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Home My WebLink About22828-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-23928 Date OCTOBER 5, 1995 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 2005 OLD NORTH ROAD SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 3 Lot 26.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE i, 1995 ~ursuant to which Building Permit No. 22828-Z dated JUNE 14, 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 ACCESSORY S~ED IN THE REAR YARD AS APPLIED FOR "AS BUILT" The certificate is issued to MARKO & LINDA ANTI~EV of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner) N/A Rev. 1/81 ildi~g Inspector FORM TOWN OF $OUTHOLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] 22828 'Z Permission Is hereby granted to: ..,~..~..~ .......... ~~ ...................... ... ./.~..~...-....~..... ..~...~.. .~..-../...-... .......... ........ ,~....~ ........... ~ ........ ~~ ....... ~ .......... ./.~ ........ ~ .......... .~ .~ ./. .~ . . . . :, . . ~ ............. ~. . . . . ~/. . . .~.Y. . .............. ~ ~, ..................... Cour~yTax Map No. 1000 Seotlon .......~..~ ........ BIock......~, .~.. ............. ~'Lot No ..... pursuant to application dated ......................................... 19 , Building Inspector. and approved by the Rev. 6/30/80 alibi - 11995 Toi,,, OF SOUTDOkO : TOWN IIALL ~0 ~-' APPLICATION FOR CERT}F~CATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new nsc: 1. Final survey of property with accurate location of all buildings, property lines, ~ streets, and unusual natural or topographic features. 2. Final Approval from Hghith Dept. of water supply and sewerage-disposal(s-9 form). ~ 3. Approval of electrical installation from Board of Fire Underwriters. 4.' Sworn statement fromlplumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Commercial buildin$, industrial building, multiple residences a d .... and installations,~a certificate of Code ComDlian~ ~r~ . n sxm~lar buzidlngs 6. responsible for the building. . ..... m arcnxtect or engineer Submit Planning Board Approval of completed site plan requirements. B. F~r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and .Pre-existing" land uses: 1. 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 the app].icant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swi,~ing pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buiidin~ - $1OO.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $~5.00., Commercial $15.00' New Construction ........... Old Or Pre-existing Buildinz~ ...... ~O~ .................. ' Ilouse No, Street ......................... Hamlet Onwer or Owners ,.,f Property ........... ~ ~ ~ County Tax Map No I000, Section... · .... Block ......... Lot. ................................. Fi~ed Map ............ Lot ..................... ~ermit No ................ Date Of Permit ................ Appl~c;nt ........................... Health Dept Approval '' ...............Underwriters Approval '~lanming Board Approval ~equest for: Temporary Certificate ........... Fiual Certicate .... ~ ..... 'ce SubmitteO: $ FOUNDATION ( IST) FLUMBIN~ STATE E~R~ CODE -7' (2: FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N,Y. 11971 TEL,; 765-1803 I ? ermit Disapproved a/c ' APPLICATION FOR BUILDING PERMIT BOARO OF tlEALTII ......... 3 SETS OF PLANS SURVEY CIIECK ......... ~ .......... SEPTIC F O Ri'l CALL .[.;; ................ HAlL .. t.?o. 3 ....... " Date 19 INSTRUCTIONS a. This application must be cmnpletely filled in by typewriter or in iuk and submitted to the Building Inspector, with 3 sets of ptans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Ipcation of lot and of Imildings on premises, relatiouship to adjoining premises or public sti-eets or areas, and giving a detailed description of layout of property must be drawn on the diagram wlficb is part of )bis appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tiffs application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throngbout the work. a. No buikling shat! be occupied or