HomeMy WebLinkAbout23771-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24902
Date FEBRUARY 7, 1997
THIS CERTIFIES that the buildin~ ACCESSORY
Location of Property 695 EDWARDS LANE ORIENT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 18 Block 3 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 4, 1996 pursuant to which
Building Permit No. 23771-Z dated OCTOBER 23, 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 "AB BUILT" ACCESSORY SHED IN REAR YARD AS APPLIED FOR.
The certificate is issued to ELIZABETH FEELY
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N/A
lng Inspector
Rev. 1/81
FORM NO. 4
TOWN OF SOUTBOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24901
Date FEBRUARY 7, 1997
THIS CERTIFIES that the buildin~
Location of Property 695 EDWARDS LANE
House No.
County Tax Map NO. 1000 Section 18
Subdivision
ACCESSORY
Street
Block 3
Filed Map No.
ORIENT, N.Y.
Hamlet
Lot 21
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 4, 1996 pursuant to which
Building Permit No. 23771-Z dated OCTOBER 23, 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 "AB BUILT" ACCESSORY BARN IN REAR YARD AS APPLIED FOR.
The certificate is issued to ELIZABETH FEELY
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N/A
N/A
Rev. 1/81
- ~ng Inspector
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
8outhold, N.Y.
C~RTIFICATE OF OCCUPANCY
No Z-24900
Date FEBRUARY 7, 1997
THIS CERTIFIES that the building
Location of Property 695 EDWARDS LANE
House No.
County Tax Map No. 1000 Section 18
Subdivision
ACCESSORY
ORIENT, N.Y.
Street Hamlet
Block 3 Lot 21
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 4, 1996 pursuant to which
Building Permit No. 23771-Z dated OCTOBER 23, 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 "AS BUILT" ACCESSORY SMOKE HOUSE IN REAR yARD AS APPLIED FOR
The certificate is issued to ELIZABETH FEELY
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N/A
N/A
Rev. 1/81
Inspector
IPOB~M NO. J
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, No ¥.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
~.7~ ,, .......
N? 23771 Z Date ........ ~... ....................................... ,
at premises ,o~oted at ....~...~~....~.. ..... ~; .~...~/O: ~..~)~: .......
.............................................~--~_~..~~ ~ .......
Coun~ Tax Map No. I000 Section .......... ~.... Bilk ~ Lot No. ~ /
pursuant to application dat~ .................. ~~. ............... , 19.~, and appr~ ~ ~e
Building Inspector.
,.,
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/I0 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
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25/~Y~
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory buildingS25.00,
Additions to accessory building $25.00. Businesses $50.00. ~_
2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00
3. Copy of Certificate of Occupancy - ~ .25¢~
4. Updated Certificate of Occup,ancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction ........... Old Or Pge-existing Bui~lding ............
Location of Property .......... ~.-. ....................... ~ ...................................
House No. Street Hamlet z
County Tax Map No I000, Section ...... ;..~ ..... Block ...... ~....i .... Lot....~..l ................
Subdivision .. · · · · Filed Map Lot ..............
Permit No ............... . Date Of Permit ................ Applicant .............................
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval .................... ....
Request for: Temporary Certificate ........... Final Certicate........... ~
5 3 .P APPI ZCA T
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
'., ~ ;2PPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'!pre-existing" land uses:
i. 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,~
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy om Pre-existing Buildin~ - $I00.00 ~/
3. Copy of Certificate of Occupancy - ~
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 ..,..~o~.~.
Location of Property ~ ~ ~/~ ~ ~ .............
House No. Street Hamlet
Onwer or Owners of ~roperty .................. . ......... ~ ..............
County Tax Map No i000, Section ..... ~..~{..
.......... Lot .....................
Subdivision .................................. .. Filed Map ............ Lot ..................... .
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept Approval .... .. Underwriters Approval ....
Planning Board Approval ........
Request~D~L.~for: Temporary Certificate .......... Final..~/,/
Fee Submitted: $ ........................... i
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 0ccupanty 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.~0.0.~
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building~.O~,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existinK Buildin~ - $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .........................................
/
New Construction...~/-- ...... Old Or Pre-existing Building .................
L tion f Property 6q~'-
House No. Street Hamlet
.......... ecf .... , .........
County Tax Map No 1000, Section..~..~. ........ Block...~. ........... Lot..~..{ ................
Subdivision ..... Filed Map Lot
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval . ·
Request for: Temporary Certificate ........... Final Certic~te ...........
// j'~
rot I' ll^'t' I. ON (') ['ID } JJ- '
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ I FRAMING
[ .]/~iSULATION
[ /-~ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ~ ~~-
DATE ~/~~' INSPECT~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
DATE
INSPECTOR,
I;ORM bi(). I
TOWN OF SOUTIIOI,D
BUI 1,1)IF1G l)ff. P/~RTI'II~ ttT
TOWN IIA/,I,
~OIJ'I]IOLI), fl .~. ] 197 I
TEl.: 765- 1802
BOAIII) ()ii' III(AI,Tll ...............
3 gl~'l'B I)t~ PI.AI~S ...............
