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Home My WebLink About22566-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23816 Date AUGUST 15, 1995 THIS CERTIFIES that the building Location of Property 944 ¥OUNGS ROAD House No. Street County Tax Map No. 1000 Section 18 Block 2 Subdivision Filed Map No. ACCESSORY ORIENT, N.Y. Lot Lot No. Hamlet 16.19 conforms substantially to the Application for Building Permit heretofore filed in this office dated J~/~UARY 9, 1995 ~ursuant to which Building Permit No. 22566-Z dated J~/~ANY 17, 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 INBT~?~.%TION OF WOOD BURNING STOVE IN EXISTING OWE FAMILY The certificate is issued to DWELLING AS APPLIED FOR. GAIL COHAN & NANCY R. GOLDSTEIN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ToWN OF $OUTHOLD BUILDING DEPARTMENI' TO1NN HALL SOUIHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] oo,, ......... ~~ ....... ~.z.. ................ ~.~..../. N~_ 22566 Z ............................................. ~.../c./...~.,' ,¢... ........... ./.~...7,,..,., .............................................. Counly Tax Map No. 1000 Section ......... _~,...~....... pursuant to application dated .............. ~,, ' ,~,,,,,,'~,....~., ...... 19..,~.?.~and approved bythe Building Inspector. F~e~.~.~.. ............. Rev. 6/30/80 '' g nspi~ ........... ~ I A 1995 BUILDING DEPARTMENT .. . . 765-1802 IT ~e~t ' 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 fo~). 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. ~.. Co~ercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Complia-nce from architect or engineer responsible for the building. 6. Submit Planning ~oard Approval of completed site plan requirements. ~. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: i 1. Accurate survey of property showing all property lines, streets, building and unusual natural om 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, 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 - $10.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Co~ercial $15.00 ~ Date... ~/~//~ ........................... New Construction ........... Old Or Pre-existing Building ............ House No.~Street Hamlet o$,~ o~ ow~,~ o, ,ro**~ty. ~.. Co~, ,~x ,~ ,o *ooo, ~,~,o~ .... /~ ....... **o~,..~ ........... ~o~..X.~.~/.? ........... Subdivision ................................... - Filed Map ............ Lot ..... ~m,~ ~:~. ...... ~..~ O: .h ..... ~"'~I~'M: .... ~'~ .... ::4.& ~: ........ Hoal~h Depe. Appro~a~ .......................... ~nderwr~er~ Approva~ ...................... .. . Planning Board Approva~ ........................ Request ~or: Temporary GertSf~cate ........... FSnal FIELD INSPECTION REPORT FOUNDATION (IST) DATE I~ COMMENTS II ROUGH FRAI'IE & PLYING Y". b 30'4 · · .Heating Capacity' * ',.' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLDG. [ ] FOUNDATION2ND [ ] INSULATIO~N~~ [ ] FRAMING_~,.,...--'***'~''- ~...]...FI~AL [ ~'~.,FIRL~PLACE & CHIMNEY INSPECT~ 76S*J.802 ~. ~--~ · BUILDING DEPT. INSPECTIOI~.~-~ FOUNDATION :tST [ ] ROUGH PLBG. FOUNDATi~0~2ND [ ]INSULATION ~U~ ........... '< .. SOOTHOLD, N.Y, 11971 r ~~~""""' ~ ~ TEL.: 765-1803 Ex'mined '~ l~/ ] ' .... l//~ ...... , .... / -- ' ..... e~' ~ ' · '.' '~ ~ .'. ~I .~ .......... / Disapproved a/c .... . ............... ~ .... ~ .... ...... ..... ................. .... BOARD OF HEALTH ......... 3 SETS OF PL.'~,~$ .......... SURVEY CIIECK ................... SEPTIC FORH CALL . o . . ...... HAlL TO: .k~..p.e..o:. ,. .~ . .s S,. '. . INSTRUCTIONS a. This 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 buildings on premises, relationship to adjoining.premises or public st?eets or ~areas, and giving 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 this application may not be comm~ncM before issuance of Building Permit. d. Upon approval ofthls application, the Building Inspector will issued a Building Permit to the applicaht. 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 Department for the issuance of a Buildink Permit pursuant to the Building Zone Ordinance of the Town of South01d, 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 describbd. The applicant agrees to comply with all applicable laws, ordinances, building code, }~ousing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insl~ct~ons. /7) f, . --_ ......... (Signatur9 of applicant, or name, if a corporation) .