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Home My WebLink About21890-zFORM NO. 4 TO~N OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22853 Date JANUARY 28~ 1994 THIS CERTIFIES that the buildin~ Location of Property 940 TUCKERS LANE House No. County Tax Map No. 1000 Section 59 subdivision ADDITION SOUTHOLD~ N.Y. Street Hamlet Block 4 Lot 5.6 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 13, 1994 pursuant to which Building Permit No. 21890-Z dated JANUARY 27~ 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 "AS BUILT" TO EXISTING ONE FAMILY DWELLING AS APPLIE~ FOR. The certificate is issued to CHERYL J. ZALESKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FOBM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 21890 Z BUILDING PERMIT ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Permission Is hereby granted to: .....¢../..¢.~.¥..~ ....... ~......Z..~.,..i ............ ...... ,?....¢g.......~.~ ....... 2; ............................. .......... ~¢..~,...¢...~.¢., ...... ././.~.?./. ......... , to....~.~ .......... ~ .......... ~.~. ......... ~..,.~.~;~......E.~.~: ....... ~.,.:../.~.~ .... et pre~,ses ,oeated at ............................ Z~......./.~'~..~./..'¢~....~: ................................. CountyTax Map No. 1000 Seotlon....~...~.. .............. Book ....... ~.....~... ........ LotNo. k.~-~ pursuant ,o application dated ............... ¢./...,~.. ......................... ;..., 19.....~....~..., and approved bythe Building Inspector. Fee $ .. 2, .~.',/,~ ....... Rev. 6/30/80 Form No. 6 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with ~he following: for new building or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unuaual 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 leas than 2/10 of 1% lead. ~.~ 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 ~oard Approval of completed site plan requirements. Be For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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 ~riting to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, -~c 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 Building - $100.00 ' 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .., ................. New Construction ........... Old Or Pre-existing Building...~. ............. Location of Property ......................................... ......... House No. Street Hamlet Onwer or Owners of Property .............................................. County Tax Map No i000 Sectio ~q Bi ck ~ ~.b , n............., o ..... Lot . . .................. Filed Map .......... . . Lot ...................... Permit No Date Of Permit' Applicant Health Dept. Approval .......................... Underwriters Approval ............. Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Submitted: ................... I/:'., · .., . SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL . (J~fiilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... ] SETS OF PLANS SURVEY CIIECK ........ CALL ............. MAIL TO: a. This application must be completely filled in by typewriter 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 streets 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, thc 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 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 in building for necessary insp~ ~. ~ (Signature of ~,pplicant, 13f name, if a corporation) .&.,. ...... (Mailing address of applicant) (Name and title of corporate officer) Builder's License No... ~o~1-~ Plumber's License No ......................... Electmctan s License No ....................... Other Trade's License No ...................... State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. he u ..... [ ~ ................................ -Z CL l e s k ; APPROV£DA.~ ~m'rn Name of owner of premises ........ 4 : (as on the fa× roll or late . B.V. # /£eo -e_______ If applicant is corporation, · F E.~_~.._~By:- ~-YL--'7---r-- ~- a signature of duly authorized officer E .~' '~' · NOT~Fy BUILDING DEP,&.RTIVYENT ~AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, ¢:OUNDATION IN'VD REQUIRED FOR POURED CONCRETE 2. ROUGH"; ~RAMING & PLU~48ING 3. iNSULATION 4. VtNAL CO¢fSTRUCTiON MUST BE COMPLETE FOR C,O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR l. Location of land on which proposed work will be done ................... ~IESIGMOR'CON~¥~ffC¥1OffECd~O~' ' House Number Street Hamlet County Tax Map No. 1000 Section ...~..~. ............ Block .......... .t_f ...... Lot.. ~.-..,~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy c~vPrOpgsfg~&9~tstrpction: a. Existing Use and occupancy ...~...~ 6J~/~t~-C'~-..~x~,'5' o ,,!'; ~ .....0 0 ......... ~/' ..... ~:'m,2F' '~ ;,r ~, ~m~ <m ................ b. Intended use and occupancy .............. ~ ~ ~'~ .............. property lines. Give street and block nu interior or corner lot. 3. Nature of work (check which appl able): New Building .......... Addition ....... Alteration . ....., ...... Repair Removall Demolition Other Work 4. Estimated Cost ............... i ..................... Fee ..................................... ' (to be paid on filing this application) 5. If dwelling, number o f dwelling unils ............... Number of dwelling units on each floor ................ · If garage, number of cars ....... ; ....................... , ........................................ 6. If business, commercial or mixed o~cupancy, specffy nature and extent of each.t~ ype of, use ..................... 7 Dimensions of existing structures if any: Front Rear ,' ' Depth Height Numbe~ of Stories Dimensions ofsame structure with hlterations or additions: Front Rear Depth iHe'ght ! N mb 6f Stori ,. ...................... i ..................... u er . es ....... : ....... 8 Dimensions of ntire n nstruclion Front Rea ':~ ' D'ep~h Height ............... Number of Stories ......................... .-... i ......... ", ................ 9. Size of lot: Front ............. ~ ......... Rear ...................... Depth ...................... 10. Date of Purchase ............. i ........ .... Name of Former Owner 11 Zone or use district in which premi!ses are situated 12 Does proposed construction violat~ any zoning law ordinance or regulation: 13. Will lot be regraded ........... I'. ................ Will excess fill be removed from premises: Yes No fp ' n 14. Nmne of Owner o remises ..... i ............... Address ................... Pho e No ................ Name of Architect ' Address Phone No Name of Contractor ' Address ~; Phon~ No 15. Is this property within 300 feet of a tidal wetland?l *Yes ........ No... ;.. .... *If yes, Southold To~n Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all bfiildings, whether existing or proposed, and. indicate all get-back dimensions from :nber or description according to deed, and show street names and indicate whether STATE OF NEWrT'ORK~, ~'_ //.- ~,~ (Name 6f individual signiqg contract) above named. ' ....... being duly sworn, deposes and says that he is the applicant of said owner or owners, and is duly application; that all statements contai work will be performed in the manner Sworn to before me this ............. · ~:~ .... day of. Nota. ?ublic,. C..iiTZ , Notllry Public, State No. 48795 ~5 .~/[ Qualified in Sufft Ik Connt~ U~ Commission Expires D~ ;ember 8, lg.~ authorized to perform or have performed the said work and to make and file this ned in this application are true to the best of his knowledge and belief; and that the set forth in the application filed therewith. .. County ,f'NewYork ' . ..................... (Signature of applicant) He is the ..................... ~ ............................................................. (Contractor, agent, corporate officer, etc.) BUILDING DEPT. INSPECTION [ ] FRAMING [//] FINAL REMARKS: ~ DATE