The URL can be used to link to this page

Home My WebLink About23154-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO Z-24059 Date DECEMBER 5, 1995 THIS CERTIFIES that the buildin~ Location of Property 650 SPRING LANE House No. County Tax Map No. 1000 Section 86 Subdivision ACCESSORY PECONIC, N.Y. Street Hamlet Block 5 Lot 6 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated N~ER 22, 1995 pursuant to which Building Permit No. 23154-Z dated DECEMBER 1, 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 "AS BUILT" The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED VERNON & DOROTHY LCECKOFF N/A N/A N/A Rev. 1/81 ~ld~ng Inspector FORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 23154 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) a, pre~,~e~ ,ooa,ed a, ................... ~.....~C/.~.... ~. .......... ........................................... CounlyTaxMapNo. lO00 Secl'lon,,,,..~,~.. ........... Block .......... ~,,,, LotNo ...... ~ ............. pursuant to application dated ....... ~.../~........~ ................... 19....~.....,-~....., and approved by the Building Inspector. Fee,...S.~...~... Rev, 6/30/80 TOWN OF SOUTiIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 A]?PLICATION 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 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. Conm~ercial 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 AppLoval of complened 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 1. Certificate of Occupancy - New dwelling $25.00, Additioas 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 - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 November 21 1~ Date... .............................. · .- .. Shed as built · New Construction.~ ......... Old O~ Pre-existing Building ................. Peconic Location of Property ..... 650. Sprin~.Lane House No. Street Hamlet Vernon Lueckoff and Dorothy Lueckoff, Onwer or Owners of Property .................................................................. Coun Tax Map No 1000, Section. 86 Block P ............ Lot ..... ? ................ Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Approval Underwriters Approval ......................... Health Dept. · ......................... Certificate .... · ..... ..... 25 O0 ~AR¥ FIANN£~ O~EN ~n /// ~ ~/~ ~, eec ~uDmitte~: ~ .................. ~.~.~'~ .v..~0X 70~ '~' ~5~/~///// ~5 ~./~ ~ cu c.O E, L.I., ....................... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .' ..... ...... , 19 l~. Permit l~o ............ .Disapl~roved a/¢ ' ' fBu~Idin Inspector) BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FoRM NOTIFY CALL ................ MAIL TO: APPLICATION FOR BUILDING PERMIT :" : ,: ~?! ' INSTRUCTIONS :'. ':':. a. Tl~s,aPplieatlo'n mu'st be conlpletely filled in by typewriter or in ink and submitted to the ~uilding Inspe¢~to~r, wi~h sets of plans, accurate plot plan to scale. Fee according to schedule. . ..... ~ :: b. Plot plan showing location of lot and of buildings on prefnises, relationship to hdjoirfing premises or public street ,,,or, areas,, and giving a de~ailed description, of layout of property must be drawn on the diagram which is part of this appli · c. The Work 'covered by this appliciition may not be commenced before issuance of Building Permit.,,, ,, ,d. Upon. approval of this application, the Building Inspector will issned a Building Permit to the applicJnt. Such p~rmi '·, shall be kept o.n the premises a ail ble for inspection throughout the ork. , , , e., 'No building shall be occu.p.i,e.d or used in whole or in part for any purpose whatever until a Certificate of Occupanc~ ' shall have been granted by the Braiding Inspector. ' ' ,! "-:7'APPLiC~TI0'N' ~S HEREBY MADE to the Building Department for the issuance of a Building permit pursu,ant to th. .Building Zone Ordinance of the Town of Southold Suffolk County New York, and Other applicable Laws O. rdmanc.e,s Or , Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto described. : The ,applicant agrees to comply with all applicable laws, ordinances, building code ho~sing code and regulations and to adml/authorized inspectors on premises and in building for necessary/ns ctions. · (S~gnatnre