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Home My WebLink About22345-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OOUumANCY No Z--23250 Date SEPTEMBER 28, 1994 THIS CERTIFIES that the building. ADDITION Location of Property 55405 COUNTY ROAD ~48 House No. Street County Tax Map No. 1000 Section 44 Block 1 Subdivision Filed Map No. GREENPORT, NY Hamlet Lot 11 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 2, 1994 pursuant to which Building Permit No. 22345-Z dated SEPTEMBER 23, 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 FOR A DECK ADDITION TO A ONE FAMILY DWELLING "AS BUILT". The certificate is issued to HENRY PETERSON (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A Rev. 1/81 · uilding Inspector FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT · TOWN HALL $OUTHOLD, N.Y. N~ 22345 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: . .......................... : ...~..... ,..~..¢.~ ...... ~ ..................................... ..... ~~.~ ............ ~.¢ ....... .~./.~z../., .... ~......~...~-~. .............. ~ ............. ~.~ ........... /~..~.~.~z~ ............ ~..,.~ .................. ...~:~ ................. ~....~ ............ ~ ............. ~ ........... /~....,/,...~...,,,.~. Count/Tax Map No. 1000 Section .......~.., .~.,', .......... Block ........ .~../.. ........... Lot No ........ .././... .............. pursuant to application dated ......~..~/.~.?,,.....,.~... ....... ' .................. 19...., .~.~...., and approved bythe Building inspector. Fee $... Z..~..~.~ ........ Rev, 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN tULL 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 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 ~ 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. 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 l.~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. ~emp°rary Certificate of Occupancy - Residential ~.~0, ~ommercial ~15.00 Date ..... . ~z7~ .~7~ ;~ ~ ~ New Construction ........... Old Or~re-~ex%sting ~uildJ~ng..~ .... .~ ..... Location of Property.~....~.../~....~~,...~.%~.,..//.?.~.~ ................ House No.__ ~treet ~ Hamlet Onwer or Owners of Property...i~_~..~.~...~~ .................................... County Tax Map No 1000, Section~ ..... ~.~../..Block ..... Z ......... Lot ....... ~ ............ ......................... Filed Map ............ Lot ...................... ISubdivision ............ Permit No Date Of Permit Applicant Health Dept. Approval ...................... Underwriters Approval ............... Planning Board Approval ....................... Request for: Temporary Certificate ........... Final Certicate ...... Fee Submitted: $ ............................. .~. '~'. ~'~ ULATION PER'~. STATE ENERGY CODE FI;IAL ADDITIONA'L CO.~-I~iEIITS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [,,'~FINAL REMARKS Z ~0 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654803 Examined , , ~o~. ....... 19..~.5/ Approved ........... 1 .97~. Permit No. ?...~....~.'.~?:. Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH CALL ............ MAIL TO: . (Bui~l~ng Inspector) APPLICATION FOR BUILDING PERMIT t l Date .................. ,19... 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 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 CounW, 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 ail applicable laws, ordinances, building/code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec i ns. /5~ ....' ('Mailing address of applicgnt) (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... O, nccxd.... ...... / .......... ........................... maria #0t11 ....... ff (as on the tax roll or lates~dT 7~7 ~ NO~ 8UI~ING DEPARTMENT AT If applicant is a corporation, signature o~duly authorized officer. 765-1~ 9 ~ TO 4 PM FOR THE ~LL~NG INS~ONS: 1. FOUNDATI~ - ~0 REOUIRED ~ ~ED ~CRETE ~ R~H - ~MING & PLUMBING 4. FINAL - CONSTRUCTION MUST BE ~M~ ~R C.O. A~ CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. ~TATE CONS~UCTION · ENERGY CODES. NOT RESPONSIBLE FOR ~GN ~ ~RU~ON ERRO~ ]. ~ocatio~ o~]and on which p~o~oscd wo:~ wH] b~ do~c .................................................. ................ ...................................... House Number Street Hamlet County Tax Map No. I000 Section .... ---- ........ Block .................. Lot ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: a. Existing use and occupancy .... ' -' ..................... 4.<i/. ........ .... ~ ......... ~ ............. b. Intended use and occupancy ................................................... '. ................. 3. Nature of work (check which a~plicable): New Building .......... Addition .... ~.. Alteration .......... Repair .......... ..,. ·. RemOval .............. Demolition .............. Other Work .............. ~ ~]l~_)~-- ' ' (Description) 4. Estimated Cost c.~ , . (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ · If garage, number of cars .... I ................................................................... 6. If business, commercial or mixe~ 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 w!th alterations or additions: Front ....... ~ ......... 'Rear .................. Depth ................... I · · Height ...................... Number of Stories .............. ; ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ................ Number of Stories ............................................. -. .......... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... I0. Date of Purchase .......... , .................. Name of Fenner Owner ............................. 1 1. Zone or use district in which pn raises are situated ..................................................... 12. Does proposed construction vici ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... .j .... ~,.~,. ~ ............ Will excess fill be r~moxed from premises: Yes 14. Name of Owner of premises ~. /f~Fg~. ....... /?.."Y/~°A~... ~: .... on o. ~1t~...~..~. ~...~ Name of Architect t ............................... on o ..... 2 ....... ' ' Name of Contractor' i i i id i ~71 '.~.~ ...... Address ~ .... Phone No...~/.~.. ~27. ~..0..¢.?'.~ 15. Is this property within '~' 00 feet of a tidal wetland? *Ye~ ........ No...~. .... · If yes, Southold 'own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF Cou ¥.OF ..... ~.~'j.~,', *~[;;;:~,d.g ~ '. ~ ~.. deposes ~d says that he is the applicant .~ ~ ~ . ~ ~ ...... being duly sworn, . -~ ~ ,~(~.~e ~}~di%~ual~i~g contract) He is the .................. ~L ~.~ .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul3 authorized to perfom or have perfo~ed the said work and to m~e ~d file ~is application; that all statements conta ned ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ne~ set forth ~ the application filed therewith. Sworn to before me this ............ $ota~ Public, ~~ ~~ounty .... ........... ' .... Qualified in Buffolk iabor e, ~ ;~ ~/I (Signature of applic~t) Con~m[saion Expires Deco;