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Home My WebLink About22731-zFOP~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23758 Date JULY 11, 1995 THIS CERTIFIES that the buildin~ Location of Property 10725 Oi~EC~)N ROAD House No. County Tax Map No. 1000 Section 83 Subdivision ADDITION ~UTCHOG~E, N.Y. Street Hamlet Block 2 Lot 16 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 13, 1995 .pursuant to which Building Permit No. 22731-Z dated MAY 5, 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 ADDITION TO EXISTING AGRICUL'~'u~L BUILDING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JAMES & RICHAI~D McBRIDE N/A Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 22731,Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: '., (. '..-~...~......(..;....~...~? .............................. ......... .......... ,o CountyTax Map No. 1000 Section ...........~......,~...... Block ........... ~ ......... Lot No ............ ,/,,~. ....... to application dated ................. ..,.t~./~. .......................... 1 9....~..'~ and approved by the pursuant / Building Inspector. Fee $..,.~.. ~ Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOIl CERTIFICATE OF OCCUFANCY 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 topographic features. 2. Final Approval from Health 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 contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, 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: 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 applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to tbe applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buitdine - $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-exi~ing Building ................. Location of Property .... ~.~ ..... House No~ ~/bV~,~- Street Hamlet Onwer or Owners of Property..~~.~.l;);~. County Tax Map No 1000, Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Ilealth Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approw~l ........................ Request for: Temporary Certificate ........... Fiual Certicate ........... ~ ~_, ~9 5~ ''' APPLICANT ................. FIELD INSPECTION REPORT DATE COI'~'IENTS · II FOUNDATION ('ST) II " ROma ~P~'~ INS~TION PER N.Y. ii ii STA~ E~R~ CODE II II II APR 3 1995 /~P}t ~ 3 J995 ~, FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 119711 TEL.: 765~ 1802 Exa,nined .~.~..c~.. ........ , 19.~..~ Approved ......... , 19 .~..~Permit No~...~..~..'~. ?. Disapproved. a/c ..................................... [ uil~ Inspector) APPLICATION FOR BUILDING'PERMIT B~ARO OF HEALTH ~3 SETS Ok' PLANS ...... ,.. ~SURVEY ................. '~, CIIECK ........ CALL . · · · HAIL TO: Date...; .............. ,19.. ' INSTRUCTIONS a. This apl~lication 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 buildings on premises, relationship to adjoining premises or public st?eet or areas, and giving a detailed description of layout of property must 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 issued 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 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 Southold, Suffolk County, New York, and other applicable Laws,.Ordinances or 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 taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Mailing address of applicant) State whether applicant is owner¼1essee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. ". .... ~,O''~ '; .....;42:"P~-'~ ..... '.:~>~.,;:....~.... i,;;.: ......... ... .. Name of owner of premises ..~.~..~...~ . al(as on tl~e';a}¢ roll or llt;st deed) ............... If ap~glJ~nt is a corporation, signature o_[ duly authorized officer· · ...... .......... (Name and title of corporate officer) Builder's License No ................ Plumber's License No ......................... : Electrician's License Other Trade's License No ...................... 1. Location of land on which pr~oposed work wii1 ~e done..~__)'X/~..~. ~ . .~... ........ ' ....... ..... .... .5-emoVu- . House Number . qBtreet ..................... Hamlet ~ ........... County Tax Map No. 1'000 Section .... ' .......... Block ............ Lot .... ~..~. Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) 2; State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .%~/ ~..~1] ~ ',~ t ',~A'r~l,l ................. b. Intended use and occupancy . t,'. .v "~/~k;~ ;~h'~ ........ ..... ...... · 3. Nature of work (check which applicable): New Building .......... Addition . Alteration Repair ........... Rem va ......... Demolition .... : .......... Other 'Work,., ........... 4. Estimated Cost ....................... Fee ..... 5. If dwelling, number of dwelling (to be paid on filing this application) ~nits ............... Number of dwelling units on each floor ...... If garage, number of cars ..... ! ............................................ 6. If business, commercial or mixed occupancy specify nature and e ~mens]ons et existing structures, 1 usef ..................... 7. D' ' · · ' I . xtent of.each type of any: Front ............... Rear .............. Depth ............... H.eight Numiber of Stories Dmlensions of shme structure wilth alterations or additions: Front Rear Depth ' ~ Height ................................ 8 ........................................... .., Number of Stories .......... ' ....~ ....... · Dimensions of entire new construction: Front ....... :; ...... ; Rear ....... Depth 9 .Height ... 2 ........... NumCer of Stories ........................ , ................................ · Size of lot: Front ........... ~ : .....:.. Rear .... 10 Date of Purchase i .................. Depth ...................... · · .................. ' ....... '.. Name of Former Owner 11. Zone or use district in which premises are situated. . ' .................... : ....... 12. Does proposed construction wolate any zonmr, law ord~ ............. ~,~,, ' ...... 13. Wall lot be reeraded . ,,. ~ ............................. 14 ~ fP ...... ~ .................. wm excess fill beremoved from premises: Yes , N Name of Owner o remises Address . Phone No. . el Name of Architect ......... ~ ......................... ' ' ' · 'i ................ Address .......... Phone No. Name of Contractor ' ' ................... ' .... . · ......... ~ ................ Address ................... Phone No ..... · 300 15. Is this property within feet of a tidal wetland? *Yes ........ No ......... · If yes,'Southold TOwn Trustees Permit may be required· PLOT DIAGRAM Locate clearly and distinctly all buildings, ~heth~r existing or proposed, and. indicate all set-back dimensions from property Lines. Give street and block nflmber or description according to deed, and show street names and indicate whether interior or corner lot. . 'NOTIFY BLIIr,~NG t)~PAR'~tI.,~NT AT. 7'~54802 ~ AM TO 4 PM FOR THE F~ )LtX'JW~NG ~NSFECTIONS: FO~ POURED CONCRETE ' ?. ~OU¢:~H ~ FRAMING ~ PLLJM~NG . 4. FtNA~ CONSTRUCTIONMU~T .... ' ~ · ' ~ ~ECOMPLETEFORC.O. ALL CONSTRUCTION SHALL ~IEET THE REQUIREMENTS OF THE N.Z SLATE CONSTRUCTION & ENERGY CODE~. N~" RESPONSIBLE FOR GESIGN OR CONSTRUCTION ERRORS'. ...... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing bontract) , (Contractor, agent, eot'potato officer, etc.) ................. said owaer or owners, ~d is duly anlthonzed to peffo~ or have peffo~ed the said work and to m~e a~d ~]e this pHcadon; that all statements contained in this'application are flue to the best o~hJs k~owled~e and belief; and that the )rk wQI be perfo~ed in the ~r set[forth in the applicat on filed therewith. ' ................. ~. ·; ......... county ' ~rm~ M~, i~ ' (Signature of applic~t)