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Home My WebLink About22178-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCcumANCY No Z-23216 Date SEPTEMBER 14, 1994 THIS CERTIFIES that the building ADDITION Location of Property 1555 BAYHAVEN LAN~ SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 88 Block 4 Lot 39 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~ 24, 1994 ~ursuant to which Building Permit No. 22178-Z dated 07JLy 12, 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 UNHEATED PORCH ADDITION TO EXISTING ONE F~LMILY DWELLING AS APPLIED FOR The certificate is issued to of the aforesaid building. (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N~ 22178 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Permission Is hereby granted to: ........ ...... 1..~..'~....~- ~ ........ &~.., ........... ..~.o..~.~...~.l.~., ...... ~...~..,...¥, ................. ,o ........ ~o.~..~..~....~.~ ......... ~. ........ :.....u~.fl.~.~..+..~.~L ...... .p.~.~.c...,~. .... ..... ~.~..~...)..~.:.:~.~. ...... ~ ........ ~..,.~...+....~..~.~ ........ .~..~..~......' ...~..~.,../.~ CountyTax Map No. 1000 Section ...... ..~..~.. .......... Block ......... . .~... .......... LotNo ..... ..~....?.. .............. pursuan, to application dated ........ ....~...f_...~....~..L~.. ......... ....~...~......t.. 19...~.../ ..... and approved bythe Building Inspector. Fee $..,"~...3 ................ Rev. 6/30/80 Building Inspector For~ ~o. 6 TO~ OF SOUTHOLD BUILDING DEPARTMENT TO~ IIALL ~ · 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to thc building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lihes, 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 ~ ~ess 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. 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 Buildins - $i00.00 3.Copy of Certificate of Occupancy - $20.00 4.Updated Certificate of Ocnupancy - $50,00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ..... ................... ~ecation of Property..~ .............. ~.R~(~...4~ ~euse ~o. -- ~ .............. --~i~{~-~..~ . 000, ........ ......... .............. Subdivision .................................... Filed Map ............ Lot ...................... Permit No ............... Date Of Pe~it. .. .. plicant. Health Dept. Approval .......................... Underwriters Approval ....................... Planning Board Approval ............... Request for: Temporary Certificate.' .......... Final Certicate ........... APPLICANT_ 765.1802 BUILDING DEPT. ON [ ] 1ST [ ] ROUGH PLBG. )UNDATION 2ND [ ] INSULATION [~-I~'MING [ ] FINAL REMARKS: FOUNDATION__ -- FOUI~DA TIOI.! '~' [2nd) ROUGH FRAME &. .......;.= .:....,: :,. ,-.-,,.-,.,-.,~'.nu .... ~suu;~o~ ~s~' ~. STATE ENERGy CODE Ye FILIAL hDDITIO~IAL CO 7~5-1802 BUILDING DEPT. INSPECTION ] FOUNDATION IST [ ] ROUGH PLBG. ] FOUNDATION 2ND [. ] ~I~TION ] FRAMING ~]~.~FI NAL 765-1~02 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH PLBG. FOUNDATION 2ND [. ] ~TION FRAMING [~/'FI NAL ,2'/'/ INSPECTOR ~~ BLDG, DFP'T I Il 7,'{I ~1'i TOWN OF SOUTHOLD J{ill IIIU 9 11 Inn~ IIF! BUILDING DEPARTMENT ?uI ,.~u~v /.. ~ t~ Il-',," TOWN HALL j ~ SOUTHOLD, N.Y. 11971 I 8LDI3. DEI~. i TEL.: 765-1803 Disapproved a/c ..................................... AP~EICATION FO BUILDING PERMIT INSTRUCTIONS SURVEY CIIECK .................... SEPTIC FORH CALL . .~.: · . . fL/-~..~. ~,¢. t/. (.,~.- MAIL TO: Date ....... ' 19 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, 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 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 codp, housing codj~;~d ~g. ulations, and to admit auth°rized inspect°rs °n premises and in building f°r neccssary inspec!