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Home My WebLink About21880-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFIOATE OF OCCUPANCY No Z-23368 Date NOVEMBER 23, 1994 THIS CERTIFIES that the building. ACCESSORY Location of Property 1060 CASE'B LANE EXT. CUTCHO~DE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 109 Block 5 Lot 14.24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 5, 1994 .pursuant to which Building Permit No. 21880-Z dated JANUARY 19, 1994 was issued, and conforms to all o~ the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY GRAPE ARBOR IN REAR YARD AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JAMES & BROOK DUBOVICK N/A Rev. 1/81 FORM NO,$ TOWN OF $OUTHOLD BUILDING DEPARTMENT 1'OWN HALL $OUTHO~.D, N.Y. N~- 21880 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to; ~.~ ~,~,~.....~,~.,:~ .......................... ..... (,~......~......~(~ ........................................... .... ~ :~.~.~..~....,~.,..,./,./,z~¢:_: ........ t o.,.~~,~ ........ ~ .......... ~ ...... ~~ ........ ~.....~ .......... / / .......................................................................... ~/~,.dz,~.Z~ ......................................................... a, prem,ses,ooa,eda, /.~. ~ ..... ~.,~,.,.,.~.~ ........................................ Counly Tax Map No. 1000 Section ,,../~..~.. .......... Block ..........~..~ ...... Lot No. ..~..~...;.....~.~ .... ptl,suant to application da?ed ...,.,~.....~..,..'. ...... .~ ....................... 19....~.../~..,,, and approved bythe Building Inspector. P~ ,.,Z~ .......... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 BLDG. DEPT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 I% lead. 5, Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Cpde Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. FoX'existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "p~e-existing" land uses: if 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 ><, ate ...... ....................... New Construction ........... Old Or Pre-existing Building ............... '. Location of Property .............. ~'.. .~.~. ..................... House No. Street Hamlet !O~wer or Owners of Pronertv . 'County Tax Map No lOg0, Section. .Block.. Lo~ ~ ' Subdivision-: · .~. · .~ · .~- ' ~ ' '~-~:~..0~. · ·~.--'~--- '-' ~--~'~-- -- ..... Filed Map ......... Lot ............ ;Health Dept. Approval,..l~. .... Underwriters Approval. Request for: Temporary Certificate ........... Final Certicate ...... ..... Fee Submitted: $ .............. ::?, 0 ............................................... . '"--,~..,~. APPLICANT COM~£NT$ ' . FOUN DA__?I 0 N ( 1st FOUI~DATION f2nd) 2. ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COM~E~;TS: O,._O 00°6 ~ 3. Nature of, work (check which applicable): New Building .......... Addition ....... ... Alteratio,g,,~ ......... Repair ........ Removal .............. Demolition .............. Other Work .~,. ............ .~.~.O.q ~ t~x,~ ~f<'~(30--~ ~ (Description) 4. Estimated Cost ............................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling unit~. ~i~ ......... Number of dwelling units on each floor... T. ........... . If garage, number of cars ........... ., .................... . ..... .. 6. If business, commercial or mixed occupancy, specify n~re and extent of each type of use ..... I~ .......... 7. Dimensions,oil' existing structures, if any Front ~ :~¢rq eq Rear Denth ' ' Height ,..I.'ZJ.~O..~.O-:...NumberofStories .... ~." '" .... ~ ..... i .... ~ i ............. DD~' ~,]e; ~¢. c. ' · ' i~ns: Front....~1~ .......... Rear .. x.~.k slons of sa tu~ with ,a!te.r.a!lons or adrift ~h .......... ~,. v ,. .... ;,. · . ..... ~ .',, ·.. netgnt ..... ,~:.~ l~.. .....~ .....Number of Stories .... ~ 1{ ............ 8. ~menslo_~to~t entire new construction: Front . .'3.e~,. ¢~oi.~l~ear ............... Depth ............... Height .~I~.C ........... Numb~of Stories .c,[ 9. Size of lot- Front ~e¢ ~:~-~W~'~ Rear ............................................. ............. · '~'~ ........................ Depth .................. ~ .~.. 10, Date of Purchase ..... .I .Ct..~ t~ ................. t~ame of~ormCr Owner ~-¢~+,~ ,¢--.~ro14 ,~ ,.3~} q- I 1. Zone or use district in which premises are situated .... ~.%c?.~ .f.c%.e. ~%-I. _~_( ' ' ' ............ 12. Does proposed construction viglate any zoning law, ordinar ce or regulation' ~ ~.' ......................... 13. ~-~l .................. c ss fillJ~e removed from premises: Yes Will lot be regraded ...... ~,, Will ex e ............................ 14. Nam e of Owner or premises. ~.~.~k% 0.U· k .Cr~.... Add~ess .[ 9.(o0.-.~.?~..~c.~.~2~l~one No. 7 '~' $ Name of Architect ...... ~ ................. Address ...... ~. ............ Phone No...~ ............ Name of Contractor....... ; :~ ................. Address ..... ..-TZ ......~.... Phone No....-Y ........... 15. Is th£s property w±th±n 300 feet of a tidal wetland? *Yes... ~.~... No · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from lines.Give street and block number comer lot. or descriptioh accm'ding to deed, and show street names and indicate whethe] STATE [ t ~ ~ OF NEI~YO~K~ cou ¥ (N me ofindiv'dual s'gning contract) above named. .... being duly sworn, deposes an~says that~he is the applicant He is the ................................................................................. (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or imve performed the said work and to make and file this ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith· ;worn to before me this ............. w ..... Iotary Public ...... ~:;~ ......... County ' ~ .'~" ~ l~ ~l* oi ~~~7~j4t ~ ..... / .~'/,~'/~.~.~ . ¢ . t ~'/,~f. 7 .'~t~~p. ~li ~)~?~ ........... . d l/! TOWN OF SOUTHOLD I!~'~';. ,-,, - ,- .;-- BUILDING DEPARTMENT IJ,VI~ p \ J~IV l) J~[~/{ TOWN HALL ~ .... ;; T,iT~', :,i';'~ , T E L.: 765-1803 Approved ..... Disapproved a/c ................... : .................. ................... (Building Inspector) [PPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLAHS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. 765.1802 9 AM '~ 4 PM FOR THE FOLLOWING INSPE~. 'ONS: 1. FOUNDATION - '~ '¢O REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR i ~ L f' , _ ~' DESIGN OR CONSTRUCTION ERRORS Location of land on which proposed work will be done ..... ..... House Number~ ~ Street ~~..~ Halmlet County Tax Map No. I000 Sect/on,' ,, ,~.'7./.4~.~. ..... Block...'T~..,.~.7... Lot...o.'~.../'..~:, .~."~-.. Subdivision.. .\ ~.kp~..1, .. cl...~l~J .<~ .......... Filed Map No ............... Lot .~%~.,.. (N~me) ....... State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .~../O..~ ~ P. ~ b Intended use and · occupancy .......................................... If applicant is a corporation, signature ~'f 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 ...... ~ ............... INSTRUCTIONS a. Tl~s app~i~ati~n must be ~mp~e~ My ~ed ~n by typewriter ~r in ~nk and submi~t~d t~ the Bu~ding ~nspe~t~r~ with 3 sots of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lo: and of buildings on premises, relationship to adjoining premises or public streets oi' areas, and giving a detailed descriptio a of layout of property must be drawn on the diagram which is part of this appli- chtion. c, The work covered by fids application may not be c~mmenced before issuance of Building Permit. d. Upon approval of this applicatiorb the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available fo~ 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 Igspector. APPLICATION IS HEREBY MADEi to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town Of Soul;hold, 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 aI~ applicable laws, ordinances, building code, hou>sing code,.an0 regulajLion~, and to admit authorized inspectors on premises and in building for necessapy ins/~fictions. , -- , ///d~Signature of applicant, o~'~me, i~a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' ~ - (as on the tag roll or latest NOTIFY' BUILDIN¢ DEPARTMENT AT Date .. ~ ¢ ....,