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Home My WebLink About22107-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. u~KTIFICATR OF OCCUPANCY No Z--23278 Date O~TOBER 11, 1994 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 375 GOOSE ~ LANE EXT. SO~THOLD, NY House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 8 Lot 20 Subdivision Filed Map NO. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 18, 1994 ~ursuant to which Building Permit No. 22107-z dated ~ 6, 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 AN ACCESSORY SHED AS APPLIED FOR. The certificate is issued to JOSEPH & JDLIA VIDULIC~ (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A ~Building I~ FORM TOWN OF $OUI'HOLD BUILDING DEPAgTMENT TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT I?HI$ PERMff MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ........ ~....~.. .......................................... 19.?..,~:~ 22107 Z Countvl'ax Map No. 1000 Section ......... .,"?.~-[~ ..... Block, ......... ~.. ............ LotNo ........ ~ ............. pursuant to application dated ..~ ........................................... 19. ~.~..,,,,, and approved bY the Building Inspector. Fee $,, ~.~.,. ' ' ,/~,//Buildlng Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 ali 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 ~hat the solder used in system contains less 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1. Accurate survey of property showing ali 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 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-existinK 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 New Cons~ruction. JJ.~..'~.... Old Or Pre-existing Building ................. Location of Property.~.~..~..O.p.9..~.. ~ ~fg. ¢.0g ~...4~ ?. .... 500~'O 0i House No. Street Ha~et Onwer or Owners of Property. .~ ...... ~. ~ ~o~ ~ ~ ~o ~000, ~o~..2~ ........ ~oc~....~. ..... .. .. .~o~.f.~. .......... . · .. . Health Dept Approval .. . Underwriters Approval ................... Planning Board Approval ........ Request for: Temporary Certificate ........ Final Certicate ..... ......................... .. . ...... 7~5-~LSOZ BUILDING DEPT. INSPECTION FOUNDATION 15T { ] ROUGH PLBG. FOUNDATION ZND [ .] ~I~TION FRAI~IlNG [~]~FINAL DATE/~SP~' FOUNDATIO,U FOUI~DATIO:! 2. (1st) ~2nd) ROUGH FRAME & ,FLUMBING 3. INSULATION PER N. STATE ENERGY CODE FI:~AL ADDITIONA'L COM~IE~ITS: ~JqOH/rlos ::10 'Jcl'aa .. '~ FORM NO. 1 ' Town oF SOUT,O,O :~ .J ~'-~-- ~ BUILDING DEPARTMENT ~ u~v ~n~ ~ ; TOWN HALL ~ ~ Lu ~ ~ ' SOUTHOLD, N.Y. 11971 Disapproved Mc ..................................... ................. . ............... , (Bu~ld~ ~tor) APPLICATION ~OR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLA~{S .......... '-~SURVEY ................... CIIECK .................... SEPTIC FORH .............. /MA~"~L TO: a. Tiffs 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 tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of tiffs 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 agree: to cuml,iy with all applicable law.,, o,'dJna~c~% building CO. le, housing code, and regulations, and to admit authorized inspectors on premises and in building tbr necessary inspections. - -- /(~ignature of applicant, or name, if a corporation) L/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises., .~.~./~. ).(~.....k/..I..~...~..L. ! .~./~. ............................................ (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 ...... .~..(~. g.~ ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ..... · ¢ .e.g-.mc. g.4x .Sx r ..... 0. .................... . House Number Street Hamlet County Tax Map No. lO00 Section .. ..... ~..~. ........ Block ....~. .......... Lot..G~.(~ ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~.~...C"7....~...c:!/....~..~.l:../Sj.~.....~. '. ....................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition ........ :'.'-~.... ........ Repair .............. Removal .............. Demolition .............. O t fie r ~.. ~k~ ~._ ~f/~.~. . i. ' ~ .... -'-("~e~crip tion) 4. Estimated Cost ~.~..t~ .......................... 00 Fee ................ ~ ....... ; .......... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each ~'~t~l'-'~. '.-~ ............ · If garage, number of cars ........................................................ ' ................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories .............................................. . .......... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories .......... ;f,.z ......... 8. Dimensions of entire new construction: Front ........ J,~ .... Rear ............... Depth . .].:] ........... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ............. '... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ...................... :'... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ':'L: : Pi ~ P' (!1" ,' ,. :.',/Ci ;. i-F. ~:~: :.,~ Avl();. ~ CO~iF-..E'FF FOR ALL CONSTRUCTION SHALL ME~ THE REOUIREMENTS OF TH[ N,Y. STATE CONSTRUCTION COD[~. NOI R[~PONSIBLE FO~ ~[~1~ O~ ~O~T~UO~IO~ STATE OF NEW YORK, -- COUNTY OF .. ,~.~.~. ..... S.S l P q. ff. ................. being duly sworn, deposes and says that he is the appUcant (Name of individual signing contract) above named. SZHe is the ............................. O.t,,q ~,04.~.. ~ ................................................. (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 application; that all statements contained in this application am true ro the best of his 'knowledge and belief; and that the work ,viii be performed in the manner set forth in the application filed therewith. Sworn to before methis //~ ' .......... 1..~.. .... /~..//.dFq( of/ ..... ~ ........... 19 ?.4 · '7 ........................ i~l.~g~RyB (Signature of applicant) .No. 025089,