SURVF.¥ ........... ~ ............
~.III~CK .........................
SF, Irt I~C ~()lIH ....................
NOT1 FY:
CAI.I ...................
MAll. TO: ....................
Ill Sal~l)rgved fl/c .................................. , . ...................................
a. 'lhi$ aH~llcati~ ~amt I~ c~;~letely fillml in by tyl~.Wlter or in ink m~l mdx.itt~l to tl,e ~dldi.g lnsl~elor with
3 sets off pla.s, accurate plol: plan to scale. F~ acconlh~ to sch~hde.
Il. [)lot plau ~h~ I~al:it~ o[ lot arxl sE la*ildi~s ~ pr~.i~s, relatim~ship to ~_joluh)g l)rouisen or lad)lie
nt,'eetn or areas, mxl glvi~ a (~t'aHal ~neril)ti~m off la~lt of I)rOl~rl:y alJst t~ drm~l ~ the diogrglr ~ticl) iff t~qrt of
'lhe ~rk co. red Dy thls aH)llcati(m s,~y ~x)t lm co.trammel Imfore isstm~me of ~Jildh~ Pennlt. ,,,
d. UlXS~ nl~n~at o[ this all)licatiou, the ~Jihli.8 'lnsl~cl:or will ism~ a ~Hldh~ Pe~,nit: to the nl~[;lica,,l'. ~,ch
e. ~) I~,ildl.g d~all Im ¢~CUl)J~l or u~d in ~.)le or in l~trt for a)~ ~rl~se ~)at~er tmtll a C~rtlficate oF
(k:caqm~s:y rJ~al t have I~e. grant~l I~ Ilm l~tilcling hmlmetor.
Atq~.lf~'l'J(~ l~ II~I~ITY ~ t~ tim lh~ildi.8 I~lmrl..e.t for the ismmr.:e oF a lhHldi.g Pen.it ~rm~m,t to the
I~gulati~s, for tim c~mtrtmti~ of la,ihlh,fls, mkllti~s or alteratloss, or for~al or ¢~icion, as herei.
¢~scr~l~l. II~ ol)plmant ages to cmply wH.h all a~lmnble l~s. orchna~J[~
.
(~~1 ica.t, or
(~s (si the taK .)Il or lal. eshle~D
IP al~>licant ia a coq~ral:i~, slpff)atu~e o[ duly ~tl~)rlz~l offficer.
{Nil)t? llll~l t itle of corlx~rate officer)
I~Jilders l.lcense 1~) ..........................
I'It~l~rs License No ..........................
F, lecl rlcim~s l,ice.se ~ ......................
other 'l'ra~'s Lice.se ~ .....................
l~'at:iCm o[ ]llal'lll ~id~ p~] ~vk will I~ Ik~ ..............................................................
.............. ..... ............ ...............................
,~,,,,,.,..~,,, ~,. ,,,, ~,.,~, .... l~ ........ ,,,~ .... ~. ........ ,,,~ 2 /
a. Existi.g u~ at~l (~(lq~q~y ...........................................................................
I~q~Hr ............ Ib~v~l ............ i.
,
PI,OT I) IMHIAH
FOLLOWING INSPECTIONS;
i FOUNDATION ~ TWO REOUIREO
' FOR POURED CONCRETE
2. ROUGH ~ FRA~ING &
3,
4. FINAL " CON~TRU~ION MUST
eE COMPL~E ~R C.O.
STATE CONS~U~ON & ENVY
CODES. N~ RESPONSlB~
CONmUGIt(~
Ik: i, (ho. ....... ...;... O
((xll l(.Lor~ ale, em:, corlxnl~le offJr, m-~ elc.)
o~ *mi(I (x~tr~l- ()r (>a~*-a) aiKI J9 (hdy atlthorJze(J Lo Ix~rfoHll OL' have I~rl'()[.~(l lite ljiij(I ~)[1~ mKi to ll~ll(~ msl J:{l~ Ihin
J~)ul Jo I~h)LtL.~ thh;
..........
JOSEPH H. GIBBON0
Notary Public. State of New York
/
No. 524618265
Oualif ed in Suffolk County
~mm,ssion E.~pires April 30.
4
CONSENT
TO .
INSPECTION
O w~i-e~r (s) Name(s)
do(es) hereby state:
That the undersigned (is) (are) [he owner(s) of the premises in the Town
, which is shown and designated on the Suffolk
County tax map as District 1000, Section f~ , Block _~ , Lot ~ /
That the undersigned (has) (bare) filed, or caused [o be filed, an applica-
tion. in the Sou[hold To~ Building Inspector's Office for the following:
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described property, including
any and all buildings located thereon, to conduct such inspections as they may
deem necessary with respect to the aforesaid application, including inspections
to determine that said premises comply wlth all of tbe laws, ordinances, rules
and regulations of the Town of Southold.
Tile undersigned, in consenting to such hlspectlons, do(es) so with tile
knowledge and understanding that any information obtained In the conduct of
such inspections may be used as evidence in subsequent prosecutions for rio-
(signature)
(print name)