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HomeMy WebLinkAbout22524-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23398 Date DECEMBER 12, 1994 THIS CERTIFIES that the buildin~ Location of Propert~ 51680 MAIN ROAD . House No. County Tax Map No. 1000 Section 63 Subdivision ACCESSORY SOUTHOLD, NEW YORK Street Hamlet Block 6 Lot 3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 5, 1994 pursuant to which Building Permit No. 22524-E dated DECEMBER 8, 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 ACCESSORY SHED IN REAR YARD "AS BUILT" The certificate is issued to JOHN HENRY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, BUILDING PERMIT ITHIS PERMIT MUST BE KEPT ON THE PREMISES UN'IlL FULL COMPLETION OF THE WORK AUTHORIZED] 22524 Z Permission Is hereby granted to: ........... ~.~ ...... ~x.,,/ ................... ! ............. J/..~.~.o. ...... ~~ 8: ........ ............................. ~ ....... /~,~,;,. ~...,~.~ .............. ~ ............ ~...~:.~/~ ........................ ~ .................................. ~ ~.....~.2.. ~Z ~./...~ ........................ ........................ .......................................................... CounlyTox Map No. 1000 Sectlon.~.....~.. .......... BlOcK ....... ...~....~.. ......... LotNo .......~.-~.'.. .............. pursuant to applIcatIon doted ........ ,/~.....: ....... ,~ ................19 .~....~...., and approved bythe Building Inspector. · ~ Fee $...~.. ,~...' ........... Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 . APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR in~ and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location o~ all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply ~nd 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 I% 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 buildJ~ngs (prior to April 9, 1957) nonrco~nforming 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.Ca,titillate ~pancy on Pre-existing Buildin~ - $100.00 3f'Copy of Certificate o-~p=~Lcy ._ $~70~ 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..Dece~r 2~ -~w Construction ........... Old Or Pre-existing Building. .X ......................... ~cation of Property .. 51680 Main Road~ South~l~-,° I~'~'~R ....... House No. Street Hamlet O of Property ~o.h..n H~n~cy. unty Tax Map No i000, Section .... ~.3 ........ Block ..... ?] ......... Lot...3.. bdivision. ('~ Filed Map n~.~ Lot .~/.~ n/a rmit No...tl/.a. ....... Date Of Permit ................ Applicant .... ~lth Dept. Approval ....... n.~.~. ........... Underwriters Approval.. tuning Board Approval ..... tl~yk ....... l~est for: Temporary Certificate ........... Final Certica. te..f~. ..... Submitted: $ ................... .......... .... 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. REMARKS: FOUNDATION 2ND [ ] INSULATION FRAMING [~i~AL, DATE FORM NO. I -~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Disapproved. a/c ........................... ~ s~rs o~ P~.n~s ...... ... SURVEY SEPTIC ' Date · 19 INSTRUCTIONS a. Tiffs 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 appl/- ca*,ion. c. The w°rk c°vered 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 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 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 in building for necessary inspections. (Signature of apphcant, or name, if ~ corporation (Mailing address of applicant) State whether applicant is owner, lessee, age,t, architect, engineer, generai contractor, electrician, plumber or builder. Name of owner of premises . ~o n Honry, (as on the tax roll or latest deed) If applicant is a corporation, signature 6f duly authorized officer. (Name and title of corporat~ officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ............ ~ .......... Other Trade's License No i. Location of land on which proposed work will be done. Main 51680 ' M, ai, n R,o. ad ' House Number Street Hamlet County Tax Map No. 1000 Section ...: t5.3. ........... Block . .6. ' Lot ..... 3. ............. Subdivision ........ . ............................ '. Filed Map No. (Name) .............. Lot ............... 2. State existing usc and occupancy of premises .... , . '--' ' ....... occupancy of proposed construction: a. Existing use and occupancy 2. s..~.o.~.y....f.~.a.~.e c]~elli'ng wi'th de~ache~ h,,-' ..... b. Intended use and occupancy · 3, Nature of work ( ' ; ' checkwh~chapplicableb NewBuildlm, 'X ' " · · . ' ' Rennh' ~ .... , " .-o .......... Addltl0,, .......... Alteration . · ' · . . ' .... , ....... ~' ~,emonuon ...... ; .......... Other Work ........... ~ '~ O % ~ '%%' (Description) 4 Estimated Cost ' ' · I Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ..... · Ifgarage, numbe'r of cars . .i .... ;' '~'?'i":~i.~3jTq: .~ .... ' .......................... · ........ 6. If business, co,mmercial or mixe~j~I~,~;~y nature and extent'of'cach't 'e of' ........... 7. Dimensions ot existing stmcture~Tifanv. Fr,,-* v ~ . ,, . yp use ............... , .... -' ................... ~ear ............ Depth Height ....... X~um~ ....... . . .... ~'~on ~! ............................ new : ' : : : : : : ' . umberof to es .......... '.: ..... Height ............... Number of Sro s ~ ' ~.,' · .............. Depth ......... 9. Size tie of lot: Front .9.9 ~ . ' .......... vv .... . 10. Date of Purchase .7~.10/§T ........... Rear · .9.9 ...., ........ i .................... ' " ... Depth 330 · ' " ........ Name of Former Owner ~ . .. O. av±d 'dj ~h'gri6~$'e'z ....... 11. Zone oruse district in which premmes are situated.. ' ......................... Does proposed construction ~t ................................. ' ' ' .132: vi ate any zoning law ordinance or reoula,;,,,. I',!O .................. Will lot be regraded ...... I ....... , 14. Name of Owner of premises John Henr~/ ....... Will excess fill be re.moved frgm premises: Nam~ of Architect .[i ............. ' .... Address .~-§.8_9.,_~kn. R..o.a.ct. Phone N~ 765-4'~2 ......................... Address ........... . ........ Phone No ................. Name of Contractor ....... "k'/,, ............... Address ...; ........ · /$~,,,~ ~,~,, . 15.' Is this property withi~ our feet of a tidal wetland? ~Yes ...... f-;-"~ ..................... i ~If yes, Southol T. own Trustees Perrazt may. be requzred. ~ ...... .... PLOT DIAGRAM Locate clearly and distinctly ~ property lin.es. Give street and bloc interior or corner lot. 1 bmldmgs, whether existing or proposed, and. indicate all set-back dimensions from number or description according ~o deed, and show street names and indicate whether STATE OF NEW YORK, COUNTy OF . .. ~.~FFOhK. ..... 1,; John ' Henry ' ........................ ik ~.~'t~h'~i -' .... being duly sworn, deposes and says that he is the applicant ' '(Name of individual sign 'c . ~bove named. Ie is th ' owner (Contractor agent corporate officer etc ) ................. ,f said owner or owners, and is duly[ authorized to perform or have performed the said work and to make and file this ppi cation; that all statements contai~ned in thi ..... a'app ~cauon are true to the best of his knowledge and belief; and that the · 'ork will be performed in the manner!set forth in the application filed therewith. ~vorn to before me this ] tar3, Pubhc, County Not~ry Publlao Stata of New York' · ,' ................. . ......... No. 4879~06 ] '" ~' " John ' ~gnature of applicant) Qualified in Suffolk County Commission Expires Oeeem?r 8, 19,.~..