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HomeMy WebLinkAbout21475-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22383 Date JUNE 10~ 1993 THIS CERTIFIES that the building Location of Property 795 LOVE LANE House No. County Tax Map No. 1000 Section i41 subdivision ACCESSORY Street Block 3 Filed Map No. MATTITUCK ~ N.Y. Hamlet Lot 27 Lot No. conforms substantially to the Application for Building Permit heretofore filed i~ this office dated JUNE 9, 1993 pursuant to which Building Permit No. 21475-Z dated JUNE 9~ 1993 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 ACCESSORY STORAGE ~D AS APpLYRD FOR. The certificate is issued to MARG~RR~ A. ASHTON (owner) of the.aforesaid building. SUFFOLK,COUNTY DEPARTMENT OF HEALTH APPROVAL N/A uNDERWRItErS CERTIFICATE NO. N/A PLUMBERS C~%RTIFICATION DATED N/A /~ildfng Inspector Rev..I/81 FORM NO.3 .TOWN OF $OUTHOLD BUILDING DEPARTMENi' TOWN HAU. SOUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .................... ........................................ 21475 Z ~? Permission Is hereby granted to: ..~...!~.~.~.~ ........ /..:.,,~'..~,~ ................... ..~~ ..... ~..... Z/Z~~,~ ................ /.-.~. ........ ~...:~~ ......... ~..., ........ ~.,..~....~. / at premises located al ....... ~ ........................................................................................ .................................................... /~~ ......... ____~ ........... ~ ....................... CounN Tax Map No. 1000 Section..Z~Z ............ BIock,,..~D~ ............ Lot No. ,~ ................. pursuant to application dated ........... ~./.,.f.. ................................. 1 9 ............... Building Inspector, Fee $,,~,,~.,,,,'~,,, ..... and approved by the 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 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 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 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 Building ................. Location of Property .... .T.~.9.e-~ ............................................. . House No. Street Hamlet Onwer or Owners of Property ....... County Tax Map No 1000. Section. ..............'~; ............................. &2ocJ.......... Subdivision .................................. .. Filed Map ............ Lot ................ .... . . Permit No ................ Date Of Permit ............. . . . Applicant...~.~.~..~. .. ~...~...w~.~. .~.~.Q'. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~... .... Fee Submitted: $ ........................ c[ I 'O ..... . ..................... c o t 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION ZND [ ] IN/SULATION [~FINAL [ ] FRAMING REMARKS: /'~/4 ~ ~ DATE J Exa,nined ..... .(,/¢ ........ ^pproved ....... b//¢ ..... Permit Disapproved a/c ................................ ; .... FORM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 _ (B, fiiffiing Inspector) APPLICATION FOR BUILDING'PERMIT BOARD OF HEALTH '1 gETS OF SURVEY CUECK t, Ot~FY · CALL HAIL TO; ALI. CONSTRUCTION SHALL MEET 1. Locationofland on which proposed Work will be done ................... ltouse Number Street D~R CONSTRUCTION ERRORS cotmty Tax Map No. I000 Section '1? I Block Subdivision ........ . ............................. Filed Map No ......... Lot (Name) ..................... 2; State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ' .-~d- ~L-' .~ ~ :~"~.', 4* ........................ b. Intended use and occupancy ......... .' 4¢~S~0[ .... B alder s L~cense No ........... PIumber's License No. USE IS UNLAWFUL Electric,an', ,censeNo ...... UT..GE '{TIFICATE ot,,e,T,ade's ,ce,se .... 0F..0CCU ANCY APPROVED AS NOTED NOra, SU, O,aG OEPAm EaT AT 765-1802 g AM- TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION -. TWO REQUIR. ED FOR POURED~CONCRETE ' ' 2, ROUGH - FRA~{NG'& PLUMBING 3, iNSULATION --., ~ 4~ FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. If applicant is a corporation, signature of duly authorized officer.' INSTRU6+IONS a. Tits application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 2 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 sti'eet.' or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli- cation. ,.,~ c. The work covered by this application mfiy 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. I 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 demolit/on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing, code, and regulations and to admit authorized inspectors on premises and in building for necessary ina~gqti~ns, a ,~ . f/. ' (Mailing address of applicant) State whether applicant is owner, lessee/agent, architect, engineer, generai contractor, electrician, plumber or builder. (as on the tax roll or ]atest deed) -3. Nature of work (check which appl Rep~r ........ Re~---, -'-' ........... ~ .... ~ 5 .... Addition .......... ~terationt. -., .... ;. ...... . ~'~, .............. ~emoht~on.. .............. Other Work 4. Estimated COSt. ~ ~. . (Description) 5 If dwelling number of dwellin (to be paid on filing this application) ' , '~ units ' " Number of'dwelling units on each floor If garage number of cars ~ .............. ' ................ 7' usm ss, commercm or m~.xed occupancy spec nature and ex ent of.each type of usg ............. 'exi ........ · nenstons el sting stmctu[es, if any: Front .......... 2 ·: ·. Rear .............. De ........ Height ............... Number of Stories .......'.... ........ . pth ....... D'me ' f ' tm ~ith alt ti additio s: Front D~ nsmnso same s cture era OhS or n . i ..... Rea epth .... i ............... '... HeiSt ....... ~ ~. ~ ....... r ................. 8 Dimensio of nti construction ...' ........ b f St ~e ' · " · ns e renew :Front ~ .: Height ' , .......... ..... Rear Depth ' N robe f St ~ ........................ 9 Siz cfi F nt ' .................................... I0: ~ ct: re ......... ri ............. ar ................. Depth .......... . Date of Purchase .......... I ....... . N off .................. 11 Zone di ict i whi I ~ ' · ........... amc omer Owner .................. · ar use str n c i premises are situated ......... ' ' ': ....... 12 D po d cti vi~l y chi gl di a~ce~ ........ ; .............................. . . ocs pro se constru on atean z n aw, or n rregulation: ........... 13 Will 16t be ded · ' .................... 14' regra ........ I .................... Will excess fill be removed from premises: y . Nme of Owner of premises ., I .. es No N eofA hit ~ ....... ~ · .. tess .... Phc No ..... Add m rc ect .... i .". · ..Add ..... ' .......... ne ............ ;... Nm 0fC0ntracto .................. tess ..... Phone No 15 thl cy ~th5a ~300 g f t5d t Ph e No ' .... .................. Address ............ : ...... on ................ d . Is s proper ~ eat o a a wetlan * ~Yes ........ No ......... Zf th ld iT ~t ' d ~ yes, Sou o o~n Trustees Perm may be ~equSre .. .... ~ PLOT DIAG~ Locate clearly ~d distinctly ~ bullrings, Wheih~r existing or proposed, ~d. indicate ~1 set-back d~ensions frc~ prope~y~ ~nes. Give street ~d block[number or description accord~g to deed, and show street n~es and Jnd/caIe whet[~r Nte~or or corner lot. ~ ~ .. STATE OF NEW YORK. coum-¥ oF... ..... S!.s ..... i--'~'TO'h .0 .....~. . . 5.'317C0 ~.-~. . .~..t"... ' being duly sworn, deposes and ays that he is the applicant (Name of individual signir; contract) . above named. te is the ' (~a~e~t', ' eorioorate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contai~ ed in this'application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner ~et forth in the application filed therewith. worn to before me this I ....... .q ........ · · ' ' .... · till' , NOTARY PUBLI~, _.Stable:of N.Y. . ~ 7. · Net 4725089, $ilffi~k'Ce~mllp ...... 77""" .... · .................... Te..Expifl MSa].n_ ,5 , . ' c, Signatnre of applicant).