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Home My WebLink About22992-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~TIFICATE OF OCCUPANCY No Z-23885 Date SEPTEMBER 18~ 1995 THIS CERTIFIES that the building ADDITION Location of Property 1095 CUS'r~K A~ENUE SOUT~OLD NY House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 9 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 23~ 1995 pursuant to which Building Permit No. 22992-z dated SEPTEMBER 6~ 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 HANDICAP RAMP ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARC STNAUSS & COLETTE KERN (owner's) 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 Building Inspector/ FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPAgTMENT TOWN HN.L $OUTHOLD, N.Y. N? 229~2 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ................... ,~./~ .............................. / Permission Is hereby granted to: ....... ..................................... ~..~.e.~.,,,~,,,, ~.~.~ ...... ,-~.~, ...................... ..~.~..~.~.~,~. ...... ~.y.....:.....././...~.Z ./.. ...... ,o .... .~..~. , ~-~.... ~: ......... ~. .......... ~3..,..~/~.,.~ ....... ~.x.........~.~.~.:/~. '..~... ........ ./..~... ........................... ,. .............. ..?...~ ....... at premises located at.......,~....d~...~....~.. ....... ~..Y'../...-~...~.... ........ ~.: .................................................. Coun~ Tax Map No. 1000 Seotion....Z..~... ........... BIock..,.,~ ............ Lot No. ... ./..~. ................. pursuant to application dated ..,~...~..~.~./..-~.........~....~. ................... 19,.. ,~,.~.. ..... and approved bylhe Building Inspector. Fee $.......~... ,~... ........... //' Bu}i'ding Inspector Rev. 6/80/80 BLDG. DEPT. TOWN OF SOUTHOLD Form TOWN OF SOUTItOLD BUILDING DEPARTHENT TOWN HALL 765-!802 A?PLiCATIOM FOR CERTifICATE OF OCCUPANCY 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 topogrsphic features. 2. Final Approval from ~ealth Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. &. Sworn statement from plumber certifying that the solder used in system contains less than 2/i0 of i% lead. 5. Commercial building, industrial building, multipl~ r~sid~nces and similar buildings and installa'tions, 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, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing ail property lines, streets, building and unusual 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 ti~e applicant. C. Peea 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling S25.00, Alterations to dweiling $25.00, Swimming pool $25.00, Accessory building $25.00, Additiona to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existin~ Buildie~ - $100.00 ~. Copy of Certificste of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.00 bocation of Proper~y ..... ~P~ .................. ~$T~g.~.~ ................ ~.Ti~.L~ ........... ~ouse No. Street lIamlet 9nwer or O~ners of Property.,H~-~..,%'~,J~.~..O~,k,~'~.~-.~.~ .............................. ~OUnCy Tax Map No lO00, S~ctio, ..... ~ ....... BJ,.~ck .... 9~ .......... Lot..~ .................. Subdivision .................................... Filed Hap ............ Lot ...................... i'ermic No...~,~.~.~. ..... Dace Of Permit...~.l~l~ ........ Applic;inC.~.~.. ,,~..~. ,~.~ .......... Health Depc, Approval .......................... U.derwriters Approval ......................... 'ianning Board ~\pprovul ........................ :~equost for: Temporary Cer~:ifica[e ........... Fi.;~l Certicace..~ ....... 7es Submz~teo. FRAHE I?1,UHI~ l sTATE 11 ADD [TtONAI., COMMENTS $.~0~ CU$ A SURVEY FOR WILLIAM $. ,~ M,O, RJORIE 13.. DEROSKI SOUTHOLD" TOWN OF SOUTHOLD SUFFOLK COUN. TY, FEB. I0~ 1967 i¥..~R. 27, 1967 GUARANTEED $OUTt'IOLD 5AVIPlG$ J~ANK. HOME TITLE DIVISION., CHICAGO TITLE '~NSURANCE COMPANY. LAND SURVEYOR IV.Y.$. LIC. NO. £$72~ RIVERHEAD~N.¥. NOTE: · =MONUMENT 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ROUGH PLBG. FINAL ] FIREPLACE & CHIMNEY REMARKS: FORM NO, 1 TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN IIALL SOUTHQLD, N.Y. 11971 'TEL.: 765-1B62 Examined ...... ,~,~, ..... , 19 g~..-~ ^ppro, , ....... ..... Disapproved a/c ..................................... Bi)ARD OF IIEALTll ...... ,~S3 SETS OF PLANS URVEY ................ ,/CHECK ......... ~ ....... SEPTIC FORtl ........... CALL ...... FLAIL TO: APPLICATION FOR BUILDING PERMIT Date .~.u.u.