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HomeMy WebLinkAbout23126-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24094 Date DECEMBER 22, 1995 THIS CERTIFIES that the building ACCESSORY Location of Property 805 NORTH OAKWOOD RD. House No. Street County Tax Map No. 1000 Section 127 Block 7 Subdivision Filed Map No. LAUREL~ NEW YoRK Hamlet Lot 13 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 30, 1995 pursuant to which Building Permit No. 23126-Z dated DECEMBER 8, 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 ACCESSORY STORAGE SHED 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 DAVID E. & ROSEMARY NOSTROM N/A N/A /B'~Inspector Rev. 1/81 FORM NO.$ TOWN OF $OUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 2312G Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLEIION OF THE WORK AUTHORIZEDI Date ........................................................... 19. .. Permission Is hereby granted t~, · _ ......................................... .............. CountyTax Map No, 1000 Section.,,, ./...~...~ ...... Block ...... ~ .............. Lot No ...... Z.,~ ............. pursuant to application dated .....././../.,~.~... ................................... 19.,~...~.., and approved bythe Building Inspector. Fee $......'~.,. ,~....~ Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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 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 the applicant. C. FeDs 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 Buildin~ - $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 $15.00 Date .... ...... ................. New Construction ........... 01d Or Pre-existing Building ................. Location of Property ~. O . ~ ~,~o~ vr~/ House No. Street Hamlet Onwer or Owners of Property...~F7.~ E ~/~O t~ .~ County Tax Map No 1000, Section .... f.g.7 .... Block .... .0..~ ........ Lot...l.~ ................ Subdivision.. ~.f~ ~r.~.~...~. O. CP .............. Filed Map...~..~ .~. .... Lot..-~. · .~. ............... Permit No.~.:$........... / ~ ~ ~ Date Of Permit...~........ -~ ~?...~Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate. / 0 ..................... ............. APPLICANT FI~LD ~[~NSPECTION REPORT DATE COMMENTS FOUNDATION (~ST) ROUGH FRAME PLUM~ING INSUI~ATION PER N. Y. STATE ENERG~ CODE FINAL ADDITIONAL COI~4ENTS: NOTE: · = MONUMENT MAP OF SUBDIVISION FILED IN THE OFFICE; OF THE CLERK OF SUFF. CO. ON DEC, 21,1950 AS MAP N0.212. SURVEY FOR DAVID NOSTROM LOT NO. :33 "LAUREL PARK LAUREL TOWN OF SOUTHOLD SUFF. CO., N.Y. SCALE: I"= 50' AUG. 25, 1965 GUARANTEED TO; HOME TITLE DIVISION OF CHICAGO TITLE INSURANCE CO. SECURITY NATIONAL BANK OF L.I. LAND SURVEYOR, N .Y.S.L"IC, NO. 12845 RIVERHEAD; N.Y. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN~J~ATION [ ] FRAMING [L/] FINAL ] FIREPLACE & CHIMNEY DATE .~. , i ''~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT By..., - 1995 TOWN HALL SOUTHOLD, N,Y, 11971 - '~ ,.~' ~;4 .'~. '~ TEL.: 765~1803 Examin~-': ~'. ~' .'. ~.'' .... / Disapproved a/c ..................................... ctor) ..... ~PPLIG~TION FOH BOtLDI~G PEB~IT o, 3 SETS OF PLAYS . . . IIECK ........... SEPTIC FORtl CALL ......... HAIL TO: INSTRUCTIONS a. Tiffs application 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 location of lot and of buildh]gs on premises, relationship to adjoining premises or public streets or areas, and giviug 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 thi.s 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 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 Deparhnent .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 laws, ordinances~ building code, housing code, and regulations, and to ' ' ' necessa~'y~nspegtions. ,, ,~.,_ /v~' admit authorized inspectors on premises and m buildiug for ' ' · ..... (Signature of applicant; or nar~e, if a corporation) ...... q ~ ...... ~. ............... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O~, ~6.W.. .................. : ................................... Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant 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 No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ~ ............................ House Number Street Hamlet County TaxMapNo. 1000 Section . ..L¢..2 ........ .... P. 2 ......... tot ..... L.4 .......... Subdivision. L~or~ / ~ Filed Map No. ~/~ Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,. u,. ................................................ b. Intended use and occupancy . .~ ~ Q o . .X.~ k. mt;18 aklg;Y~ Repair .............. Removfil 4, Estimated Cost ..... j, Nature of work (check which applicable): New Building ......... Addition .......... Alteration .......... Demolition .............. Other W.o~k ,~ ............. .... ~ ~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling uqlts .............. Number of dwelling units on each floor ................ If garage number of cars .... 6. If business, commercial or mixed Occupancy, specify natt re and extent of each type of use .......... 7 Di .... gst 'ifa F R D'plh' ........ · menslonsof eXlstln ructures,, ny: rent ............... ear ........ e .............. Hdght ............... Number~ of Stories ........................................................ Dimensions of same structure withi alterations or additions: Front Rear Depth ...................... I Height ...................... Number of Stories ...................... 8. Dimensions of entire new construcltion: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ' Rear Depth Date of Purchase ' Name of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed ' ' ' ' ordinance or regolation: construction violate auy zomng law, ................................ Will lot be regraded .......... i ................. Will excess fill be removed from premises: Yes No . Na ne of Owner of premises .j~,t.d, £, . ~,o.,¢.T'~t..*~. Address ~.a..F't~.qCt~..O.A'.,~.W.~."~l~one No..~..~.,~...~../~..~... . Name of Architect ~ Address Phone No Name of Contractor Address Phone No ' £s t:his property w±thin 300 feet of a t±dal wetland? *Yes ..... ~.. bio.., ...... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all btfildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and allow stredt names and indicate whether -~' :' "~\. , I"~'.:~'~;:"~ ¢;OE.~NG r~~h3~ ALL CON~:;'EHUCT~ON ~HAI,L MEfi~ STATE OF NEW Y,QRK ~/,~-~2 ~ ,,, S.S' COUNTY OF... e~. .¢<t.'q. Cq/. (~,. . · · ~ ~ ..... d. ~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing[contract) above named. He is the ~ , (Contractor, agent, corporate officer, etc.) i . of said owner or owners, and is duly agthor~zed to perform or have perforated the saki work and to make and file this application; that all statements contained in this application are tree to the best ofhts knowledge and belief; and that the work will be performed in the manner so~ forth in the application filed therewith. Sworn to befor~e this/) ~"~'-'-~ ~ .......... [~" ....... ~/~..~ ¢.e~ .... , 19~ . / / NCARY PUB~I~S~te bf N.Y. ~ ~jf ? [ / .o. ...