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Home My WebLink About22492-zFORM NO. 4 TOM OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23375 Date NOVEMBER 29, 1994 THIS CERTIFIES that the building ADDITION Location of Property 690 NORTH SEA DRIVE House No. Street County Tax Map NO. 1000 Section 54 Block 5 Subdivision Filed Map No. BOUTHOLD, N.Y. Hamlet Lot 1S Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 26, 1994 pursuant to which Building Permit No. 22492-Z dated NO%~4BER 29~ 1994 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" The certificate is issued to BLANCHE SEIBERT (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAl1 $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 22492 Z Permission Is hereby gran,~d to: // ~ , _. .,~ , ~~.,~....~.....~ .................. ...~4...,..~.~,..~.....i ............................... ...... .................................................................... pursuontto application doled ................ ~~..~.. ........... ]g...~.../~......,- ~ and approved byfhe Building Inspecfo~r. ,ee,..~ ....... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~P~C~TIO~ FOR CERTifiCATE OP OCCU~ANC¥,~O~~ 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 ail 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, 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 Buildinm - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial~15.00 ~ Date ......... ~.~..~ .~.~..'~..~.t . ............... New Construction ..... Old Or Pre-existing Building .......... Location of Prope;;;i i.[ .... ~.~.~. .................. ~.~.~. J~..~..i. i[~.'.~.~ .... ..~....~/~.~..¢..~. House No. Street Hamlet Onwer or Owners of Property ..... ~.~?..~...~-....~.'.~.3.~?..~..~.. ............... County Tax Map No 1000, Section ........ Block ............. Lot ................... Subdivision ............................ .. . . . . . . Filed Map ............ Lot ................ . ... .. Permit No ................ Date Of Permit ................ Applicant ........................ .... . Health Dept Approval Underwriters Approval .......... Planning Board Approval ................ Request for: Temporary Certificate ........... Final~c~. Fee Submitted:~... ~$ ........................... ..~~~..~..,..~. . 3LATIO:! PER'~. Y. STATE CODE FI:rAL 765-1~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ]FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND [ ] FRAMING REMARKS: ROUGH PLBG. INSULATION DATE INSPECTOR ,~xamined.~: ;,~:~.'L~.~'~..~'~"i, Ii)'/.. Disapproved a/c ..................................... . lng In ~fi'LICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PLANS .......... SURVEY ................... CI1ECK ...... NOTI p¥; I'IA I L Date~. ................ ,19 a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation r c. The work covered by this application may not be commenced before issuance of Building Permit. r'~. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hail'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 sail 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 .uilding Zone Ordinancd of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or :egulations, for the construction of buildings, additions or alterations, or for r.e~val or demoJ, ition, as herein described. 'he applicant aglees to comply with all apphcable laws, ordinances, buildin~oli'~,..koa:k/a gl~"'pO:'fie, and regulations, and to dmit authorized inspectors on premises and in building for necessary ~~. ~ ....,~-/d=tys(~~ln ~r;'~ ...... ~'("~' ....... ~ ...... / -.~ - ---f/~t..,'I'4 . C~l-~,~t, t, ./. .... F,. ~.,. ~.~. . .~.~'.~. . . . ~. .¢. ~ 0. ..... (Mailing address of applicant) ;rate whether applicant is owner, lessee,/Igent, architect, engineer, general contractor, electrici'an, plumber or builder. ............. .~x~.e..,. ~ .?,.... ~..a. lame of owner of premises .~.~..~...~. ~- (as on the tax roll or latest deed) f applicant is a corporation, signature of 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 ...................... · Location of land on which proposed work will be done. ...... ~ qO .........................../~(~Z"~..~/~ D/~-- ........... .... ' ~~c~...~ ....... ~.. House Nmnber Hamlet /ff~ " ~e~, .~ /~ County Tax Map No. 1000 Section ............... Block .............. Lot ................... 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 ........................................ ' ............................. ,~ ~n~ ~,~ ......... ~. ~..~C~. ~tt~...~...~, ~. r ...... b. Intended 3. Nature of work (check which plicable): New Building .......... Addition ..... Alteration .......... Repair .............. Reqaoval .............. Demolition .............. Other Work ............... 4. Estimated Cost "' Fee ............................ (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 ol existing structures, if any: Front ............... Rear .............. Depth ............... Heiglit Number of Stories Dimensions of same structure with alterations or additions: Front ........... Rear .................. Depth i Heiglit Num her of Stories . Dimensions of entire new consiruetion: Front ~Rear .............................. Depth ............... Height ............... Number of Stories ............................................ 9 Size of lot: Front I Rear ..................... Depth I0 Date of Purchase I ' Name of Former Owner 11 Zone or use ...... ' ............................ · dlstnc:t in wluch premmes are mtuated .................................................... 12 Does propdsed construction violate'any zoning law ordinance or regulation: 13. Will lot be regraded ........ , ................. Will excess fill be removed from premises: Yes No 14 Name of Owner of premises Address · ' · ..................................... Phone No ................ Name of Architect ......... i ................. Address .................. )Phone No ................ Name of Contractor i Address ' Phone No 15, Is this property within i300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southoid ~own Trustees Permit may be required. ". i PLOT DIAGRAM Locate Clearly and distinctly alll buildings, whether existing.or proposed, an&indicate all set-back dimensions ~rom property lines. Give street and bloeklnumber or description according to deed, and show street names and indicate whether interior or coruer lot. APPROVEp AS NOTIFY BUILDING '785-1802 9 AM TO 4 P~OR FOIJ,~WING INSPECTIOn: ' , 1, FOUNDATION TWO REOUI~EO FOR POU~EO CONCRETE 2,' ROHGH -, FRAMING & PLUMBING q.. FINAl,, CONSTRUCTION MUST 8E COMPLE]E FOR C,O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENT~ OF THE N.~ STATE CONSTRUCTION ~ ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERROR8 STATE OF NEWYOR_K~ :oum OF.. si, s ..... ~..~. ~ .~....~..~tq..~14¢!.'~..lj ................ being duty sworn, deposes =d says that he is the applicant (Name of individual signing contract) ~bovenamed..: , - ~ , , ~ , ,~ ; , ~ . ................ /.. . . ~ . i~ (C~tractor, agent, corporate officer, etc.) ,f said owner or owners, ~d is duly ~authorized to perform or have perfomed the said work and to m~e ~d file this :pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the york wgl be perfomed in the m~ner ~et forth in the application filed therewith. ,worn to before me this ..... ......... NOTARY P~Bt C, ~to ~ ~w Yo~k ~ ~ .............. No, ~2a~o=,~ (Signature of applicant) QuelJfie~ In Suffolk County Commission iExpire~ April 30~ 19