~ .t~ .......... , 19' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to tile Building Inspector, sets of plans, accurate plot plan to scale. Fee accel'ding to schedule. b. Plot plan showing 19cation of lot and o£ btdldings on premises, relatiouship to adjoining premises or public sti-, or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of fids aF cation. c. Tile work covered by lids application may not be commenced before issuance of Building Permit. d. Upon approval of this applicalion, tile Building Inspector will issued a Building Pem~it to tile applicant. Such per shall be kept on the premises available for inspection throughout the work. e. No building shall be ocet;pled or used itl whole or in part for any purpose whatever until a Certificate of Occupm shall have been granted I?y the Building Inspector. APPLICATION IS HEREBY IvIADE to the Building Department for the issuance of a Building Permit pursnant to Building Zone Ordinance of the Town of Soutbold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildh~gs, additions or alterations, or for removal ~}I' demolition, as herein describ The ap ~licant agrees to comply with all applicable laws, ordinances~ building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary inspecfions. (Signature of applicaut, or name, if a corporation) · .~.q'~c...c93..3~,p,.' ,N~ -. t .a.°."m-}9..~D..r S .'L, t.t.%'7.t ..... (Mailing address of applicant) State whether applicaut is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber or build Name of owner of premises . . .~,~.. ~...~.Tg. bg.~.-5 . .~O~D...c~.~ . b.: .'E-L::~el ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly autboriied officer, (Name and title of corporate officer) Builder's License No .......................... 1995 Pimnber's License No ......................... Electrician's License No ....................... Other qtade s Ltcense No... .................... 1. Location of land on which proposed work will be done .......................... ..................... louse Number Street llamlet Cotmty Tax Map No. 1000 Section ....'7.~. ............ Block ... P.':[ ' Lot ..[6. ............ Subdivision . .; . Filed Map No. Lot (Name) Slate existing use and occup~lncy of prenlises and inte. nded use and occupancy of proposed construction: a. Existing use and occupancy 5i~ .~t~. ' ' v~'v- v' ' 3~;! "~,..~ ................... b, lutended use and occupancy ~' ........................ , ~ · ' ~c2~ ,~ ~ , ~2~qn.2ffin~ ..................... *. tqat.~*c w ,.~,,. ~.c*~-~A-~ ,,n c ,~t,};llcame): Iqew Buimlng .......... Additiou .......... AJteratioa . .~.; .... Repair Removal Demolition · ~ Other Work · .... (Descriptiou) Estimated Cost . ~ .~7.:g.°.,.~. 9..: ...... ' .................. Fee ..................................... (to be paid on filing this application) If dwelling, number of dwelling units 1. Number 0f dwelling units on each floor. 4 · If garage, number of cars ........................................................................ 6. Il' business, commercial or nfl.xed occupa my, spec fy natnre and exte,t of,each type of use . ~]& ................ 7. Dimenslo.s ut` existing structures, if any: Front .. ' Rear .............. Depth .............. tleigbt ............... Number of Stories ............. , ......................................... Dimensions of s~me stmctuiTe with alterations or additions: Front ................. Rear ................. Depth Height ' Number of Stories ' 8. Dimensions of entire new construction: Frout .............. : Rear ............... Depth .............. .Height ............... Number of Stories ........................ , ..................... : ......... Si flor F ' R D pti ze o : runt .................. ear ............. ; ........ e I ..................... Date of Purchase .................... · ......... Name of Former Owner ............................ Zone or use district in which prenlises are situated .............................................. ~ ..... Does proposed construction violate any zoning law, ordinance or regulation: .............................. Will 10t be regraded ....... '. .................... Will excess fill be removed front premises: Yes Name of Owner of [~[emises .................... Address ................... Phone No .............. Name of Architect ........................... Address ................... Phmm No ............... Name of Contractor .......................... Address ................... Phone No .............. I.s this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly aud distinctly :ill buildings, whether existing or proposed, and, indicate all set-back dimensions fro property llnes. Give street and block number or description according to deed, and show street names and indicate whetb interior or coruer lot. 10. 11. 12. 13. 14. STATE OF NEW YOILK~ , country oF .... ..... s.s ...... ~tgl .~'~.....~..-...~x..~: .~)'. d ......... ......... being duly sworn, depose~ alia says that lie is the applic (Name ut' individual signing coutract) above named. tie is the . .~.... .................... LZ> .~q~-~. ......................................... '- -. ......... (Contractor, agent, coq~orate officer, etc.) u[ said owner or owners, and is duly authorized to perform or have perfom~efl the said work and to make and file application; that all statements c,ontained in this applicatlou are true to the best of bis knowledge and belief; and that wink will be performed in the manner set forth in the applicafion filed therewith. Swum to before me this ~) ......... ..... , u : ........ ...... NOTAHY PUSU~'$tat~ of N ~, (Signature of applic ~o. ~7~D8~. ~affolk' ~u~ '