ofq(pplicant, or ffafne, if a corporation) , : (Mailing address of applicant) St tO ~h th Ppli a ~: e er'a cant iS_owner, lessee, agent, architect, engineer, general contractor, electricit/n, plumber or builder. ' ' ~/ern6h Lu?c~off and Dorothy Lueckoff Name 0f owner of premises . ....................................................................... (as on the tax roll or latest deed) '!: ' ,' If 3p'Plieaht is a cbrporati0n; signature Of duly authorized officer. ' (Name'and title ofcorpbrate officer) . ALL'CONTRACTOR'S MUST ,BE SUFFOLK COUNTY LICENSED ~Builder's License No - :, Plumber s License No, ......................... ' Other Traders License NO.. J ................... :, 1,,,, Location of land on'which proposed work will be done~ .... Spring L Peconic , ~ Hot se Nu nber, , ,, ~., ,. , Street Hamlet ' O0unty Tax Map No. 1000 Section 86 Block 5 6 , ' Su vis n ...... ; ............................ Filed Map No ............... Lot ....... :.'. ..... ,' (Name) 2. ' State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' ly 10. a, Existing use and occupancy : Shed as built - approximate '* X 10' ',b. Intended Use'and occupancy ...,... ................... ............ New BuildingX ' ' ' ; "- 3, Nature of Work (check which applicable): Shed as bui 1 t - '~-, .......... Addition ..... ..... Alteration . .... .. Repair Re noval De~nolition ............................ Other Work ~ ~ ' "(Descrip~tion) 4 Estimated Cost $300 00 ! i ~ ," (to be paid on filing this application) ' ' 5. If dwelling, number of dwelling Units ................ Number of dwelling units on each floor,. If garage number of cars 6 If business ................................................... .................. commercial or mixed occupancy specify nature and extent of each type of use ' ' ' ' · ,,, 7 Dimensions of existing structures if any: Front Rear . ....... , ' ..... ' Ntlml~er of Stories ' ' ' Depth Height .................................. , . i', .... ~.~ . . . . Di i 'of same e with alte ado r additio F .' .... mens OhS stmctur r ns o ns: rent ....... , .... , .... Rear Depth Hight Number Of Stories "' ' * '" ? ",8. Dimensions of entire new conitruction: Front ' Rear Height Number of Stories ............................. Depth ,. .... ,;., .....·.. 9. Size of lot: Front ......... , ............ Rear .................. .... Depth ..... 10. Date of Purchase ......... ~ .......... Name of Former Owner ...... ' ...................... 11. Zone or use district in which p~rmnises are situated ' gl ' 'i 12. Does proposed construction v ate any zonin aw, ordinance or regulation ... ' 13. Will lot be regraded ....... ; .................... Will exce s fill be removed from premises: Yes 14. Name of Owner of premises ] No .................... Address . .... Phone No.~.'' ' ' ~, ,· Name of Architect i , ............................ Address .... ': .Phone No. .' .....; ; ,, Name of Contractor ........ 1 ............ Address .... : ....... Phone N , 15. Is this property locatedl within 300 feet of a tidal wetland? *Yes ,.,,;-,NO,,;, ~,': , :" · If yes, Southold Town Trustees Permit raay~ be required, , ,, ,: PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. mdmate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and ind{ea? ,whether interior or cornerlot. ~ ' · .: , , ~ ,,, ; Approximate location of metal shed as shoran on annexed survey. ,She~t, s approximately 10' X 10" ' ' ' ...... STATE OF NEW YORK, . S : COUNT, YOF;., ;SUFFOLK , $. :, ,, j; , , ,, , D. gr. Qth~ Lueckoff i ....................... , ................... beiug duly sworn, deposes and says ~hat he is the applicant (Name of individual signing contract) ,,,, above named, He is the owner (Contrac{cor agent corporate officer ) ................. , , , etc. of said owner or owners. ~md is dt lyl authorized to perform or have performed the said work, and to make and rile'fids application; that all statements contaihed in this application are true to the best of his knowledge and belief; and that the work will be performed in the rammer ket forth in the application filed therewith. Sworn to before me this . 21 st November . , . .......... Notary Public,. ///~' .~..,2'~./~. '....~. ~~...~ · No, ~2--2'~59600