-: ~ . (Mailing address of applicant) /] State wl'~ether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. N~neofownerofpremises /'x"JA/</C"/' ("~O61/',J ~'OCDST~?/'-] o~t~ G/¥(L ,'4-. (as on the tax roll or latest deed) If applicant is a, corp, oratioh, signature of duly authorized officer. '".'(Nhnie and ~title of corPorate officer) PlumbersLie=e No ............... Other Trade's License No .................. ~ OCCUPANCY OR USE iS UNLAWFUL W THOUT- CERTIF)CATE 'OF OCCUPANCY Location of land on which proposed work will be done ................. House Nmnber ..... ~ir~i .............. Hamlet ' .O.t~ 0.0. ' ~ .0. z 09. County Tax Map No. 1000 Section .. , ...... Block ...... '. · · ' Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy 0~e.~ t~ e. Jq c.~ .b. Intended use and occupancy · , · 3. Nature of work (check whmh applicable): New Building . . Repmr ........ : ..... Rem,oval .............. Demolition .... ; ...... 4. Estimated Cost .... ...... . d ' . . . (to be paid on fi 5. --awemng, number of dwelhng units ....~ ......... Number of dwelling units on each~ . If garage, number of cars .... 4 .................................. 6. If business, commercial or m~xe8 occupancy specify nature and 7 ...... ~ extent of.each type of use ............... . Dimensions ol eXmbng structures if any: Front Rear ' ..... Height Numger of Stories ............................. Depth ............... Dimensions of shine structure with alterations or additions: Front ~ ................. Rear .................. Depth ' HeiSt .................. "· :. ...... Number of Sto~es ' ' 8 Dimensions of entire ~ · ' ...... ' ............... : · new const~ct~on: Front Rear Depth ....... ~.'h[ ~b cig Num er of Stories . ~ze OllOt' Front . . ~ · n_ _ ' ......................................... ~ ....... 10. Date of Purchase ', .... _' ¢' '~t~':c' ', .... ~ .... ~ . . ' '~ .... ~. ., ....... ' ....... ..~ame oI~omer 11. ~one or use fl~stnct in which preini~es are situate~ ............ ~: ....... .12. D°es pr°p°sed construction viol~te any zoning law, ordinance or regulation: ........................ ~ .... 13. Will lot be regraded ....... :. i .... . .... Will excess fill be removed from premises: Yes No [4. Nme of Owner of premises . · · ~ ................ Address ................... Phone No ............ ;... N~e of Architect ' Address Phone No Nme of Contractor ......... } ................ Address ............. . ...... Phone No ................ 15.' I9 th~s property w~thtn 3D0 feet of a t~dal wetlan~ ~Yes ...... ~o ......... · If yes, Southold T~wn Trustees PermSt may be requSredJ ' ' PLOT DIAG~ Locate clearly ~d distinctly ~1 build,ga, whether existing or proposed, ~d. indicate ~1 set-back d'~ensions from prope~y ~nes. Give street ~d block n~mber or description accord~g to deed, and show steer nines and indicate whether ~te~or or corner lot. ~ . - . 766-1802 O 1. FOUNDA~ON - ~OREOUIRED FOR POURED CONCR~E 2. ROUGH - F~MING & P~BING ~. INSU~ON 4. FINAL - CON~RU~ON MUST BE ~MP~E ~R C.O. A~L ~RU~ON 8HA~ ME~ ~E REOUIREME~ OF ~E N.~ STA~ CONS~U~ON & ENERG~ CODES. N~ ~$~NSIB~ FOR DESIGN OR CONS~U~ON ~ROR8 STATE OF'NEW YORK, COUNTy ................'s.s ,q-. . ' . .................. ~ ............ acing dray sworn, deposes ~d says that he is the applicant (Name of individual signing Contract) ' above named. He is the........ .................... ~ ......... . .......... . ................... ! (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d fs duly authorized to perfom or have perfo~ed the said work and to'm~e and file this application; that all statements contained ~ this'application are frue to the best of his knowledge and belief; and that the work will be perfomed in the manner set,forth in the application filed therewith. Sworn to b~fore me this i ........... ' ..... :. ...' ...... Nota~ Public, . ...... ...... NOTARY PUBLIC, Stole of New ~,~v~ ' - ~ ' ~ ......... ~' ' '"' ' · ..... No, 4947877 Suffolk County Term [xp~res ~ebm~rV ~7., ~9~ ' . , . (Signature of applic~t)