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Home My WebLink About22542-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. CERTIFICATE OF OCCUPANCY No Z-23431 Date THIS CERTIFIES that the building Location of Propert~ 155 PINEWOOD ROAD House No. County Tax Map No. 1000 Section 110 Subdivision DECEMBER 30, 1994 ADDITION Street Block 3 Filed Map NO. Hamlet Lot 2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 28, 1994 .pursuant to which Building Permit No. 22542-Z dated DECEMBER 30, 1994 was issued, and conforms to all of the ~equirements of the applicable provisions of the law. The occupancy for which this certificate is issued is A DECK ADDITION TO ANEXISTING ONE FAMILY "AS BUILT" AS APPLIED FOR. The certificate is issued to SANFORD FRIEMAKN of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner) N/A N/A Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 22542 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) at premises located at ....... .~.,~ ............................................................... CounlyTax Map No. 1000 Section ......,~.Z.~.. .......... Block ......... ,..-~.... ........... Lot No ........ ~ ............ pursuant to application dated ............ ~.'~.....~.. .......................... 19..~...~......,-- and approved bythe Building Inspector. / ~llng InsJ:)ectdr Rev. 6/30/80 Form No. 6 Tow 0r SODT OLD [,1~--| Hi! BUILDING DEPARTMENT · 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% icad. 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. Be 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. 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 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 .................... c t New OhS ruction ........... Old Or Pre-existing Building ................. Location of Property ................................/St C' ~.. fA/O~}. ~. .. .~.~..T~..~..~...'~... . . ............. . .. .... House No. Street Hamlet Onwer or Owners of Property .................................................................. /.(9. lo County Tax Map No 1000, Section ............ B ck.......,........Lot ........... . . ...... Subdivision ........................... .. .. ..... Filed Map ............ Lot ...................... Permit No .............. Date Of Permit ............. A~l~cant ~fLc~t~ ~, ~0~7- Health Dept Approval Underwriters Approval ........... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........ Fee Submitted: APPLICANT /0~o0 7G5.1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: [ ] FINAL DATE / INSPE BLDG· DEPT. ~ TOWN OF SOql;rHOLD ~ TEL.: 765-1802 Disapproved ak ..................... ' (Bfiildin~Inspector) APPLICATION FOR BUILDING PERMIT FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 BOARD OF HEALTH ......... 3 BETS OF PLANS .......... SURVEY .................. CI1ECK ................... SEPTIC FORH ............. CALL ........... HAIL TO: INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink a~d submitted to the Building Inspector, with 3 sSts 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. ¢. 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 i~sued 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 co.d¢,,tAc~sing j~ode, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe - . ' .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. .' ............................................................. N~me of owner of premises ..... .~.~. ~..~?..'~......~.. I..~.~..~.~/. ..................................' ........... (as on the tax roll or latest deed) If 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 L~cense No ...................... ; Other Trade's License No ...................... 1. Location of land on which proposed work will be done. / t ~/'~/voo t') ./~..e../~... } ltouse Number Street Hamlet Cotmty Tax Map No. 1000 Section . . ['/0 . Block _5 ' Lot '2/ Subdivision ' Filed Map No ................ (Name) . 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~'lg/&{-~ ~/~"7 ~l~'5'f)~'t~cez' b. Intended use and occupancy ..... . .~.~.~.~...../,~..?..s~....~..I.C-5. ~: :* ~.~..~Vi'~4~':~ ~ . ..________________~.t...'-~..ff... .3. Nature of work (check which ~PPlieable): New Building . ~ .... on ....... i.. Alteration .......... Repair ........... Removal .............. Demolition .... : ......... Other Work .......... ..... I .... · . Description) 4. Estimated Cost · /.~ i ., ' i ................... Fee ....... i (to be paid on filing this application) 5. If dwelling, number o f dwellin~ units ......... Number of dwelling units on each floor .... · Ifgarage, numberofcars ... i ................... '.... ' .......... 6. Ifbusmess, commerc~alorm[x,edoccupancy, specify aturea exte t f. h t e ............ 7. Dimensions of existing structures,if any: Front ............... Rear .............. Depth ............... Height ............... Nu~.ber of Stories ... i. i ..................................... Dimensions of shine structure With alterations or additions: Front ............. Depth Height .................. Rear ...... 'i ~ ......... ; ' Number of Stories 8. Dimensions of entire new cons~ruction: Front Rear .............. : ............... Depth ......... Height i Number of Stories ..... 9. Size of lot: Front .... : ' Rear.. De ..... ' ................... pth 10. Date of Purchase I ................................... 11. . . . · .... . ........ ' ....... Name of Former Owner ....................... Zone or use d~stnct ~n which premises are situated ...... ' ' .... .12. Does proposed construction violate any zoning law ordinance o~ ~--,}~o*[,-'-'.' '~ ........................... 13. Will lot be regraded ..... u ............... win excess fill be removed from premises: Yes No 14. NameofOwnerofpremises .~.~ F~r,~'~' ~ ....... Name of Architect · ......... 1 .................. Address ................... Phone No ................. Name of Contractor ........ I .................. Address ................... Phone No. . ' 1300 15,' I.s th±s property w±th±n feet of a t±dal wetland? ~Yes ........ No ~If yes, $outhold flown Trustees Perm±t may be requ±red. .':. i PLOT DIAGRAM Locate clearly and distinctly alI buildings, Whether existing or proposed, and, indicate all set-back dhnensions from property lines. Give street and block! number or description according to deed, and show street names and indicate whether interior or corner lot. , ' _.---- ..10. · ' 0Tm .. ~ ' ~ ~ '1, 7~I~NDATtON ~ TWO REQUIRED ~ ~ J ~_.j ~ ~ ~ ~ . FON POURED CONCRETE ~- . '~ 4. FINAL CONSTRUCTION t~UST ~OR C.O. f¢~ ~O~ ALL CONSI~I,~Ohl SNALL ME~T . 'r~F REO[,IIREMENTS OF THE N,Y, :. ~ ~ ...... STATE CONS~ON--& ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEW YO~L ~ ' . cou v . .... ..... ~'~Y~'"~ ~" ~' "' '~ ?~ ..... being duly sworn, deposes =d says that he is the applicant (Name of individual signi~g contract) above named, i He is the ......... : .. . ........................ . (Contractor, agent, cor' ) " ........ j porate officer, etc. of said owner or owners, ~d is duly jauthofized to perfo~ or have perfo~ed the said work and to m~e and file this application; that all statements contaifled ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the manner ~et forth in the application filed therewith. Sworn to before me this ................. day of ....... , 19 . Net~ Public, State ~J ~ y~ ................ ~ ....' No. 48~9~0B ~ (S~gnature of apphc~t) Qualified In Suffolk,Coun~ ' · .¢ ............ C~mmil~ioa ~xpire~ Deeem;ber