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Home My WebLink About22597-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23642 Date MAY 15, 1995 THIS CERTIFIES that the buildin~ Location of Propert~ 28785 MAIN ROAD House No. County Tax Map No. 1000 Section 102 Subdivision ACCESSORY Street Block 5 Filed Map No. CUTCHOGUE NY Hamlet Lot 23 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 1, 1995 pursuant to which Building Permit No. 22597-E dated FEBRUARY 20, 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 STORAGE SHED AS APPLIED FOR. The certificate is issued to RICHARD F. LARK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A Building Inspector / FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ...~,~¢~.... ............................................ 19...?~....~ 22597 Z Permission Is hereby granted to: , __ ............................................ ..~..~.Z~ ....................................................... pursuant to application dated ..~ ............................................... 19..~'.. ......... a'--"'""~nd approved bythe Building Inspector. Fee $.~~,, ~ Bj,~-ding inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-I802 APPLICATION FOR CERTIFICATE OF OCCUPANC] 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/I0 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. Submit Planning Board Approval of completed site pian 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. 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 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 .... .M.a.y...2z..!9..9 .5 ........................ New Construction....X. ...... Old Or Pre-existing Building ..... 28785 Main Road .C.B ~ ~ ~.o.g %1~ Location of Property .............................................................. House No. Street Hamlet Onwer or Owners of Property Richard F, Lark County Tax Map No 1000, Section,.,.1.0.2.',0..0 .... Block.,.P.5...q0. ....... Lot ...... q2.3.:p.qq ......... Subdivision .................................... Filed Map ............ Lot ...................... 22597 .Z 2/20/~95 Appli R..i.c.h.a.~ ~. I~ji Permit No ............... Date Of Permit.... ........... cant.. , · ..... , ...... Health Dept. Approval.' ......................... Underwriters Approval ....................... .. Planning Board Approval ........................ Request for: Temporary Certificate ...... Final Certicate. X Fee Submitted: 25.00 '/' ~ _< __ APPLICANT Ifichard F. Lark ."i E L P.f~I:~S~ E'C? l 0:: IIDA?E it C O~W~£~T3 FOUNDATION ( ls t) FOUNDATION (2nd) 2. ROUGH FRAME & :PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ].~SULATION [ ] FRAMING [/_/~FINAL [RE]M:IRR::~A(~CHIMNEY DATE~ INSPE~ ~-~ '~:. FORM NO. 1 FL~ -!l'~[~ }L,_;: TOWN OF SOUTHOLD L,~ , ~ BUILDING DEPARTMENT BLDG. DEFT. TOWN HALL ,, -,~TOWN OESOUTHO.tPl , i ,~,,.., ,~ SOUTHOLD, N.Y. 11971 - TEL.: 765-1802 Examined ~- ._~-,.O. ........... 19 ~::~" Disapproved a/c ...................................... ~ . (~ildi~spector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTII ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK · ........ ::::-:. SEPTIC ...... CALL ................... HAIL TO: Date .................. 19 ~ a. Tlfis application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 so. ts 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 streets 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 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 Department 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, houf2m~ code, and reg~tions, and to admit authorized inspectors on premises and in building for. necessary inspections.~ --' (Si=natur~f~ lri~laT,.6rLnaar~}~, ifa corporation) p..?. o..x..9.7, e.,' .N.Y....Z.Z. 9..3.5 ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises . .1~$ 3h.o,g .d..F....~.a.r.k. ...................................................... : (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. N/~ (Name and title of corporate officer) · Builder's License No .......................... Plumber's License No...Ix!/.~ ................... Electrician's License No..IxI/.~- .................. Other Trade's License No...~/A. ............... Loc tic of la d whi hp d k illb d ' a n n on c ropose wor w e one ............... 28785 Main Roa_~/~. Cutchoque ltouse Number Street Hamlet County Tax Map No. 1000 Section 102.00 Bl~ck 05.00 Lot 023,000 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Law office b. Intended use and occupancy ...L.a.w.. 9.f.f.i. qg. ~.it;h. ,s.t:O.r~.cj.e. shed ' ' 3. Nature of work (check which hpplicable): New Build Reprdr .............. Removal ............. $.'~ ~O0. 00 4. Estimated Cost... s ................... 5. If d~velling, number of dwellin~ units N/A · If garage, number of cars ... }~./.A ............ 6. If business, commercial or mixled odc'up'a~l;~i 7. ,D. im.ensions of existing structures, if any: Front .... height ...I://k ........ Nrta. bet of Stories ..... i ' Dimensions of same structure with alterations or additi Depth ! Height - 8. Dimensions of entire new construction: Front. .. ~H. mght 6..6... r..8. ..... Nuhj, ber of Stones . 1 9. ~zeoflot~ Front 76.53.' .~ .... 10. Date of Purchase . 1.2../..2.9./77. .... 11. Zone or use district in which'p'! emises'ir;'sit~}~c~ ' ~'1~ 12. Does proposed construction violate any zoning law, on 13. Will lot be re,reded No 14. NmneofOwnerofnremises Re-chard F. Lark Name of Architect . . .N/A Name of Contractor R. ol~r?'/I:' ~K.'66h"i': 15. Is this property within 1300 feet of a tid~ *If yes, Southold !Town Trustees Permj ....; PLOT D Locate clearly and distinctly ali buildings, whether exi property lines. Give street and blocki m/mbe~ ~- .~-'~-' interior or corner lot. · ua u~cnptlOn SEE ATTACHED MAP AND STATE OF NEW YORK, COUNTY OF.. $[J?.F.Q .L~( .... S.S RICHARD F i LARK (Name of individual signiqg contract) above named. , He is the... ~../,-.~'./?.A:.~.. i (Contractor, agen rm~:sald owner or Owners, and is dulyiauthorized to perform application; that all statements contai:~ed in this application work will be perfonned in the manner :et forth in the applicati Sworn to before me this ................... day of...~ffi~y_~ .... Notary Public,~.,.. $.uXfolk ..... _~ .... /- -,'/~- \..Cou Commission Expires De.c..ember g · ~ ........ Addition ...... .-~' · Alteration ......... Demolition ........... ~tlier W~)rk ............. (Description) (to be paid on filing this application) Number of dwelling units on each floor... N./A ........ Iture and extent of each type of use ...N./.A. .............. 'A ........ Rear .... ixJ,/A ....... Depth ...N/.A ......... )ns: Front ................. Rear .................. ............ Number of Stories ............ , .......... ........ Rear ............... Depth ............. 123 76 ' · Depth .2.8 0.' Name of Former Owner Va.lp. nt. in? W.~ .S.~p.e. - Haralat Busines~ ............. [nance or regulation· No · Will excess fill be removed from premises:N/A Yes .No ddressCutchoqua, NY ...Phone No. ddress . N/A . . . Phone No...N/,A. ..... ' '"' ddress I~[r Phone No. ¢ ~.8.X~ ¢.6 . wetland? ~Yes ........ No..~ ...... ' t may be required. [AGRAM ;ting or proposed, and. indicate all set-back dimensions from :cording to deed, and show street names and indicate whether SKETCH. being duly sworn, deposes and says that he is the applicant , corporate officer, etc.) )r have performed the'said work and to ~nake and file this re true to the best of bis 'knowledge and belief; and that the m flied therewith. Rlolxia/rd F. Lark'S/ (Sig.lcure ofa li a'n'ti