Loading...
HomeMy WebLinkAbout22242-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23209 Date SEPT~ER 13, 1994 THIS CERTIFIES that the building ACCESSORY Location of Property 135 ISLAND vIEW LANE GREENPORT, NY House No. Street Hamlet County Tax Map No. 1000 Section 57 Block 2 Lot 31 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 19, 1994 pursuant to which Building Permit NO. 22242-Z dated AUGUST 9, 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 IN THE REQUII~ED REAR yARD OF A SEASONAL SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. ~?~ANORKRAVITZ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED (owner) Rev. 1/81 N/A N/A FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N£ 22242 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby grant~d to'., .~..¢..~.~ ....... ~...~..¢...,.....¢...~ ....... ....... ~,~.~.~....~..., ...... ./...Y.,..~ .... ,o....~...~<.~ ....... ~.....~¢...:~.~,:..:....¢..~..v.......~.Z..~_.~:.,~..~,,,,.~,.,... .... ~.~.~.~... ...... ,....,~..~ ....... ~'~....~~..~../~. .............. ~~.,.'.../..,~ ........ ~.~.~.,:..~..>~.....~/F~../..-..~...¢:... ........ '. ............................................... ~..~.¢...~p~..+...........A..Z:..?./.., .................................... CounlyTaxMapNo, 1000 Secflon,.,,...'~.,....~... ....... Block ...... ~ ............... LotNo..,~,,.,Z .................. pursuclnt to application dated .................. ~.~..,ZY..../..2 .......... 19..~..2..~......, and approved bythe Building Inspeotor, Fee $.-,~)..~,..,,. ~ ....... Building Inspecf~/ Rev. 6/30/80 // TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitt~'~O*'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~disposat(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% 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 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 ..................................... New Construction ........... Old Or Pre-existing Buildin~ ........... Location of Property .... i.'..~. ~ .... ~..~.~..~.'~. ~' .~. [ .~....[~..~. [. ''' *'~-~J~'~P~ House No. Street Hamlet Onwer or Owners of Property. . . .. County Tax Map No i000, Section........... ~ ~ ...Block.... '~.. .... Lot ...... ~ ~. Subdivision .................................... Filed Map ............ Lot .................... . . Health Dept. Approval .......................... Underwriters pprova ...~: ..................... Planning Board Approval ...................... .. Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $. )UIlDATION ' (]st) UI~DATIOI! (2nd) UGH FRAME &. SULATIO}I PER'~. STATE ENERGY CODE FILIAL ADDITIONA'L COM~IENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING ~ .., ~I~AL INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [J FOUNDATION 2ND [ ~.] ~,,ATION []FRAMING [//]/FINAL FbRM NO. 1 TOwN OF SOUTHOLD j~ ~ 9 1~, BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ApprovedEXam'ned .,1 Disapproved a/c ' ICATION FOR BUILDING PERMIT gDARD OF HEALTH ......... 3 SETS OF PLANS SURVEY CIIECK ......... =~ ~o~. .. :--------~- INSTRUCTIONS 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 st?cots 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 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 Certificat~ 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, hous~ code, and regulations, and to admit authorized inspectors on premises and in building for necessary~ -- (Signature of applicant, or name, if a ~orporation) (Mailing address of applicant) State whether applicant is owner, lessee, agdhtl a~chltect; ~hgineer, generai contractor, electrician, plumber or builder. .' ..................... ............. ' ' ' APPR0~Dz, AS NOTED Name of owner of pre nises' ~ t ~ ~'~' ' ~' '~ '[ ¢ ~ ......... ~~'f': '~ 8:1~' '' ~' ~1'~'~'''~' ''~ ~ (as on the tax roll or latest ~t~t~JY fltflLOlNG OE"F~TM~N_ 765-1802 9 AM TO 4 PM FOR THE FOL. LOV~q NG INSPEC~'~ON$: '''~ .?':r~°:''' T%,'C; R[()tJIRED C<HV, fq k ~ : {:Of~ C O. ('ONSr:,~C?t()~ SHALL 'MEET ~FO[I{F~[~r,I~ENI'S OF THE N,Y, NOT RESPONSIBLE FOR If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ............... . .......... Electncmn s Lmense No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ............................ : ..... ....... ...... a. .......... . Itouse Number Street Hamlet County Tax Map No. 1000 Section ... :.~...~. ....... 1.. Block ..~. .......... : Lot.. ! Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) 2. Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: ' a. Existing use and occupancy . . .C"~.'.O'..~.~..~. ~..~.. ~--~"~%~~ .......................... :~{::'. ~,,,~ '? :,::c~:~, .............. b. Intended use and occupancy ..................... ' ................ . '3. Nature of work (check which ~tpp mable): New Building ......... Addition ...... Alteration .... ~ ..... Repair .............. Removal Demolition ............... Other Wot ? ' ..... ae © .............. ,~o+O ,~.,..~,.._ t ~scription) dC 4. Estimate ost ........... ~ ...... .. . . Fee ........... j. ......... (to be paid on filing this application) 5. elhng umts ..... 7 L~i~nsiness'c°ymercial°rmix~a°ccupaacy'spec~ynatnreandexteat°f'eacntype°fuse ", ............ · mensions ol existing structures, if any' Front ~ . ~ '~ .... He'gnt N ~be ofS~ i .............. R]a~ .... . ....... Depth ........... Dime io fshm e with It ati dditi F ............ ns nso estmctur a er onsora OhS: ront Re D pth ' ' Height .............. 8 Dime ........ ~' ' · ., -' ........ ,.. Number of Sto~es ........... :. ions of entire w constmcti n: Fr ' · ns ne o ont .............. Rear D pth ........ Hight Numb of Stories ' ' ............... e ....... e ............... er ............. :. ' ....... 9 Si f 1 Fro .......................... . zeo ot: nt ....... ~ ... ' Rear ' ............. 10 Dat of P chase . · ....................... Depth . e ur .......... , .......... . ......... Name of Foyer Owner 11. Zone or use d~strlct m winc em~ses are situated ....... . ............................. i61 g I ................. 12. Does proposed construction v ate any zonin aw, ordinance or regulation: ........ . 13. Willlot be regraded ', ..................... ....... . .................... Will excess fill be removed from premises: Yes ~ No 14. N~e of Owner of premises ........... , · ·. ~ .... Address ................... Phone No .......... '...;... Nme of Architect ........................... Address ................... Phone No .......... , .: .... Nme of Contractor ........ : .................. Address ............. . ...... Phone No ................ 15.' ~ this property within 300 feet of a t~dai wetland? *Yes ........ No ......... · If yes, Southoi, ~own Trustees Permit may be required. PLOT DIAG~ Locate clearly ~d distinctly gl' bulldogs, wheth&r existing or proposed, ~d. indicate ~1 set-back d~ansions from property Hnes. Give street ~d blocklnumber or descnphon according to deed, and show street nines and indicate whether ~te~or or corner lot. : . STATE OF N~O..~"~ / I/ S S COUNT, Y 9F &WT~ ~D 1 ~,..¢. ...... bf,cuc.t .. ......... (Name of individual signing contract) above named. . being duly sworn, deposes and says that he is the applicant He is the . .~ ..... (Contractor or'porate officer, etc.) ' ' of said owner or owners, and is duly[authorized to perI'B-'~-'-or have performed the said work and to make and file this application; that all statements contaihed in this'application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me thi~ I ........... xi°'tary Pu~'i~' ~' ' C~°unty ... . ........ I. _ ?o. 4879505 ~ ~ ~ ' ' (Signature of ~plicant). uual~ ed in Surfak Cou~ ~'