HomeMy WebLinkAbout22494-z TOWN OF SOUTBOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23419 Date
DECEMBER 21, 1994
THIS CERTIFIES that the buildin~ ACCESSORY
Location of Propert~ 2395 ALDRICH LANE LAUP~L NY
House No. Street Hamlet
County Tax Map No. 1000 Section 125 Block 2 Lot 1.6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 14, 1994 ~ursuant to which
Building Permit No. 22494-Z dated NOVEMBER 30, 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 AN ACCESSORY TENT STRUO'A'uKE IN 'A'~ REAR YARD AS APPLIED FOR.
The certificate is issued to
LOUIS BOSCHETTI
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
(owner's)
N/A
~~Buil'ding Inspector
Rev.
1/81
FORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HAiL
SOU'THOLD, N.Y.
22494 Z
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission Is hereby granted to:
............ ...-~.~.....~..~. ~,'-.~..' ..............
...........
to..,,. ,.~,,,,~,,,'-~,,,
......... ../.~ .......... ~ ........ ~ ............. ~~ .............. ~ ......... ~~...
CounlyTax Map No. 1000 Sectlon.,,,,~,~,,~ ........ Block ...... ~,,,.~,, .......... LotNo .....Z,,,~,, ............
pursuant to application dated ............. ~..~.,:..../,, ..~... ......... 10......~,~ and approved bythe
Building Inspector.
Fee*..~..~ ......
Rev. 6/,~0/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN ~IALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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.
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.
Fees
i. 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-existinK Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.60, Commercial $15.00
New Construction ........... Old Or Pre-existing Building .................
Location of Property .........................................................................
House No. Street Hamlet
0nwer or Owners of Property..~.~.~.. ...... . /~.~ .~1~.~...'.~xf.~... ............ ~.¥~. ...........
County Tax Map No 1000, Section..../~...~. ..... Blo~k....~.. ....... .. . Lot .... ./.'.~... . ........ .. .
Subdivision .................................... Filed Map ............ Lot ................... ...
Permit No.~.~..~.~. ~...~....Date Of Permit....//.~.~. ?.~f~.~..Applicant..~.~.. ~ ......
Health Dept Approval Underwriters Approval ...
Planning Board Approval ......
Request for: Temporary Certificate ........... Final Certicate .......... .
Fee Submitted:
NOV 'I/11994
[~LDG, DEP1,
] OWN OF SOU'D,IOI ~
Exam,ned ........
' FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 1197~1
TEL.: 765-1803
BOAgD OF HEALTH
3 SETS OF PLANS
SURVEY
CIIgCK
sE T,c';j ..............
hO,~Fy~
HAIL
........................ .... //,/
· APPLICAT G PERMI
Date .//:..7. .......... ,
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter 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 sti'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 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 ihe 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, housing code, and regulations, and to
admit authorized inspectors on premises and itl building for necessary i.tz~pections. ~
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, ager~t architect enoineer ...... i .............. ' .... '..
APPROVI D
, NOTED
(as on the tax roll or lat~)~l~:~td~t)lLiDlflG' DI:PARIMENT '~ '
' 765-1802 9 AM TO 4 PM FOR THE
If applicant is a corporation, signature 6f duly authorJied officer. FOI&OWING INSPECTIONS:
,, 1. FOUNDATION - TWO REQUIRED
' FOR POURED CONCRETE
(Name and title of corporat~ officer) 2. ROUGH - FRAMING &'PLUMBING '
! S. INSULATION
Builder's License No ........... ' 4. FINAL - CO~STflUCTI'ON MUST
BE COMPLETE!FO~: C.C.
ALL CONSTRUCT'[ON SHALL MEET'
Plumber's License No .........................
THE REOUffiEMENT$ OF THE N';Y,
STATE coNS.TRU~TION' & E, NERGY' -
Electrician's License No ............ : .......... CODES, ~ ~ESPONSIB[E, FOR ,
Other Trade's License No. i DESIGN OR ~O~SYRUCTI0fl ERROR$' ',
l. Location o 'd on which proposed work will be done ......... "' ' ' . .':...
House Num her Street
County Tax Map No. 1000 Section ... :./.~'~. ....... Block .... ~ ........ J... Lot /- 6
Subdivision..; ..... . ......... . .................... Filed Map No ............... Lot
(Name)
2: Stvte existing use and occupgncy of premises and i~:tc,.ded use and occupancy of proposed consfi'uction:
b. lntended use and occupancy ..... .~.~.....~.. .... ~~/~..~"¢ .,~..~ ... ................... .
.3.
o
10.
ll.
,12.
13.
14.
15.
property lines. Give street and blocklnumber or description according to
interior or corner lot.
Nature of work (check which ?pPlicable): New Building . 2 ........ Addition .......... Alteration . .>_.; .., .
Repair .............. RemovaI .............. . Demolition ...... : .......... Other Wor~_-df/~...' .
· '7/" '"" ' _~ ~ ~'Description)
Estimated Cost ./~..07. ~ ! , ' '
·: ........................... vee .... ,.~. ~. ..................
i (to be paid on filing this application)
If dwelling' number °f dweltin~~gunits ............... Number of dwelling units on each floor....
· If garage, number of cars ' . ...........
If business commercial or mixed occupancy specify ..............................
' ' nature and extent of each type of use
D ..... ' if any: FrOnt · ' .............. , ....
~mensions of existing structures
Heigt/t Nffmber of Stories Depth
' ............... Rear .............. . ..............
Dimensions of shme structure with alterations or additions: Front
Depth ' Height .................. Rear ..................
.................... : ...................... , Number of Stories ' '
Dimensions of entire new construction: Front ......................
Height Nmn bet of Stories .............. : ' ..............
i . Rear Depth
Size of 1~: .......... "' ' ........................................................
Front Rear '
......... '~ ................................. Depth
Date of Purchase
' Name of Former Owner
Zone or use district in which piemises are situated .............. ........... .
Does proposed construction vi61ate any zoning law ordinance or regulation: ............................
Will 10t be regraded '; .....................
.... .................... Will excess fill be removed from premises: Yes No
Nam~ of Owner of premises ........... , · ·., ....Address ..; ............. Phone No ............ ;...
Nam of Architect ....... : .. Address Phone No ....... .
Name of Contractor ~ · .:..,. ·
........ : .................. Address ...; ............... Phone' No .............. ,.
I.s this property within !300 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold iTown Trustees Permit may. be required. .
... ' PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate ail set-back dimensions from
deed, and show street names and indicate whether
,. ," ','" ' ,'.: ....~k;~ ........... ' ....... being duly sworn, deposes and says that he is the applicant
iteis the '
(Co traaor, agent orpo;ate o'ffi e; e't; ') .....
~f said owner or owners, and is duly,authorized to perform or have performed the said work and to make and file this
~pplication; that all statements contained in thisapplication are {rue to the best of his knowledge and belief; and that the
.york will be performed in the manner ~et forth in the application filed therewith.
~worn to before me th~'~")
.. 4 ll/ '
~/0. 4725089,..S~jf~J_~ Couj/~]. . (Signature of applicant) .
Term Expires U~y 31, D~ ..