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Home My WebLink About21990-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22936 Date APRIL 11, 1994 THIS CERTIFIES that the building ALTERATION Location of Property 4395 SOu'r~ HA~BORRD? SOuT~OLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 87 Block i Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 4, 1994 ~ursuant to which Building Permit No. 21990--Z dated APRIL 4, 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 DOUBLE SIDED DOP/4ER WITH BATHROOM "AS BUILT" The certificate is issued to NORMAN F. McCOOK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A Building ~nspect ~ FOGM NO.3 TOWN OF BOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ........ .......................... 21990 Z Permission Is hereby granted to: ...... ~_~......../,.......~..~.....E..~.~.~: .......... .... ~ ....... .~..~..,...~..~7~.....~.:... ...~~..~../.~..,, ......... /.~.....Y..,. ...................... ~;~...-.....~.~..:~./.~ ........ ~./..~..~.¥ ........... ~..~..~,¢.~ ....... ~...~ ............................ .................. .'.f~s ............ ~£? ./..,. ~ ~...~..~..,~..:.: .............................................................. .......................... ~..~ ~.~.../..~...../. ....... ~-...~.,. ................................. CounlyTaxMapNo. 1000 Sectlon,,,,,..~..,..-?... ......... Block ....... ../. ................ LotNo .....~ ................... Building Inspector. Fee $.,,,./,,,"~,, ............... Rev. 6/30/80 and approved by the 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 all 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 that the solder used in system contains less than 2/10 of i% 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 Ppre-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 Buildinz - $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-exis~ing Buildinz.~ ............. Location of Property....~. ~.~..~..~....~P.~....~-~. J~.~ .~....~..~ ~...~ .~..? ~..~ ........... House No. S~reet Hamlet Onwer or Owners of Property ................................................. .... . ........ . .. . County Tax Map No 1000, Section..~.7~.~.~....Block...~.~ ...... Lot..~..~..Q ....... Subdivision .............................. ..... . Filed Map ........... . Lot ................. .... . Permit No ............... Date Of Permit ................ Applica Health Dept. Approval ........................ · . Underwriters Approval ....................... . . Planning Board Approval ...................... Request for: Temporary Certificate ........... Final Certic~te..~.~....~ Fee Submitted: $ ............................ i~~ BUILDING DEPI'. INSPECTION OU~;DATION (lst) OUNDATION (2nd) ~0UGH FRAME & .PLUMBING ]~;SULAT!0N PER N. STATE E~IERGY CODE Fi;;AL ADDITIONA'L COMMENTS: ... TOWN HALL .., ~ ,'~ ,TO~LD. . SoUTHOLD, N.Y. 71971 · ,, TEL,: 765-1803 Disapproved a/c APP~ATION FOR BUiLDING'PERMIT B~ARD OF HEALTH 3 SETS OF PLANS SURVEY ......... . ......... ~tIF-CK .... · ..... ~. s,.,~.. SEPTIC FORtl ....... · ~. ~ ~. CALL ~.*s .............. HAlL TO~' '~ ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink an'd submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to s~hedule. '~ b. Plot plan 'showing location of lot and of buildings on premises, relationship to adjoining premises 'or public sti'eets -or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ' . ' ' ¢. ' The work covered by this application may m~t be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will i~sued 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 Occupan'cy shall have been granted I~y the Building Inspectorl - ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building PermR pursuant to the Building Zone Ordinance of the Town of South0~d, Suffolk County, New York, an~t other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or fol' remopal or,<t.~rn~olition,,as'herein described. The applicant agrees to comply with all applicable laws, ordinances, bulic[ nj~ code~ hpT~ing/~o~lations, and to admit authorized inspectors on premises and in building for necess&ry i~ :jto~ { I Jt~ { · ~/1]~ ~ \ · . / (Sigl~t ~~, or namekffa[corporation) ~ (Mailing address of applicaitt~ State. whether applicant is owner, lessee, 'agent, architect, engineer, generaJ.'contractor, electrician, plumber or builder. · . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authoriied officer. (Name and title of corporate officer) Plumber's License No .............. '... 2 Electrician's License No ................. Other Trade's License No ........ , .... Location of land on which proposed work will be ]:tone. ltouse Nmnber ': '. ' Street, ' Cotinty Tax Map No. 1000 Section .:. ;q :., Block :.~.l~.t,°,..~ .... :... Lot..~ ...... ,.,.,., SubdNision ' Filed Map No Lot (Name) State' existing use and occupancy of premises and intended use and o~cnpancy of proposed constructioni a. Existing use and occupancy..0..Vb.%.qT, .?~..t, .~'~. ~,,'. ~ .................................. .. b. Intended use and occupancy 0~: ! '3. Nature of work (cheek which, applicable): New Building .: .... Additionb.. ~ .... Mteration Repmr .. ............. Removal ........... :.. Demolition ...; ~, 9lt~er Work. ' " escription) 4. Estimated Cost ~ ~.~... , ' gtl' ppll ' ) 5. Ifdwelling, numberordwelfingunits............... Number of dwelling units on each floor ............... If garage, number of ears I ' 6. If business, com~nercial or mixed occupancy, specify nature and extent oLeach type of use ........ 7. Dimensions of existing structures if any: Front Rear .............................. Depth .............. Height ~umber of Stories ' ' ' . Dimensions of shine structure with alterations or additions: Front .. ............... Rear ................. pth ight ' De .... ~ ............. i.....He ... ......... ' ...... .. ,..NumberofStories ........... ' ......... 8. Dimensions of entire new co~stmction: Front .............. ~ Rear ............... Depth .............. Height .............. . ~umber of Stories ...... , .~ .~ .... ._. ........ 9. Size of lot Front ~ ~ ~. ~ ~ .... ' ........... ~ ........ · · ..,., ~ ........... ;.. ~ear ........ :~.O... ~,h Il'Lie l$l~ I.~5 ..... ~;',' ~;'~' ~:'_:t: '"~"..'.~.' 10. Date of Purchase ........ Name*Ch .... ' ' ' ~ 11. ~one or use district in which premises are'situated..~ ~ ....... : ' '. .... 13.1 :. WillD°eSlotPr°p°sed construction ~iolate any zoning law. ordina6ce or regulation: .... ~Q .................... be regraded .... r'a' 'r~. 'v.' · · Will ex~ess fill be removed from premises' 14. Nmne clOwner oforemises ...... ~ ~-~¢~a~a.~.~ ..... ' Yes N~e of Architect. ........ '. ..................Address ................... Phone No ......... ' ....... N~e of Contractor ....... ~.. ..... ............' Address -. ... ...... · '......PhoneNo ............ ~.. 15.' I9 th~s property wLthth 300 feet of a e~dal wetland? *Yes ........ No.~ ...... · If' yes. SouthaL~ ~own ~rustees Permit may be requ~red. ' ' PLOT DIAG~ Locate clearly and distinctly ~1 build~gs. Whether existing or proposed. ~d, indicate ~1 set-back dimensions fro, prope~y ~nes. Give street ~d bloCk number or description accord~g to deed. and show street n~es and indicate whethe: Mtefior or corner lot. i STATE OF NEW¥OTM ~' I ' cou ¥ .-; s.s . .......... ..... ',' ......... ~ mum s:g~ing contract) above ~amed. : being duly sworn, depose? and says that he is the applicant work will be performed in the mannir set forth in the application filed therewith. Sworn to before me this ....... . ................ day ..... ...... co,,,, LL /, ,f 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 application; that all statements contained ha this application are true to the best of his kn.owledge and belief; and that the