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Home My WebLink About22625-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23677 Date JUNE 1, 1995 THIS CERTIFIES that the buildia~ ADDITION & ALTERATION Location of Propert~ 2100 JACKSON STREET NEW SUFFOLK NY House No. Street Hamlet County Tax Map No. 1000 Section 117 Block 10 Lot 18.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated Building Permit No. 22625-Z FEBRUARY 23, 1995 ~ursuant to which dated MA~CE 10, 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 A ROOF ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RUSH FORGUER of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A // Bu llding inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] N£ 22625 Z Coun~/ Tax MaP No. 1000 Section ...... /.~.....~....... Block ........ '.~...~... ........ Lot No. .,~'..~...E../. ........ pu,suon, to opp,,oot,on dated ........... ~~ ...... ~ ........... ~9....~....~..andapprovedb~,he Building Inspector. Fee $..K.../..~.. ........... Rev. 6/30/80 Form No. 6 TOWN OF SOU'FIIOLD BUILDING I)EP~RTHENT TOWN IIALL 765-1802 APPLICATION FOg CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the bnilding inspector with tbs following: for new building or new use: 1. Fiual survey of pro, perry with accurate locatiou of all buildings, property liees, streets, hnd unusual natural or topographic features. 2. Final Approval from liehlth Dept. of water supply and sewerage-disposal(S-9 form). 3. Apprevai 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. Commercial bu.ildin~, industrial building, multiple residences and ' ' ' · and lns.tallatzons,~a certificate of Code Com,,l~ ..... ¢~ ,. slmllar.buzldzngs responsible for tile building· or euglaeer 6. Submi°c Planning Board Approval of completed site plan requirements. B. . F~r ~xisting 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 aud finusual natural or topographic features· 2.A properly completed application aud a consent to iuspect, signed by the applicant· 8 If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to tile applicant. C. Fees I. Cert. ificate of Occupaucy - New dwelling $25.00, Additions to dwelling $25·00, Alterations to dwelling $25.00, Swj~uning pool $25.00, Accessory building $25.00, Additioos to accessory building $25.00· Businesses $50.00· 2.Certificate of Occupancy on Pre-existing Buildine - $[00.00 3.Copy of Certificate of Occupancy -.$20.OO 4.Updated Certificate of Occupancy - $50·00 5. Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.OO' ~ ~ereet }lamle~U '' O~er or Owners .,,f Property ..... . .~j~ ................................... Subdivision ................................. Filed Hap ..................... · ' ' Lot Permit No....~..~.~.~.~....Date Of Permit ............... lc:hr ............... · Appl .. !lealth Dept Approval · ' ......................... Underwriters Approw~l ....................... :'lanning Board Approval ~equest for: Temporary Certificate ........... Fiual Certicate ......... %e Submitted: $ ...... ~.....Q . ~ .............. INSPECTION REPORT DATE CO~q~ENT S ~OUN~ATrON (~sm) II " FOUNDATION (2ND) P~.tr~rNc INSULATION PER N. Y. STATE ENERG"f [I FINAL ~[[11 ( ~ l// 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. REMARKS: FOUNDATION 2ND [ ]/~(SULATION FRAMING [' ,~ FINAL //. 765-X802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [~F~MING [ ]FINAL REMARKS: '~__/~*~*~ ~* INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTH ......... 3 SETS OF PLANS ...... -... SURVEY .................. CIIECK ................... SEPTIC F O RI'! ............. -Exanlined .e .~..~.~....~.../?.., 19:.)./" TEL.: 765-1802. Disappr?vedI a/c " .... ' · "\ . ,, ' '' /// , (Building Inspector) ~' ~ "; \ :', ' yLIOATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. Ttds application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 adjoining premises or public sti'eets ~or 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 this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~sued a Building Permit to the applicant. Such permit 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 Occupancy 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 Ordinance of the Town of South01d, .Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions 9r alterations, or for removal or demolition, as herein describbd, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insi~ction~. /'~ ,o . ......~ff"'d~' ':"'.''67~ ....................... (~/~natur~ of applicant, or name, if.a corporation) tai lng address o: app icant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. owner of premises../9/')~..--0~..~ ;'n. ih'e' t'a'x' ;o'li ;} i~t~it' ~:e'~)' ' ' ' ........ - ..... ........ N~me of If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.../.3. o. dd..ff./. ......... Plumber's License No ............... . .......... Electrician's License No ....................... Other Trade's License No ...................... 1oo '5- ck.qo/o $7' 1. Location of land on which proposed work will be done ............................. ' ................ ' '' ' ......... ' House Number Street Hamlet County Tax Map No. 1000 Section .../'./..7,, 7'', ...... Block /0 ' Lot.../.~,'../ Subdivision Filed Map No. Lot (Name) 2: State existing use and occupBncy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................... b. Intended use and occupancy ~.~/LD , ~ ' (~3~ 'z~ogjo a~zodzoo '~u~ 'zo3o~z~uoD) h 'po~ ~aoq~ · .~. .... SSOt:ll:la NOIJ.3tlHJ.SNO3:10 IdOJ ~l'181SNOdS]a ION 'S~IO03 AgldaN~ ~ NOIJ. 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