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Home My WebLink About22630-zFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23581 Date MARCH 30, 1995 THIS CERTIFIES that the building Location of Property 170 LAUREL A~ENUE House No. County Tax Map No. 1000 Section 56 Subdivision ACCESSORY SOu'raOLD, NEW YOltK Block 3 Filed Map No. Street Hamlet Lot 4 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated M~RCH 3, 1995 pursuant to which Building Permit No. 22630-Z dated MARCH 16, 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 ACCESSORY STORAGE SHED IN REAR YARD "AS BUILT" & FENCE ENCLOSURE AS APPLIED FOR. The certificate is issued to RODERICK W. FOSTER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A FORM NO.$ TOWN OF $OUTHOLD SUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o,~ ......... ~..~ ............... ,P~...~ N£ 22630 Z Building Inspector~_ Rev. 6/30/80 FOUNDATION (IST) Fg~A__TION ( 2ND ) ROUGIt FRAI~ & PLIJI'IBING INSULATION PER N. Y. STATR ENERG-'Y COD I Il ADDITIONAL COiV~IENTS: 76S.1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ~ BLDG. DEPT. ' ~ L TOWN OF SOUTHOLD ~ Examined ............. /~'..., Approved... ~z~_/_~t~.', ~9~emit No. ~. ~¢~ Disapproved [c ' ,.. /f . (Buildis~ Inspectpr) FORM NO. 1 TOWN OF SOUTHOLD SOUTHOLD, N.Y. 1197~1 TEL.: 765-180;2 B~ASO'0F HEALTH ........ 3 SETS OF PLA3S ......... ,SURVEY .................. CI1ECK ...... .,. CALL /~2' HAIL TO: Date ...;...; .......... ,19... INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with s~ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoir~ing premises or public stl-eet: qr areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli cation. c. The work covered by tkls application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will igsued a Building Permit to the applicant. Such permi shall be kept on the premises avti~Jable 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 bY the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordlnance of the Town of Southcld, 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 tc admit authorized inspectors on premises and in building for necessary inspections. (Signatur~ of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~ne of.owner of:premlses . ~ zg~/C'/'C/~7- ' ~'6/, ~ ~'~¢~ ' '; .................... . .....,',' ',' ...... ; ' ~ :,: ;¢ .ICS7,¢-~ ..................... ~as on me mx rp~q~l~test'ae~a) If applicant is a corporation, signature of duly authorized officer. '. (Name and title of corporate officer) Builder's License No .................. Plumber's License No ......................... Electric~an s L~cense No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number /70 ~'/~g-/.4'~. /fiT~ St-r~et Hamlet Couhty Tax Map No. 1000 Section ................. Block ............. ' Lot ............... Subdivision..; ..... . ............................ '. Filed Map No ...... ' ......... Lot ............... (Name) . State existing use and occup;mcy of premises and intended use and occupancy of propqsed constr:uction: Existing use and occupancy ~ a ' b. Intended use 'and occupancy //~c'~C~e-5'-fO/~...~..~..,/~..~'~' "' '.,~...~.z/~.._~/Z/~"z:5 "" ~'i! ( hi h Ppli bi ) ilding ' Additi .3.Natureofwork checkw c a ca e NewBu .......... on .......... Alteration .... ; ..... Repair .............. Removal ..... , ........ . Demolition ............. Other Work ............... 4. Estimated Cost .......... ~ ....... ~. : .~,X, 2,~ paid on filing this application) $ !~dwelhng nu.raberofdwelhnglunits ", ............ . ' ' Number of dwelling units on each floor ii garage numeer of cars ...... ; ......... 6 If business commercial or mixed occupancy specify nature and extent of ............ · ' . , .each type of use 7 Dimensions of existing structur6s if Front .................... · any: Rear ' Depth Height Number of Stories ' ' ' Dimensions of shine structure, with alterations or additions: Front Rear ' ' Depth ' ' Height .......................... ..................... ' ............. '. Number of Stories ' ' · D~mensmnsofenhrenewconstruction: Front . ............... Rear ............... Depth .............. Height ' Num'be of Stories 9. Sizeoflot: Front ......... Rear... ' i ............. 10 Date ofP rchase ................... Depth .................. I 1 Z di ..... l~i ..... ......... ' ........ .. Name of Former Owner .................... ~ ....... · one or use strict in w ch pr~mises are situated .............. ' ....... ....' · . Do d let i gl di h ................. i ........... · es propose construction vic e any zen n aw, or na ce or regulation .,... · regraded ....... ' Will fill be d fr ' i 14 Nam cfC fp · .: ................... excess remove om prem scs: Yes No · e wnero remises ...i ........ Add Ph eno Name of Architbct ~ Address Phone No Name of Contractor ..... ~ . . ' th± pr ..................... Address ............ ; ...... Phone No. ,. .............. 15 Is s operty within 300 feet of a tidal 'wetland? ~Yes ........ No ......... · If yes,'Southold Town Trustees Permit may.be required. ... i PI~OT DIAGRAM Locate clearly and distinctly all !buildings, Whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF Ni~;g~'O~ //,~'~ 'S i cou 9-o -- (Name of individual signing contract) lbove named. &PP~O1/ED AS NOT£D . Ull~ BUILDING DE~ 765-1802 9 AM ~ 4 ~TR~ ' '. Fo~[ow~ I,s~o~s: FOR POURED CONCRETE z ~OU~H. F~M;,~.a Pm~mN~ · 4.'FINAL CO~RU~O~ ALL. CONSTRUC~ON SHALL ME~ ST~ co~smum~o~ m CODES, N~ RE8PONSIB~ FOR ~EmG~ Oa co~smum~o~ ~o~s being duly sworn, depose~ and says that he is the applicant hie is the , . (Contractor agent, corporate officer, etc ) )f said owner or owners, and is duly ~uthortzed to perform or have performed the said work and to make and file this tpplication; that all statements contained Jn this'application are /rue to the best of his knowledge and belief; and that the gork will be performed in the manner set forth in the application filed therewith· ' ' ;worn to before me this ' .... : · '.: · '...~.f,~.~'.~,day of ..... _... '.. _~Q(~k~: 197.~ . Notary Public, State of NeW York '// .... . .................. · /.. 7C.~? ........... NO. 4879505 , '.~ ~ Qualified in Suffolk County Cj/[~ (Signature of applicant) Commission Expires Decembot 8, 19 ~ , I I 128.06 ': :, A ..... r:.90 AF.~A,, .3'.2~9 AC BLDG. DEPT. TOWN OF SOUTHOLD~ , /. POLl WOE / ~ ° , : N'~9 24 E. k,IAGY ,~^Y 'i A