used iu wlmle or in part for any purl)ese whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tile Building Zone Ordinance of the Town of Soutbbld, Soffolk County, New York, and otl~er applicable Laws, Ordinances or Regulations, for tile construction of buildings, addit OhS or a tara)ions, or for removal ~F demolition, as herein described. Tile applicant agrees to cmnply with all applicable laws, ordinances, building code, bousiag coda, and regnlations, and to admit antborized iuspectors on premises and ill buildhlg for necessary inspections. ~' . _: ....... ' /(Signature of aP'lSlicant, or name, if a corporatio~) .... (Mailing address of al)~c~'r/'~'~z'" ~ '' . I/q'?/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises /t~,~4t[o ~Z~ /_/x, v6r:t ~iq/7~l¢,~..~f. c (as on the tax roll or latest deed) If applicant is a corporatioq, signatnre of doly authorized officer. (Name aud title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of hind on wbicb proposed work will be done. llouse Nmnber Street llam'et' County 'Fax Mall No. 1000 Section ...-xl'~..~/- ........... Block . .~. ...... ' Lot ...-~..~'.: .? .......... Subdivision ........ . ............................ '. Filed Map No. (Name) .............. Lot .............. : 2: State existing tlse and occupgncy of premises and intended rise and occupancy of proposed constroction} .,. , a. Existing use and occnpancy ' ...... :Y ~,'~8 ~:&:V-',DL~r~d'~ ~'~A?O~ ..................... " b. Intended use and occupancy ...... J, lq,ltalic oJ ,, tjx,, Lunt~,k ~villcn dlit)llUaUje): /qeW LitHldJllg ..........Addition ......... AJlelalion .... ~ ..... Repair Rembval Demolition Other Work ' ' .... (Description) 4. Esfimated Cost . . . ,r.~ Fee , (to be paid on ill' ~g this apphcatlon) 5. If dwelling, nmnber of dwelling il,Shits ................. Nmhber 0[ dwelling units on ea~b floor.. .............. · If garage, nmnber of cars .... 6. If business, con.nerclal or lni,xe0 occupancy, specify natnre slid exte,t of,each type el~ USe .............. ~... 7 D' m~sio~sofexst ~gstnctures if any' Front ' Rear Depth llmght ........ Nun!her of Stories ........................................ itl ' ' ' Dimensions of shine stmctu e ~v ~ alterations or additions: Front ............. Rear D,epth ' i lleight Number of Stories ' 8. Dimensions of entire new construction: Front ............... Rear .............. Depth ............ tleight- ' Number of Stories 9 Size of lot'. Front i ' Rear Depth 10 Date of Purchase ; ' Name of Former Owner 11 Zone or nsc district' in which premises are situated ' ' 12 D d ' ' gl dl ' I · oes propose co lstrt ctloll v o ate ally zonln aw~ or nance or regu atioll: ............................... 13. Will lot be regraded ....... ; .: ................... Will excess fill be removed from prenuses Yes , No t4 Name of Owner of premises [ Address Phone No Name of Arcllit~ct Address Phone No ' Name of Contractor ] Address ' Phone No 15,' l..s this property within }00 feet of a tidal wetlaud? *Yes...; .... No ......... *If yes, Southold Town Trustees Permit may. be required. PLOT DIAGRAM Locate clearly and distinctly allI,uuuildm' gs, Wbeth'er existing or proposed, and, indicate all set-back dimensions from property lines, Give street and block 'number or descriptioh according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOP, K,~c. -- IS.S coulcry OF ...... ~.~.a..k.~... ~ /~..., ~ .~..~-.../ff O ... ~?~/?../.~. · · ',. · ' ~-~ !t./ ' . being duly sworn, depose~ and says that he is the applicant (Nanle oft ldiv~dual signing contract) above nanled. ~ lle is tile (Contractor, agent, cor'porate officer, etc.) of said owner or owners, and is duly authorized to perform or bare performed the said work and to make and file this application; that all statements contMned fll this application are true tO tim best of his ~mwledge and belief; and that the work will be performed in tim manne~ set forth in the application filed therewith. Sworn to before me this ~ , ................ ~. ~/day~.. N~ARY PUBIC. Stat~ of N,Y. , ' , "' ~ig.~/e'~ ~l~J~t~ . Term E~ir~