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Home My WebLink About22069-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23075 Date JUNE 30, 1994 THIS CERTIFIES that the buildin~ Location of Propert~ 1350 ROBINSON LANE House No. County Tax Map NO. 1000 Section 98 Subdivision ADDITION PECONIC, NY Block 4 Filed Map No. Lot No. Street Hamlet Lot 28.1 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 27, 1994 pursuant to which Building Permit No. 22069-Z dated MAY 19, 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 A DECK ADDITION TO A ONE FAMILY DWELLING "AS BUILT" AS APPLIED FOR. The certificate is issued to DONALD & J~DITH DEMAREST of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 (owner's) N/A s/~ N/A ilding I ~pect or/ FORM NO.3 BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N-° 22069 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON '[HE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ....................~ .'.//..,~..~ ................................ , 19....?,.~.. Permission Is hereby granted to: .....:: ................. .P......o..:..~.:../.~.~ ............ ....!.. .......... ........ ~..--z~...~ ....... ~.¢......: ...... ../.../.¢..z/.. ........... t,:,..~,.-~,~,, ........... ~x.~,:.~ ......... .~.~.,r..~.o.~ ........... z~......./.........~ ..... ...... ~:~ ........... x~~. ...... r....~z ....... ~.d~!:....~: ...... ~~ .... Co,,n~'rax~op~o. ~000 Seo,on......~. ........... ~1oo~ ....... ~.~.,. ........ ,ot No. .. ,?~. .Z ............. pursuant to application dal'ed ........... ,~..../,~,,,,Z ......................... 1 9.,,.?...~..,, and approved bythe Building Inspector. ~ee ~...Z~. ....... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 BLDG. APPLICATION FOR CERTIFICATE OF OCCUPANCY,,~OWNO~-s~UT'~OLD 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 1% lead. 5. Commercial building, industrial building, multiple residenqes 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 dwel~ling $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 4/7/94 Date ................................. .. .... .. New Construction... X Old Or Pre i ting Building Location of Property ~q Robinson Lane, Peconic NY House No. Street Hamlet Judith Demarest Onwer or Owners of Property ........... ...........D°nald ~nd... ...................................... . . County Tax Map No 1000, Section...~ ......... Block ..... ~ ........ Lot ..... %~..L ....... Map of Peconic BaM Oaks ~4 Lot Subdivision .................................... Filed Map ............................. Permit No ................ Date Of Permit ................ Applicant .................. ... ...... .. Health Dept. Approval ....................... · · . Underwriters Approval ................... ... . .. Planning Board Approval ................... .. .. . Request for: Temporary Certificate ........... Final Certicate..~ ........ Fee Submitted: $ 25.. 00 Rudolph H. Bruer, as attorney for Henry Smith APPLICANT Vd dlOIN' ,Og*~91 ROBINSON LANE 3N~'1 NO3Nl~3ObJ .m Z 765-1802: BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION :)ND [ ]INSULATION [ ] FRAMING [~INAL REMARKS: ~~ / FOUNDATIO~ FOU~¢DA TIO~! (2nd) 2°' C0~4£~T2 ROUGH FRAME & · PLUMBING INSULATION PER N. STATE ENERGy CODE 4. Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH .~.-..... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................. ,. SEPTIC FORH .......... ''.. CALL ................... MAIL TO: Date .ALZ ............. 19.%& INSTRUCTIONS ~ a. This applicatkm must be completely filled in by Wpewriter 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 mid 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 ali applicable laws, ordinances, building code, housing code, and regghtions, and to admi.t authorized inspectors on premises and in building for necess~~ ~ ~*~'~..~~...~..~ --- ' ~~li~a~, or name, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . .D.°.n.a.!d..a.n.d~ .J.u.d.i.t.h..D.e.m.~.r.?~s.t ..... (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 ..................... . ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ....... .1.3.5.0..R.o.b.i.n.sg.n..L.a.n.e ......................... 1350 Robinson Lane Peconic NY House Number Street Hamlet County Tax Map No. I000 Section .... .9.8 ............ Block .... .b ............. Lot....2.8: 1. ............ Subdivision ... ~.a.p. .o.f. .P.e .e .o .n.~.c . .B .a .y . .O .a .k ? . ' .......... Filed Map No..3.~.3.~ .......... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing one family dwelling with a. Existing use and occupancy ....D.e.c.k. ~.1 .................... :re:,;~:- .............. Existing dne family dwelling with ~m¥~;~,-'~c::.~ v,~a~ b. Intended use and occupancy .. p.e.c.k. ~.1 ..... ~.' ,. ~,~ ~, o~ ............ .'~ ~>:'Z~, ~,~ 4 ~,~¢~ ~i~i~) ........... 3. Nature of we ( heck winch applicable): New Building .......... Addition .... '"- -.' Repair ............ Removal .............. Demolition ........... ' : (Descrip%ion) 4. Estimated Cost . .~12.9.. ...99. i Fe ~J'~ :i .~g]~. i (to be paid on filing this application) 5 If dwelling number of dwellingiunits Number ................. · ' ............... of dwelling units on each flo~J~,o,.J? ~ If garage number of cars ' ' '~'~' ~'~" ....... 6 If business co.mmercial or mixe~ occupancy specify nature and extent of each type of use 7' Dimension's 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 ' 8. Dimensions of entire new construction: Front ........... Rear Depth Height Numb r of Stories 9. Size oflot: Front ...1.47...45 ]............. Rear.. .... 139. ....50 ........... ........... Depth .2.1.q..~.... .............. .1...5.1..~,c.r.e.s. 10. Date of Purchase .4/7/94 , Name of Former Owner St~la Sm. ith 11. Zone or use district in which pr6mises are situated .................................................... 12. Does proposed construction viol'ate any zoning law, ordinance'or regulation: 13. Will lot beregraded ..N. 9 ..... l...................Willexcessfillberemovedfrompremises: Yes No 14. Name of Owner of premises ...i ................. Address ................... Phone No ................ Name of Architect ' Address Phone No Name of Contractor ' Address Phone No 15. Is this property within ~00 feet of a tidal wetland? *Yes ........ No...P~ .... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail i buddings, wh~ther 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. See attached survey See attached plans STATE OF NEW YORK, COUNTY OF. ~IJFFgI~. .. S.S ......... R..ud. olph. .....H.: ....Brue. r.. · · · · · · · · · ·... · · · · · · · ·...I being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .................................qgq~.t/at tqr. ne7 . ................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulylauthorized to perform 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 andbehef;' and that the work will be performed in the manner ~et forth in the application filed therewith. Sworn to before me this ' Notary Public .............. County ,' /} , ~ sun~com~ ~'~ ~ (Signature of applicant)