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Home My WebLink About22751-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23645 Date MAY 15, 1995 THIS CERTIFIES that the buildin~ ACCESSORY Location of Propert~ 705 SMITH DRIVE SOUTH SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 76 Block 2 Lot 28 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 20, 1995 pursuant to which Building Permit No. 22751-Z dated MAY 11, 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 AN "AS BUILT ACCESSORY STORAGE SHED IN THE REQUIRED REAR YARD OF A ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. DONALD & VINCENZA INSULL SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner's) Rev. 1/81 N/A FORM NO.$ BUILDING DEPARTMENT TOWN HALL SOUTHOLO, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETiON OF THE WORK AUTHORIZED) 22751 Z Permission is hereby granted tp~ ,, ~ ~ / · ...... ~../...~..~......~.z...~// ......... ................ ~.~¢...~...:..~/...- .... ~~L~......~~,.:.z~....~..~~..... ~ ~~. pursuant to application dated ................. ~...~, 1 Q.~,.~dnd approved by~e Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTIlOLD BUILDING DEP~ .ARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 H~ith Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electric~ installation from Board of Fire Underwriters. Sworn statement from~lumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar bu and lnstallations,~a certificate~of Code Compliance f .... ildings · ~ ~om architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. 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 the applicant. C. Fees i. 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 Buildine - $i00.00 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 ate ........ New Construction Old Or Pre ............ existing Building ......... Location of Propertv..~.~.~....~..72../..~.~. DF,~.~ .~o.~ .~f/~ House No. ' ..................... ' ,, Street Hamlet Onwer or Owners of Property.. ~. County Tax Map No 1000, Section ............ Bleck ...... Lot .. subaivision ................................... Filed Map ................. ' ~ot Permit No ................ Date 0f Permit .......... Applicant . . . llealth Pept Approval ' ' ......................... Underwriters Approval ....................... Planning Board royal ............. :.~ Request for: Temporary C_~-~ificate ........... ~. [ .. Fi,,al Certie te ........ 2 0 Fee Submitted: i ' . · ...................... 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGHPLBG. [ ] FOUNDATION 2ND [ ] I~ULATION [ ] FRAMING [v] FINAL [ ] FIREPLACE&~i~HIMNEY REMARKS: ~ FIELD INSPECTION REPORT ff~ATE FOUNDATION ~FOUNDATION (2ND) !' ROUGH FRAME & PLUMBING Il INSIILATION PER N. Y. STATE ENERGY CODE II ADDITIONAL COMMENTS: DON INSULL APR 2 0 I995 :~ 4°~ 2 0 ~5 1 TOWN HALL ..t,.<, ~ SOUTHOLD, N.Y. 11971 ,- ' ::":,,~ ,~..~ I ~ ,, TEL.: 765-1802 E×amined ~// ?? ' ' Approved ~~/..., 19 rmit No ............ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT BOARD OF HEALTH ........ 3 SETS OF PLANS ........ SURV£Y .. CALL .... MAlL TO: Disapproved a/c .................. //. (Building Inspector)/ .. - ' . ~ ',,-'~' Date ................. 19~...~ INSTRUCTIONS a. T~s application must be completely filled in by Wpewfiter or in ink and submitted to the Build~g Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~g location of lot and of build,ge on premises, relationship to adjoining premises or pubic street or areas, and giv~g a det~led description of layout of property must be drawn on the diagram which is pa~ of this appE cation. c. The work covered by tMs application may not be commence~ before issuance of Budding Pemit. d. Upon approval of this application, the Building Inspector will issued a Bulldog Pemit to the applicant. Such pemi sh~l be kept on the premises available for ~spection throughout the work. e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cx shah have been granted bY the Building Inspector. APPLICATION IS HEREBY MADE to the BulldOg Dep~tment'for the issuance of a B~lding Pemit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws,.Ord~ces m Regulations,' for the construction of buHd~gs, additions or alterations, or for removal or demolition, as here~ deschbed The appScant agrees to comply with'all applicable laws, ordinances, bu~d~g code, housing code, and reguhfions, and tc admit autho~zed ~spectom on premises and ~ build~g for necessa~~, -- ~ ~~ins~ecti°ns' . ~. . · · n ' ............ ~ '~-% O~J .1 ~ . I '"'~"-<Si*nature°fapplicant'°rnamc'ifac°rp°rati°n) ~ J~ ~ ..... .. · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, Chglnee;, generai-'contractor, electrician, plumber or builder. M~me of owner ofpre;~ise~ ~)..o.n..~./.~..../'J:.....~.~ g. ].( ..... 4-....~.( .0.qe.n..'c,_:~, ~v~ j) .................. ':: "' (as on the tax roll or latest deed) If applicant ~s.a*cO~ptSr~ition, signature of duly authorized officer.' (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... . ........ : ' · ~o. ~..' ....... 3.~. ,~.6...Dx,x..~....~...~..%... ' %0, Itouse Number Street Hamlet County Tax iVlap No. 1000 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: ~. ~,,~,~ ~,~ ~ o~n~ ....7~....... . ' . ... ...................... ~ Intended use and occupancy ., ......... · ........................................... · 3. Nature of work (check which applicable~ New Bu"~'-- ' ~ ' i Re-air . ,~ I , ~: aul,g ....... , Addition ....i. p · . t~emoval r, . . · ·. Alteration ....... ,.. ' ~ '"" ' · (Description) 4. Estimated Cost... / ...... :; }: .................... Fee .......... I (to be paid c filing this application) ' 5. If dwelling, numberofdwellingiunits ............... Number 0fdwelling units on ach floor ................ If garage number of cars ', . ' 6 If business commercial ormi i ......... : .............................. xe~t occupancy specify nature and extent of each type of ds'e ...................... 7 Dimensions of existing structures if any: FrOnt Rear ' Height Number of Stories ............... Depth Dimensions of same structure wi!th alterations or additions: Front ....................... Depth . ' ........ Height ....... ' .... . ........ ' ............... Rear ........ ,' ..... .... i. · Number of Stm 8. Dimensions of entire new constr~ction: Front ~ Rear Height Number of Stories ........................... Depth ............... 9 Size of lot: Front ' ....................................................... · · ' ' Rear ' · ' ....... ' ' ~ ................................. Depth ................... ,~.. I0. Date of Purchase ........................... Name of Former Owner ................... 1. Zone or use district in which premises are situated ......... ': ....... l~t g 1 ' 12. Does proposed construction vie e any zonin aw, ordinance or regulation: ........................ ..w, de/ .... .... :. . ...... 13. fll lo regra i .................. Will excess fill be removed from premises: Yes No 14. v~ane oi uwner olpremlses .... ~ ............ Address ' P ~one No ......... · · Name of Architect .... i " .................... ....................... Address ................... Phone No ............ , .... Name of Contractor 'i . ~ [5. I,s th~s property withzn 300 feet of a tidal wer~.,,¥~' -,-;- ............ Phone No ................ · x~ yes, ~ou~no~a 'lgwn Trustees Permit may be required ' I ........ · ,, 'l PLOT DIAGRAM ' t a ed:satin%C~lYoc~l)uu~lbdemr ogs; 2hs~e_t.h_e,.r. exis.t?g,.or p. ro?ose, d, a~,d; indicate 1 set-back dimensions from prop e · ~. · ~u,puon accorumg re sees, ann snow street names and Indic interior or corner lot. . . ate whether DATE: ~ FEE:~ NOTIFY' BUILDI'~ 765-1802 9 AM ~ FOLLOWING INSP ~, 'FOUNDATION FOR POURED, 2, ROUGH. FRAM ,3. INsu~TION )...AS NOI'ED CTIoNs: TWO REOUIRED ~NCRETE lNG & PLUMBING · 4. FINAL . CON, ~RUCTION MUST · SE COMPLETE FI )R C.O. ALL CONSTRUCTiON 8HALL MEET THE RECIUIllEMENT8 OF THE N.Y. ' STATE CONSTI:IUCiiON & ENERGY CODES. NOT R_Ft~PONSlBLE FOR DESIGN OR CONSTRUCTION ERROR8 ........ being ulysworn, deposes d (Name of individual signing ~:ontract) . )eve named· ~ is the ' ~ (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly aul~orized to perform or have performed the said work plication; that all statements contained ~n this'application are true to the best of his knowled )rk will be performed in the m,4nner set 'orth in the applicati6n filed therewith. ~orn to before me this .... . ..... ........ i Notm~ P~blic, State of N ~w York ' · sa/s that he is the applicant nd to make and file this and belief; and that the (Signature of applicant) . OWNER: T~T FOR APPROVAL OF CONSTRUCTION ONLY T 0'~" STATEMEN INTENT THE WATER ~UPpLY AND S~WAGE: OENCE WILL COLIFORM r TO THE STAND.D8 OF BUFFOLK CO- DEPT. APPLICANT