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HomeMy WebLinkAbout23143-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24062 Date DECEMBER 6, 1995 THIS CERTIFIES that the building Location of Property 675 M~?RR pLACE House No. County Tax Map No. 1000 Section 55 Subdivision ACCESSORY Block 6 Filed Map No. SOUTHOLD, N.Y. Street Hamlet Lot 28 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 9, 1995 pursuant to which Building Permit No. 23143-Z dated NOVEMBER 29, 1995 was issued, and conforms to all of the requirements of the applicable provieione of the law. The occupancy for which this certificate is issued is ACCESSORY STORAGE SHED IN REARYARDAS APPLIED FOR "AS BUILT" The certificate is issued to M~RIA UGRICICH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A Building~ FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN I.LALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 23143 Z Co,r,,¥TaxMap,,,o. ~000 Sec,on ........ ?..~.... B,oc,,......~ ............. LotNo ..... ,~.~ ........ pursuant to application dated ......................... ~..~... ........ ~ 1 9.....~..~...., and approved bylhe Building Inspector, Fee $..~...~....~. Rev. 6/30/80 Building Form No. 6 TOT~N' OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ,, . T©V,,'i',! O~ ,.Ckt~ O1 r~ ~ . APPLICATION FOR CERTIFICATE OF OCCUPANCY A. T'his 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. · B.. For existing buildihgs (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' signeH by the applicant. If a Certificate of Occupancy is denied, the Building Inspect'or 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. 2.Certificate of Occupancy on Pre-existing Building - $100.00 3.Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 .N. ovembe r 6 1995 Da~e . ? ......... ~ ........................ New'Construction ........... Old Or Pre-existing Building. -Shed Locatio of Property 675 M.~ier Place House No. Street 'Hamlet Onwer or Owners of Property M..a.r.i.a. U~ricich County Tax Map No 1000, Section,..q5.5.00 Rlm,[- 06~00 .Lot. 028.000 Subdivision ' ................................... Filed Map .......... Lot ...................... Permit No ................ Date Of Permit ........ ........ Applicant .......................... Health Dept Approval Underwriters Approval ' Planning Bard Approval ' Request for: Fee Submitted: $...%Q%OP .... Temporary Certificate ........... Final Certi~dte..X.% z 'APPLICANT' 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [[]] :OR~UNMiDNA~ION 2ND [[ .~ATION [ ]FIREPLACE & CHIMNEY DATE INSPECT~~* ROUGH FRAHE & PI,IJHB l NC, II ADDITIONAL COMMENTS: RI.DG. I3[.!"1', Tc~'.!a: 9F ,~O,!!']!-IQI.[~ ....... i ~OUTHOLD, N.Y. ,~,). ~ TEL.~ Appreved ..... ~d~ ~, 197I. Permit NO. · 'FORM NO, 1 ToWN OF 8OUTHOLD BUILDING D EP,'q, RTM ENT TOWN HALL Received ........... ,19... AP~),~ATION FOR BUILDING PERMIT Date ,..l~o. vcr&her, .1.Q .., 19 .'95 INSTRUCI'IONS a.. flus apl I caho ~ must be completely filled in by typewriter or in ink and sebmitted to the Building Inspector, with 3 sets df plaus, accerate p. lot plae .to scale. Fee according, to schedule. b. Hot plan showing Iocahou of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giviug a detailed description of layout of property must De drawn ou 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. Open approval of this apphcation, ti e Buikling luspector will issued a Building Permit to the applicant. Such penuit shall be kepi oo tim premms available for ins ~ect'o ~ throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever uutil a Certificate of Occupancy shall have been gtanled by the Building Inspector, AI'PLICATION IS IIEREBY MADE to the Buildiug Department for the issuance of a Building Permit pursuant to the Buildi,g Zeue Otdina,co of tim Town of Southold, Suffolk County, New York, and et mr applicable Laws, Ordinances or Regulatious, for tim coustmction of buildings, addHions or alterations, or for removal or demolition, as herein described. The applicaut agrees to comply wHh all ap ~hcable laws, ordinances, building cede, housing code, and regulations, and to admit atttborized iuspcctors on premises and in building for necessa~ iuspections. , (Si~n 1~ , ff ~on) (~ilin~ nd&ess o~ ~plicnnt) ~late whdher applicant is own~r, lessee, ng~nt, nrchi{ecL cegineer, ~eucral tax mil , ' 9,, · 1[ applica,,t isa corporatiou, sig,,att,r¢ of duly autho,izcd officer. ~E~: (Name a ad t t e of corporate O'ffiCer;) FOt. L.OWtNG INSPECTIONS: Builder's License No ...... Humber's LiccJlse No .... Electrician's Liceuse No. , .47,~:,.,., I. Locahou of la Id on wi,ch pm)osed work will be tim c. 675 Haier Place, llouse Ntunber Street I, (:OUND~GION . TWO REQUff~,ED FOR POURED CONCRETE BE COMPLETE FOR C.O. : ALL CONSTRUCTION S~AEL STATE CONSTRUCTION .......... .~,. a~. ~oNs~.. ~ ....... o~ oa llamlet County Tax Mai, No. IO00$ectiou ....0.5.5...0..0 ........ Block .o6,..00. Lot ' .o28.000 Subdivisiou ..................................... Filed Map No ........... ~ . . . Lot ........ (Naluc) 2. Slale existing use and occupancy of premises aud inteeded use and 9ccupancy of pro ~osed .construcfion: l']xisling use and occupancy ~P~ ' ' .......... r ; b. lutel~tled use and occupaucy .............................................................. Oil] s} oqsll:.ql s,(es pue sosod0 ) 'tuo^3s Alnp qo[ Jaluoo Jo ~O[,IOlllI ................, ON ouoqd ...................., ssolppV. .......................... 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'SU!llO~p Jl q; .p CONSENT TO INSPEC FION MARIA UGRICICH Oxmler(s) Name(s) · the undersigned, do(es) hereby state: That the undersigned (is) (l~r~) tile owner(]~) of the premises in the Town of Southold located at 675 Mater Place, S'outhold, New York · which is shown and designated on the Suffolk County tax map as District 1000, Section 055.00, Block. 06.00 Lot 028,'00.0 That the undersigned (has) (xhmam~r filed, 'or caused to be filed, an applica- tion in the Southold Tox~m Building Inspector's Office for the following: Existing Shed That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances· rules and regulations of the Town of Southold. The undersigned· in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for rio- lationg of the laws, ordinances, rules or regulations of the Town of Southold. · , (sigaa~e) ' Maria Ugricich (print name) Dated: ~ovem~ber (signature) ----------- (print name)