application may not be cmi enced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue 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.
APPLICNr1CN IS IlEIEBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Iluilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the constriction 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 builddingr necessary in tions.
. CJ� pp
(Signature of applicant, or namie,•if a corporation)
...................................................
(Mailing, address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....Q !tJ..:.e:......................................................................................................
Nae of owner of premises ...L1�.b.?.�!.Ql.1�f.'L .l .... .�.s!'.4.�.`C............................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.........................................................
(Nano and title of corporate officer)
Builders License No. .........................
PlumbersLicense No. .........................
Electricians License No. .....................
Other Trade's License No. .................... /y
I. Location of land on which proposed work will be dcxw..."............. .. 'r�„',!r,!,,,,,,,,,,,
.....�O O ................. ... ..4-k.... f'�.�.�!`�C..,I... .�?�,?' A� ..�...N..�..........
Ikmuse Numimer Street Hamlet
'lCounty Tax Map No. 1000 Section ................ Block ................ Int
jSubdivision ...................................... Filed Map No. ............... Int ...............
' (rim)
4
2. State existing use and occupancy of premises and intendeduseand occupancy of proposed construction:
a. Foci sting use and occvpancy .. Q ...Y! ....u!t..................................
b. Intended use and occupancy _ r!.! �'�... ,,,, D, 1AT.'.;,l"S ..............
1. N•rture of milk (check aAdch ap)licable): N-w Ikrildinl; ......... . tuklition . .. . ...... Alteration .X.... ..
leper it ............ I?EmK7val ............. DenrroliLion •........... Other Work ..................................
O O (Description)
/I. E'st.incited Cost ...'.O4......."T 7..... fee •.................•...........................
(to be paid on filial; this application)
'.i. if (ho-A I ing, rxriber of diw_l 1 ing units .......••... Naber of owel I ing uni Ls rx► each floor ................
If garage, umber of ears ..........................•...•.•.....
h. If Ix►siness, c_rnmercial or mixed occupancy, specify rk►l.ure aril exLenL of each hype of. use......................
]. Dimensious of existing strucLures, if any: Front... .....•.... Rear .. .dq......... Depth ..�.�•.........
IleiglrC ... ,........•..... Muber of Stories .....'.........•...... . // 1
Din►ensions of same stnrcture with al l erat ions or r><kli L ions: Front ...•.. .G• •.... Rear ..........
Ik:plh .&�......... Ile-iglrL ....L7............. Umber of Stories ......
11. Dimensr(x►s of entire new constructtion:vFronL ............ .•.. Rear ............... Dept-ti . ..... .•......
Ileil�rL .......................... Naber of Stories
9. Size of loL: Frrx►L .................... Rear Depth .... '
IO• Ikrl a of llrrchase R-mv of Fouwr Grier •...,i/ .6k'.�fd`'!!�.. �'.1�1.q.- / u►�
II. Zcxw or use disLricL in wl►id► premises are siluated ..............•................................. ... ...........
12. Does proposed coustrrxaion violate any zoning law, ordinance or regulal:ion: ........................
17. Will loL be regraded ............1......„... Will excess fill he rom wed fran premi
s
e
s:
L sS
Nares of Oweer of pronises ..(�/s...!-1,QS tkklress ` .. .. C .. Plx�rre No. 76r� - 07S
N:m►e of Ardtitect .......•..........••..........• ..... Acklress liwone W). ....... .. ..•..
None of GxrLrac(or ...........................•....... A(klress ...............................I'Ircx►e N). ......... ... ..
I`i. is this properLy within AX) feel of a ti(Lil weLlarxl? * YES .......... NO ..........
*1F Yl---c;, '11714N 'ITa)51109 M-11MIT MAY ISI: Ia?(r11R1'.1).
PLOP DTAGRAM
locate clearly aril distinctly all Imildings, whether existting or prolxxsed, nix] irxlicaLe all set-back dimensions
fran property lines. Give street and block umber or descripticxr according Lo (treed, aril slow street names aril irxlicate
rA►ell►er inferior or corner ]ot.
I
jqQ(, f
ROV D AS (NOTED
C9 U g C DATE: B.P.11� 7
/pC) NFEE: BY:
OTIF
u„�— Y BUIL ING DEPA AT
�lS� S5-1802 9 AM TO 4LLOWING INSPECTIONS: FOR THE
F°
�w
- --� - 1. FOUNDATION - TWO REQUIRED
; ..
FOR POURED CONCRETE
2. ROUGH - FRAMING S PLUMBING
� '�.v►� 3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
AL"ONSTRUCTION SHALL MEET
Xe_(Wtaa4f RIWIM"EOUIREMENTS OF THE N.Y.
`'call' (V raw YOM, Sti STATE CONSTRUCTION S ENERGY f
01juIY (IF CODES. NOT RESPONSIBLE FOR c
DESIGN OR CONSTRUCTION ERRORS
Ml
...... OCC UVAN
W / �` '•a•t�'1• l �S•C`.e• •• ••• ••••..•••,..Ix�ing duly s yluOR s the applicant
(Utak' of uxlrvrckurl. signing ccnrtracC) USE
IS ,
alxwe IkrIK(I, UNLAWFUL
I. �W :.........•....... E�WO .
TERTIFIC...(0nrtracLor, ngeot, corlx)rate officer, et.c.)Ike rr; ll►e
of said cr. ier or chnx_rs, aml is duly :nrthorizecl Lo (x?rfonn or have Iv.r3" d�� t x ke arxl file this
application; Lhaf, all slalemnl s ccmtairxecl in Ibis nlrpl icat i(nr are Lrrx L > ll ► r 1 ge nrxl lx?l ief; mxl
(hat. the work will lie perforimA in the n4rnr►er seL forth in LI►e application filed Urerewit_h.
`itaorn Io before me this o
. ...•. ..��1.. . .....day of tt
(
Not ary I'ubl is .... ......... f ..
�'' Signature of Appel
ROBERT 1.SCORT.•J
NOTARY PUBLIC.State N.Y.
No.4725089.Suffol
Term Expim May 1, 18
rs
YENNEC OT T PARK r;
AT GARRaLL di• ANO. �� 'LP � o O
SOU rf,roc.v a / , ,-, '� - o m
SUFRCo.,N.Y N.B,a i"J70.35 k O I4
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N.
SCS-ENG-314 (Rev. 7-72)
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