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Home My WebLink About23828-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~EBTIFICATE OF O~JPANCY No Z-24762 Date NOVEMBER 27, 1996 THIS CERTIFIES that the building ACCESSORY Location of Property 630 SOUTHERN ~ROSS ROAD House No. Street County Tax Map No. 1000 Section 110 Block 3 Subdivision Filed Map No. CUTCHOGUE, N.Y. Hamlet Lot 9 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NO%q~4BER 15, 1996 ~ursuant to which Building Permit No. 23828-Z dated NOVEMBER 26, 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 STORAGE SmD "AS BUILT" AS A~PLIBD FOR. The certificate is issued to ARTHUR VANDERBECK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A M/A N/A Rev. 1/81 //B/ldlng ~nspector I~R~ NO. ~ TOWN OF SOUTHOLD ilUlLDlblG DEPART/~ENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 3828 Z Permission is hereby granted to: F. I~ICNAgL ttgl,~gR (VANI)I~P~ECK) P.O. ~OX 331 SOUTH JAI~SPORT, N.Y. tl970-0331 CONSTRUCT ACCI~SSORY STORAGE SHED "AS BUILT" AS APPLIED FOR. County Tax Mop No. 1000 Section ............ !.!..0. ...... Block 3 Lot No. g pursuant to application dated ......... .~..O..V..:...!.5..~. ............................... , 19..9..6...., and approved by the 13uilding Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 APPLICATION FOR CERTIFICATE OF OCCUPJ 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 instal£ation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in sysnem contains less than 2/i0 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings end"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, i957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and -u~tur~l or topographic features. 2. A properly compteted~ap~cati~oD and a consenn_~2~iaap~c~t signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the r~aso~s 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 Occupancy on ~re-e~ist__inK Buildin~ - $i00~00 3. Copy of Certificate of Occupancy - ~ .25~ 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $i5.00, Commercial $15.00 ........................ New Construction ........... Old Or Pre-existing Building ................. ~ .... Location of Property... ~. ~.~.....-~,~~..~. ~.~.~..././~'~.,...~'".~.~. ~. House No. Street / Ha~et Count *ax Ho 1000, Section..././..*. ..... Bloc ..... ........ ....... .y. ............ Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Pianning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate Fee Submitted: $..~.~,~. .................... i~__~,,~.~~ , 151998 'fOSM NO. 1 TOWN OF SOUTHOLD B'01LDtNG D~PABTME, N'T. TOWN HAL. L .~OUTHOLD, N,¥. 11971 TEL.; 765-1802 a. This application ;ets of plans, ,~ccurate b, Plot plan showin or areas, and giv}ng a de cation, c. Tile work covere~ Date , INSTRUCTIONS ust be completely filled i~ by' typewriter or in ink and submitted to the Building Inspector, with 3 plan to scale. Fee accordi~g to schedule, location of lot and of building~ on premises, relatimxsldP to adjoining premises or public streets died descriplion of layout of property must be drawn on the diagram which is part of this appli- by this application may not be coml!~enc~.t! before issuance of Building permit. this upplication, the Building Inspector WILL issued a Building permit to the applicant, Such permit ti. Upon approval o shall be kept on the prerriises available for inspection throughout the work, . of Occupancy e. No building shal I be occupied or used in whole or iu part for any purpose whatever until a Certificate shall l]ave been gr0nted ~y tho Building Inspector. , . rtm ut for the issuance of a Building Permit puTsn~llt to the APPLICATION IS I~EREBY MADE to the V~rk and other applicable Laws, Ordi ~anc? o,r BUlI(Iiii$ Logo urumm,~? ....[~ -* .... ,, .tltlHla~sq or alteratious, or tot removal of u~..u,,. ,, , .. ......,i t. Regulations, for the col structlon ? o~?mng~, ",~';[~,7 ~.u,.a,,~ ~uildin~ code, l~usin~ode, aaa regutauv-~, - ..... ~h. am~licant a~rees t~comply w~th au appucao~e,p--} ......... /~~nt, or namC, if a .................... [ appl' t) (Mailin~ address o ~ca~ Stale whether applicmit is owner, lessee, agent, architect, cngil~ear, general contractor, electrician, plumber or builder. Name e[ owner 0f prC~ scs ,, ./,~(y/./,t,~l~ .1; .