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Home My WebLink About22799-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23680 Date JUNE 5, 1995 THIS CERTIFIES that the buildin~ ADDITION Location of Property 630 NKW SUFFOLK LAN~ House No. Street County Tax Map No. 1000 Section 109 Block 6 Subdivision Filed Map No. N.Y.' Hamlet Lot 5 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 18, 1995 ~ursuant to which Building Permit No. 22799-E dated JUNE 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 DECKADDITION TO EXISTING ONE FAMILY DWELLING 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 DORVILLE F. & ALICE FINKLE N/& N/A N/A Rev. 1/81 FOBM NO.3 'TOWN al: SOglXOt. D BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N_~ 2279~ Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Cou~b/TaxMapNo, lO00 Sectlon,,,,.../....~?.,~... ........ Biook....'''~'~'' .............. LotNo .....~ ............ and pursuant to application dated ............... ~ ................................... approved by the Building inspector. Fee~ ........ Z~ ....... Rev. 6/30/80 Form No, 6 TOWN OF SOUTIlOLD BUILDING i)EP~RTHENT TOWN IIALL 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 }{ghlth Dept. of water supply and sewerage-dlsposal(S_9 form)· 3. Approval of electrics/ installation from Board of Fire Underwriters. 4. Sworn statement from fplumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residencee 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· F~r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.pre-ex,sting land uses: I. Accurate survey of property sho~ing 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, tile Building Inspector shall state the reasons therefor in writing to the 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. Certificate of Occupancy on Pre-existin~ Buildin~ - $100.00 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... 77 . ,ew Construction ..... ~ .... ' ''~',' '~ .................. ...... ~+~ u~ rr~existing Build~mg.. .Uz.. . . · ........ Location of Property ...~. · " uouse ~o. '~ ' .......... acree~ Hamlet (/ p ,, ~ - ~ '~ ~ ~-f ........ ~..~.~.r. q ..'~ . County Tax Map No ~uuu, aection ....... .~..~.-.Block .............. Lot ... Subdivision ................................. Filed Map ............ Lot ............. · ' ............. Applicant ......................... Health Dept Approval · ' .............. Underwriters Approval Planning Board Approval .................. Xequest for: Temporary Certificate ........... Final Certicate .... .~..... Examined ............... , 19...~'''- Approved .......... 19... rmit No. ~..~.7..¢~.~-.. Disapproved a/c ........ ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 (t~t:~Kng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apl~lication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing 19cation of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- I 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 thc 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 Departmer~t for the issuance of a Building Permit pursuant to the Building Zone Ordiuance of the Town of Southbld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, fro' the construction of buildings, additions or alterations, or for removal ~{r demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build~il~g code, housing coded and regulations, and to admit authorized inspectors on premises and in buildhag for necessary, insp~~ ff ,.~~~ ~ -' (Signatur~cant, or name, if a corporation) (Mailing 'address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of ~owner of pre lllSeS ............................ (as on the tax roll or latest dee~pj}~$ If applicant is a corporation, s~guature of duly authoriied officer. DAT~: ~ ~,~B.P.# (Name and title of corporate officer) NOTIFY 8OIl. DING DEPARTr','r ~!T AT 765480~ 9 AM TO ~ ;~] '{ rile Builder's License No .......................... FOLLOWING 1. FOUNDATION - FOR POURED CONCR,, Plumber's License No ......................... 2. ROUGH - FRAMINO · 3, INSULATION Elecmc,an s L~cense No ................ · Other q rade's License No .............. ' ' ....... ' Locat,o. o ' an,l ,n wl.o. proposed work w,it b done ....... . . /I ,'1 ,~ ~ -> · CO,)E$. :"NOT House Nu,nber ~ Street/ ............ o.nt Ta, ap o.,000Sec,ou ......... ' Lot.D...:. Subdivision .......................... ~ .......... '. Filed Map No ............... Lot ............... (Name) Stat~ ex/sting use and occupancy of premises ,an~ended use and occupancy of proposed constructioni · . . · , a. Ex~slmg use and occupancy ., ........ ~'Y:<';: ['.':;J,: .:.~:~!,~?~)~9~ .......... ' ...... b. Intended use and occupancy ..................... '., '3. Natme ol woik (check which aiplicable): New Building .......... Ad~i~l~....~.. .... Alteration .... ; ..... Repair .............. Remgval ........... . Demolition . ~ ......... Other Work ............... ~..,! ~.~ (Description) .4. Estimated Cost ............ /.77-~;~..'' ............... Fee (to be prod on fihng this application) ' ' ge ' 'mb 0fd 5. If dwelling, number of dwelhn rots ............. ., Nu er welling units on each floor.. .............. If garage number of cars i ' 6 If business commercial or m~xed' occupancy specify' nature and extent of each type of use 7. Dimensions of existing structure~, if any' Fro it ' Rear Depth l-leight Numlber o f Stories ' ' ' Di f h t ~ "th It ' dd'ti :F OleUSiOIlS O S Inestmcu e WI a eratlons Or a I OIlS font ................. Rear ................. D pth .... ' ............... Hight i Nu f St ' e ~. · e ........ , .' ........ : ; mber o ories ................... 8 ' ' ' ' constgmtion: Front Rear · Dunensmns of enttre new .............. : ............... Depth .............. Height ............... Number of Stories ........................................................ Size of lot: Front : ' Rear . ' Depth Date of Purchase ........... ! ......... .. . Name of Former Owner Zone or use district in which pre[nises are situated .............................................. . . Does proposed construction violote any zoning law, ordinahce or regulation: '.... ' Will lot beregraded............' .................Willexcessfillberemovedfrompremlses Yes No Name of Owner of premises ~ Address Phone No Name of Architect i Address Phone No Name of Contractor . Address . Phone No ' 15,' I.s this property within 3,00 feet of a tidal wetland? *Yes ........ No..~$ .... · If yes, Southold T!own Trustees Permit may. be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block r umber or description according to deed, and show street names and indicate whether interior or corner lot. I0. 11. .12. 13. 14. STATe OF //× coum-¥ ', , , ........ .... . ....... (Name of individual signin~ contract) above named, i being duly sworn, depose~ mid says that he is tim applicant lle is the (Contractor , agent , corporate officer , etc . ) of said owner or owne~.s., and is duly ~uthorized to perform or have performed the said work and to make and file this · application; that all stat~dments contained hi tliis'application are true to the best of Ins' knowledge and belief; and that the work w~l be perfoflned in the intoner set fOrth in the application filed therewith. ' ' Sworn to before me tlus .......... ~>~... ~0. ~ . ~missmn txpnes u~em~i