~>~rn?Z ' . .... .... ....... -- (Signat~e~of a~icant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ........................................ , .................. ' 'Name of owner of. premises .... ~ .-~-..~ .A./..~..x(. ;...~.,...~..~.. ?..~...~..~-..~..,~....d~../..pSi..'~..t~...~. ....... (as on the tax roll or latest deed) If appligant is a corporation, signature of 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 ...................... Location ofland on which, proposed work will be done. . . ~. .m -. ; . :. . · P,~,:t W~k~f;<i:~ ............................ ; ...................... :".~77'?. A. ~. House Number Street Hamlet , co,,,,, ,o. ...... ¢.g.f. ...... ...... ........ Subdivision ..................................... Filed Map No ............... Lot ................ (Name) State existing use and occupancy of premises and intended use a~d occupancy cf proposed ~onstmction: a. Existin~ use and occupancy ....... '...~... ~0~. ~ .~Y/.. ;:;~'~/~[~~q 9. 10. 11. 12. 13. 14. property lines. Give street and block r interior or coruer lot. Repair .......... Removal .............. Demolition .............. Other Work ....... ; ....... , ..... Estimated Cost ~ /. 5. ~) 0 0 ~ ,(De'scrip ion) ....... mumDer oi uwanmg units on eacn nooi'... '. t.";' T ~ 72 .... If garage, number of cars i I ' If business, commercial or mixed occupancy, specify natu~re and extent of each type of use ....... Dimensions of existin, st eture , if any: Front .... ....... Rear. '. _O.T' :*:.t:':'::- Height ............... Number of Stories .... ] ........ i ......... th . ' ' Dimensions of same structure with alterations or additions: Front .... ~:t .......... Rear....~[ ......... Depth ...... ,~-~. ........... .i'. Height ...................... Number of Stories ..... [ ........ ; ..... Dimensions of entire new construction: Front ...... ~ ....... Rear .... I. ~ ...... Depth .... .~.~.' ..... Height Number of Stories ! Size of lot: Front / ~ ~'. ~, Rear . { ~- 5' t [[epth ... (..7~../~..: .... Date of Purchase .... l .~..//./i ~ ......' ......... Name of Former Owner {,~ o.R,3)4.6L .Z.O.td ?,1.6~ ....... Zone or use district in which premises are situated...; .................... Does proposed construction violate any zoning law, ordinance or regulation: ... Will lot be regraded . . ~ ......... ' · ....... i ......... g~ll excess fillbe removed,from premises: Yes --No Name of Owner of premises/t{~6t~.h( .*.00.~.ZO~.~.L.//v~]~a~rd~ress .a%..~.~t. ~;l.4t~..~... Phone No. 6.7.~. 7. ).'J..~. ~... Name of Architect ~ Address Phone No Name of Contractor ......... ~ ................ Ad&ess ........... . ........Phon~zNo ................ Is this property within 3100 feet of a tidal wetland? *Yes ........ No...~.~ .... · If ye~s, Southold T'own Trustees Permit may be required. Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from umber or description according to deed, and show street names and indicate whether "!' STATE OF NEW YORK, S!S COUNTY OF ................... (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or. have performed the said work and to make and file this app lcatlon; that all statements contaiqed m this application are true to the best of his knowledge and belief; and that the work will be performed in th.e manner ~et forth in the application filed therewith. Sworn to be. fore me~ this. . ,"'~l . ~[//~ ' ...=:........ ............ , yv~ ' c~ ~- ~ E ' · ~ .... ~ · .. ... county 8 A'm' O UC, ' NO. 30-4694627 ' - QUALIFIED IN NASS~.U COUNTY . .... CERTIFICATE FILED IN NASSAU COUNTY,.... / COMMISSION EXPIRES VIARCH 30, 199,~ (Signature of applicant) CERTIFICATE OF .OCCUPANCY