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Home My WebLink About22716-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-23696 Date JI~NE 12, 1995 THIS CERTIFIES that the buildin~ ACCESSORY Location of Propert~ 2130 F~/%LENE L~NE ~4~q~EL NY House No. Street Hamlet County Tax Map No. 1000 Section 144 Block 2 Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 11, 1995 pursuant to which Building Permit No. 22716-E dated APRIL 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 CONSTRUCT AN ACCESSORY STORAGE SHED AS APPLIED FOR. The certificate is issued to MARY F. & JEROME P. VANORA, AS TRUSTEES of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A //U 1 ldlng Inspector Rev. 1/81 FORM NO.3 TOV~I OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 22716 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No. 1000 Section ......................... J(~'//'0/ Block ........... ~ ........ LotNo. ............................ ~--'--'--'--'--'--'~ ' ~,?././.. , approved by the pursuant to application dated ..... ~ ......................................... 19.....~..~.....,-~nd Building Inspector. Fee // ~lldlng ;nspecTor Rev. 6/30/80 Form No. 6 TOW~ OF SOUTIIOLD BUILDING I)EP6RTMEMT TOWN IIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This applicatiou must be filled in by typewriter OR ink and submitted to tile building inspector with tile following: for new building or new nsc: 1. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual uatural or topographic featnres. 2. Fieal Approval from llDhlth Dept. of water supply aed sewerage-disposal(s-9 form). 3. Approval of electric~[ installation from Board of Fire Underwriters. 4. Sworn statement from/plumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Comerciai building, industrial building, multiple residences a ' ' and installations,~a certificate of Code Cum a' ¢ . nd s~mtlar buildings 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-ex~sting" land uses: 1. Accurate survey of property showing all property lines, streets, building aed enusual 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, Swiming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $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., Co~ercial $15.00' Date .................................. dew Constructmon .......... Old Or Pre-existi[g Building ....... ..' c .......... llouse No, Street H~let County Tax Map No 1000, Section .... l¢~....Block ...... 4.~ ...... Lot ....... Subdivision .................................... Filed Mnp ............ Lot ...................... !lealth Dept Approval ' ' ...................... Underwriters Approval ....................... .'lan lng Board AIproval ' (equest for: Tempornry Certificate ........... Final Certicate ........... eec Submitted: $ .......... FOUNDATION Ilstl FOUNDATION (2nd) ROUGH FRAME ~?L~UMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG, [ ]FOUNDATION 2ND [ ] I/NSULATION / [ ] FRAMING [c,~ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR · c' i': TOWN OF SOUTHOLD ' TOWN HALL Disapproved a/c ..................................... _ . K~uHdin~pector) ' APPLICATION FOB B~ILDING'PEBM[T CALL t MAIL TO: Date ' · 19 ' INSTRUCTIONS a. This applicati°n must be completely filled in by typewriter or in ink and submitted to the Building inspector, with · sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of lJuildings on premises, relationship to adjoining premises or public s6'eet or areas, and'giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appl: cation. ' · c. ' The work covered by this application may nit be commenced before issuance of Building Permit. . d. Upon approval of this application, th~ Building Inspector 'mill i~sued a Building Permit to the applicant. Such penni 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 Occupanc' shall have been granted ~,y the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of South~ld, Suffolk County, New York, and other applicable Laws,Ordinances o Regulations, for the construction 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 admit author/zed inspectors on premises and in building for necessa_q~_,n~ections. ~ r~ ~ . _ ........ (Sign~e'l~re of applicant, or name, if a corporation) . ' . · . . (Mailing adarels o f applicant) ~)~, .~r//~>,~-c9 State whether applicant is~lessee, agent, architect, engineer, general contractor, electrician, plumber o~r'bu/d'er. ...vi//7. ~. t. ................. .. . ......... : ......... .................................... - ........... (as on the tax roll or latest deed) ............ If applicant is a c~on, signature of duly authorized officer.' Builder's License No ............ ' Plumber's License No Electrician's License No Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ................................................ ' · ," .y,. . ouse Number . Street Hamlet Couhty Tax Map No. 1'000 Section,... :/..Z/...Zil-. ....... Block .... ~.~.. ' Lot .... O. ,~.~.Q ......... Subdivision ........ . .............. ; .............. '. Filed Map No.. ...... Lot (Name) ...................... 2: State existing use and occupancy of pr~nises anc~ intended use and occupanc,, of -rovo--~ ' - -' ' · g~ ~ P i ~¢u consrrucuon: a. Existing Use and occupancy ',. ~ W'~;} ~ b. Intended Use and nccnn~,~v ~ ~q ~ . ~.0:',: ~. · - . . ....... .~tL,%,~ . ..,)~<r .... -,~-,9 ......... '3. Nature of ork (check wl~lch :applicable): New Building .......... Addition ...... (~... Alteratian .. .._ ~. Repair .............. RemovaI ....... Demol Lion ..... ii 'l i igor,. ,'~...-~.. ~ ~ ~'~Description) interior or corner lot. 4. Estimated Cost. ... Fee ... .~ (to be paid on filing this application) 5. If dwelling, number of dwelling units'. .......... ., Number of dwelling units on each floor. If garage, number of cars I .............. 6 If business commercial or mix'ed specify ............................................... "' ' , .. occupancy, nature and extent of.each type of use .................. '7. Dimensions or' existing structures if any: Front ' Rear ~ Depth Height Number of Stories ' ' Dimensions of shine structure with alterations or additions: Front ................. Rear ... Depth ' : Height ' Number of Stories · Dimensions of entire new construction: Front ' Rear ' .............................. Depth .... ............ Height ' Number of Stories 9 Size ofl0t: Front ' ' Rear ' · · ........ .': ............................ Depth 10 Date of Purchase , Name of Former Owner 11 Zone or use district in which .... · plem~ses are mtuated ' 12 Do s p oposed etlon '61ate zoning law ordinal{ce or regulation: 13. Will 16t be regraded .... ': Will excess fill be removed from premis ......................... es: Yes No 14 Name of Owner of premises Address : Phone No Name of Architect ' " Address Phone No Nam of Cont actor ' Address e r ........ ; ............................. ' Phone No ' ' 15.' thE p ty ithi :300 f tEd 1 'wetl d? ....................... Is. . s pro er w n, eel of a a an *Yes ........ No ......... · If yes,'SoutholdiT, ow.n Trustees Permit may .be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or Proposed, and, indicate all set-back dimensions from property lines. Give street and block number or descriptiofi according to deed, and show street names and indicate Whether '. ~:OLtOWtMG ~NS~ECTIONS: ~, 'ROUGH ~ FRA~ING &' PLUMG{NG 4. I'~tMAL. , .,'~ COnSTrucTIoN ~UST. ~E COMPLETE FOR C.O. ALL LONsFRUCIK)~ SHALL MEET (-ON,>TRiJCIlO~ ~ ENERGY .CC~f~ES. M~' RESPONSIBLE FOR .D~;~G~ O~ CONSTRUcTIo~ ERSORS STATE OF NE~-~RI~.~ // /'$ S (Nam~findividual signing contract) ' ' ' ~bove named. , (Contragtor, agent, cor'porate officer, etc.) >f said owner or owners, ~d is dulyi authorized to pcrfom or have perfo~ed the said work and to m~e and file this *pplication; that ail statements contaihed ~ this'application are t'rue to the best of his knowledge and belief; and that the .york will be perfo~ed in the m~ner~set forth in the application filed therewith. ;worn to before me thj~ . ~CLAIRE t OtEW' ' ~~~. NOTA~ PUBLIC, State of No, 4879505 ~ ' . ' ' · · ~uslified in Suffolk ~un~ ~ ~ ~' (~'gnature of applicant) - ~mmiss~on Expires Oecem~r 8. 19~ ' ~ ', . ~NV~ SDNIAVG ~70H~RO~ ~'~JO/V~/~ ~ ,4~/4/ ~ ~ON~.4 '~' ..~,14/0~_~/~ :~lOJ ,L]A~lrl$ ]HJJ]AI~ ']IgN]^V ~]ONYt::IJ. SO OOt, '~OA ~' oNnox 6