-.. · , ,,, ........... (as on the tax roll or latest deed) If applicant is a corpO atica, signature of duly authorized officer. (Name and title of corporate officer) Buihlm's License No .......................... I'hmd:,er's Lice,~e No ........................ l:lectrlcl0n s ~AceJlSe No Other Trade's I,i~cense Nc) ...................... I. Localiou of llmd ~n which proposed work will be done. ~ .................................. Ilo.se Number : Street llamlet Counly Tax MaptNo. 1000 Sec[ion ff/~ Block ~ Filed Map No ............... Lot ....... Subdivision ' (Name) ' ' t] nd ccu ancy of prOposed constructimu t c f remmesand intended se~ P Slale existing t,s~ and ucc ~pan y O p . 12, 13. Ntttttrc o{ work (check winch applicable): New Building .......... Addition .......... gilteration .......... Repair .............. Removal ............... Demolition .............. Other ',~,~ot k ............... ~' ~ (De~scripflon) Es0mated Cost ..................... Fee .................... '" (to be paid on lilin~ this application) If dwelling, n':mber of dwelling units ...... ~. ........ Nnmber of dwetUng units on each flqor ................ If garap ,, bet of cars ........................................ ; ............. i .................. If busim ,'ommercial or mixed occupancy, specify natnre and e,~tent of each type of use ,..; .................. Dimensions ct exist ~ stmctt res, r any Front ............... Rear .............. D~ptt~ ............... Height ............... Number of Stories ...................................... Dimensions of same structure with alterations or additions: FrOnt ................. Read .................. Depth ...................... Height ............ > ......... Number of .S?ries .... i .......... ! ....... Dimensions of entiJ;e new construct~om Front ..... /.0. ...... Rear .... J ~. ...... Depth .... ~:~ ......... lleight ...... ~0. ....... Number of Stories ........ t../_.~. ......................... I .................. Sizeof ct Front .Z'.~..~. .... :.., Rear.. -- ~ ~'~ . . Depth ,~..~0 . . Date of Purci~ase ............................. Name of Former Owner ........... Zone or use district in which premises are siluated ................................... : .................. Does proposed construction violate any zoning, law, ordinance or regulation: .............. : .................. Will lot be regraded ....... ,;, ......... _~_ .'r~4 ..... Will excess fill be removed from premises: Yes Name of Owner of premises,4~r~..~ff, .al~..J/,t~.~.r~~,, ................ Phone ~No ................ Name of Architect ........................... Address ................... Phone NO ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all bui.lding~, whether existing or proposed, and, indicate all se(-back property, lines, Give street and block number irlterku Or corner dimensions from ~s and indicate whether OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE, OF OCCUPANCY 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INS2ECTIONS: ~. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ; 2. ROUGH ~ FRAMING & PLUMBING ~. tNSU~TION I 4. FINAL ~ CONSTRUCTIO~ MUST BE COMPLETE FOR C.O. J ALL ~ONSTRUCTION SHALl. MEET THE REQUIREMENTS OF THE N.Y. STATE CONS~RUCTION & ~NERGY CODEB, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION rERRORS STATE 3F NEW, YORk. COUNTY OF .... .A'... (Name of individuM signing contract) ..... being duly sworn, depo,~, s and say that he is the applicant above Ilallled. IIe is the ............ ~. ~'/~ (Contractor, agent, corporate officer, etc.) of s.nid owner or owners, and is duly authorized to perform or have perforated the said work a{M to make aud file lltis apphcation; that all statements contained N this applicatiy~ are true to the best of his knmxledg~ and belief; and that the work will be perfomled in the manner set forth in the application filed therewith. Sworn to before m~ ........................ or .... .... , Notary Public, State of New York / / - ~ ~/ ~ . OuaJihed m Suffolk County ~ .: · ~~~, ~ ....... C(~r~rfH¢~sJc,r~ Expires Ma,/22, 19 ~ -- : (S gnat,I~ O(' applicant);.~ ~o~ ~z~ ~o 0 0 0 C1¥0~ ClOOM3NId 'n~: ZO C~z .LN3~I~/~vcl 30 ~003 ,O'L~' Zo Oz