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Home My WebLink About22677-zFORM NO. 4 TOWN OF SOUTEOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23670 Date MAY 31, 1995 THIS CERTIFIES that the building ADDITION Location of Propert~ 38675 MAIN ROAD ORIENT, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 15 Block 2 Lot 17.4 Subdivision Filed Map No. Lot No. conforms substantially to the ~pplication for Building Permit heretofore filed in this office dated MARCH 24, 1995 pursuant to which Building Permit No. 22677-Z dated APRIL 17, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED STEPHEN A. KELEMEN N/A N/A Rev. 1/81 /~ildi~g Inspector FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. 22677 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ~/· ~/ ........... Permission Is hereby granted to: .~~..~:.~./.~.~ ....... ¢..~.....~.~ .~/..~......~..).. ........ ! ................ ~ ..................... .~ ~:~z..~;.-: ...... ./..~.¢.....~ ......... : ........ at premises located at .................... . .~......~..~....~..~~c-. --~.~..~...~~ .................................... CounlyTax Map No. 1000 Section.,.Z~ ............ Block ....... ~ ........ Lot No ...... Z~.~ .... pursuant to application dated ............. ~'. ......................... 19..~...., and approv~ bythe Building Inspector, /~ulldin¢ Impector Rev. 6/30/80 TOWN OF SOUTIIOLD BUILDING I) EPAIFi'tlENT . TOWN IIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to tile bnilding inspector with tile following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual uatural or topographic features. 2. Final Approval from I{ghlth 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 contairs less than 2/10 of 1% lead. ~ 5. Co~ercial building, industrial building, multiple residences a ' · and installations,~'a certificate ~ ~ , ~ ~. . nd s~mzlar buildings responsible for the building, t or engzneer 6. Submit Planning Board Approval of completed site plan requirements. B. F~r 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 appf~ican~. If a Certificate of Occupancy is denied, the Building Inspector shall state the .. reasons therefor in writing to the app].icant. I. "~Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swiping pool $25.00, Accessory building $25.00, ~ .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 - $20.00 " 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 ................. tlouse No, Street tlamlet ooo, 2 ......... Subdivision ................................ Filed Hup ............ Lot ...................... Health Dept Approval ' ' ....................... Uuderwriters Approval ................ :'lanniog Board Approval ' ~equest for: Temporary Certificate ........... Final Certicate ........... 'ce Submitted: $ ROU~It FRAPlE & PLII~IBING INSULATION PER N. Y. STATE EI~gRGY CODE FINAL . ;z~77 :~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ]INSULATION [ ] FRAMING [~Fi~L [ ] FIREP~"~i~ CHIMNEY ~ // REMARKS :"//~' DATE~I NSPECTO~ 765-1802 BUILDING DEPT.' INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ [ ] ROUGH PLBG. [ ]INS~ [ ~'~AL ] FIREPLACE & CHIMNEY DATE Examined qt. FORM NO. 1 TOWN OF SOUTHOLD BU,~LDINO DEPARTM ENT~ TOWN HALL SOUTHOLD, N.Y. 1197:I TEL.: 765-1802 Disapproved a/c ..................................... · /(,I3ui4:ffing Inspector) APPLICATION FOR BUILDING'PERMIT BOARD OF HEALTH ........ 3 SETS OF PLANS ........ SURVEY ................. CI1ECK sEF=,C t:OTl FY; CALL t ............... HAIL TO: Date ' 19 INSTRUCTIONS a. This apl~licafion must be completely filled in by typewriter or in ink an'd 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 l~uildings on premises, relationship to adjoining premises or public street or areas, and giving a detailed descriptioh of layout of property muir be drawn on the diagram which is part of this appL c~ation. ' · . c. ' The work covered by his apphcahon may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Insp6ctor ~ill i~sued a Building Permit to the applicant. Such permi 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 thc Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmer~t for the issuance of a Building Permit pursuant to th Building Zone Ordinance o£ the Town of Southbld, .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 t~ admit authorized inspectors on premises and.in building for necessary i~~ ........ ~~- (Signatur9 of applicant, or name, if a corporation) (Mailing address of applicant) i' State whether applicant is owner, lessee, agent, architect, engineer, genera contractor, electrician, plumber or builder~ 6.,'/,t ' . , teoe ler en ' Name of owner of premises ..................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authori2ed officer.' ; ( me and title of corporate officer) ' "' ' mlder s L~cense No .......................... Plumber's License No ' Electrician's License No Other Trade's License No ...................... I. Location of land on which proposed work will be done .... ................ 3 .37Z ' 4;., ·.. ; ......... /~-~ House Number Street Hamlet Couhty Tax Map No. 1000 Section . . · '..~. .. Block ' .................... Lot../..-/, ............ SubdMsion..~ ................................. '. Fi]ed Map No. (Name) .............. Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,' '~s/ '~ted hnd occupancy .~..c.c~. ,~,~,~,~,~,~,~,~,~.. b. Inten Use . ,3. Nature of work (check whmh applicable) New Building .... Addition q> Alteration ...... Repair .............. Removal .............. . Demolition ...... Other Work - 4 Estimated . (to be paid on filing this application) 5. If dwelling, number of dwellin~ units~. .............. Number of dwe ling units on each floor ............. Ir'garage number of cars ... ~ .... ~6. ~ business, commercml or mtx~d occupancy, specify nature and extent of,each type of use ..................... t. tAmensions of existing structures, if any: Front ....... ; ....... Rear ........ Depth ............... Height ............... Nu~nber of Stories ..... i ......... ~ . .'... ' ............................ · Dimensions of shine structure with alterations or additions: Front ............ Rear .............. lmenslons o/entire new construction Front ~.. , l,do, n .u · a [ ............... rmrnoer orStones ........... . ................. :.. ........ 9. Sizeoflot: Front ....... · Rear ' ~- 10. [ u~rurcaa~e .......... 1 .......... ' ....... '.'. Name of Former Owner ........................... 11. Zone or use district in wh. ich premises are situated .............. ' .............................. i 2..' ..... .12. Does proposed constructmn viQlate any zoning law, ordinar~ce or regulation: ..... '..... ...........~ ............ ~-~ 13. ,W, ill lot be regraded ....... '.[/l. O .... , ............. Will excess fill be r,e~n0ved from premises: ~ Yes Name of Architect ' ' Address Phone No Namethof Contractor ' .... il ....... ........... Address ............ : ...... Phone No ............ ' .... 15.' Is is property within 1300 feet of a tidal wetland.* ~Yes ....... No..LV~. ..... ~ ~If yes,'SouChold iTown Trustees Permit may. be require~. ' I ' ' PLOT DIAGRAM : Locate clearly and distinctly all buildings, ~,heth~r existing or proposed, and, indicate all set-back dimensions fro*m property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ,8.S COUNTY OF..., ............. (Name of individual signing contract) above named. being duly sworn, depose5 and says that he is the applicant (Contractor, agent , corporate officer, etc. ) .... ' .............. authorized to perform or have performed the said work and to make and file this ned in. this'application are ~rue to the best of his knowledge and belief; and that the set forth in tim application filed therewith. ~f said owner or owners, and is dui: tpplication; that all statements conta: ~ork will be performed in the manner ;worn to before me this 1 ' day of j. 4otary PuMic ..................... County · ; O0~ER .................................. . ~ota~ Public, ,State of NewY~ (Signature of applicant) ~. ~22563, Suffotk.~un~ ' Tarm ~ires D~m~ 31, 19' (~ o~