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Home My WebLink About21506-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22783 Date DECEMBER 14, 1993 THIS CERTIFIES that the building Location of Property 1705 HENRY'S LANE House No. County Tax Map No. 1000 Section 74 Subdivision ADDITION Street Block 1 Filed Map No. PECONIC~ NEW YORK Hamlet Lot 8 Lot No. conforms substantially to the Application for Build~ng Permit heretofore filed in this office dated JUNE 21¢ 1993 pursuant to which Building Permit No. 21506-Z dated JUNE 30, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLIN~ AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A GERARD M. & CATHY E. STANKEWICZ /~ild%ng Inspector Rev. 1/81 FODM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED] Date ............. .~...~... ................. 19..~....~... Permission Is hereby granted to: ........................................ ..~~./..~........~L...LI.~...~.~.......: ......... :.. . CounlyTax Map No. 1000 Section .~...~,.,,,~,. ........ Block. ........ :,[ .............. Lot NO ...... ~,,. ................ p.r,.anUo app,ca,on dated ...~ ........... ,~../ .......... ~ ~...¢...~...., a.d approved ~ythe Building Inspector. Fee s....7...~.,...~...~'.. Building Inspector Rev. 6~30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 . A~PLICATION 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: i. 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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $t5p00, Con~nercial $15.00 New Construction ........... Old Or Pre-existing Building..4'~.' .... House No. / Street Hamlet Onwer or Owners of Property .................... . ...... Subdivision .................................... Filed Hap ............ Lot .................... Permit No ......... Date Of Permit ......... Applicant ................ Health Dept. Approval .......................... Underwriters Approval ......................... ~Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... FIELD I:~SFECTION ~'Z~OATE Ij COMM£NT$ ,~-x.. % FOUNDATION ~- (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .FLUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-~.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION FRAMING REMARKS: [ ] ROUGH PLBG. 2ND [ ] INFLATION [/:~INAL DATE INSPECTOR TOWN OF SOUTHOLD BUH_DING DEPARTMENT TOWN HALL SOUTHOLD NY 11971 ................................ ; .... (Building Inspector) ~PPklCATIO~ FO~ BHILDI~G INSTRUCTIONS BOARD OF HEALTH ......... 21 SETS OF PLANS .......... SURVEY ................... ClIECK ..................... SEPTIC FORH .............. CALL ................... NAIL TO: Date .... i.~'/· 0. Ttfis 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 sti'eets or nreas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. e. 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 igsued 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 all applicable laws, ordinances, building code, ho, using code, and regulations, and to admit authorized inspectors on premises and in building for necessary'?2~4~.p~.t~ ~,)~pecti ns. ~,2 ' .... ~'Vw'~' 11/~ 'f '~'~J~--:t'~Z ' .............. a ........ - -' , . (Signature of applicatp/r or name, if a corpor tion) State whether applicant is owner, lessee, agent, architect, engineer, generai :contractor, electrician, plumber or builder. . ........................... (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 ....... ' ......... Humber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will ~)e done ..... /..~.~. ...... ~ Z~z.y. ~ ..... ~ ..... ltouse Number Hamlet County Tax Map No. 1000 Section ............... Block .............. :... Lot...' ............. Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) Statd existing use and occupancy of premise~s and intended use and occupancy of proposed construction: a Exist n,, use and occupanc b. Intended use and occupancy ...... .. I.~ 0~ .... ~.~../~:?~... .... · ' · 3. Nature of work (check which applicable) New Building .: ....... Additioff:.%/~t~C~.. .... Alteration ....... Repmr .............. Removal ......... Demolition k~tt~'~" ", '- .. 0~fier Work .......... ' ~ I .... (Description) 4. Estimated Cost l ~?,0., ' ' ....... , ......................... tee ...... t ,/.~ ...... ~ ................ . i -..-, (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............... Number Of dwelling units on each floor ................. If garage number of cars ~ ' 6. If business, commercial or mi.x~d occupancy, specify nature and extent oLeach type of use 7. Dimensions o! exmtmg structures, if any: Front ~ ' Rear Depth ; ....... Height Number of Stories Dimensions of shine structure with alterations or additions: Front ................. Rear .................. Depth i Height ' Number of Stories 8 Dimensions of entire new consiruction: Front ' ......... ' .............. ~ ........ · ' Rear Depth Height Number of. Stories 9 Size of lot: Front I ' Rear ' ~ '.. .......... ,' ................................. Depth .................... 10. Date of Purchase .......... i ....... ...........' . Name of Former Owner 11 Zone or use ....... · district in winch premises are situated 12. Does proposed construction violate any zoning law ordinar~ce or regulation: 13. Will lot be regraded . ...... ; ~ ....1~..'..~/~,,~) ......... Will excess fiJl be removed, from premises: . ,Yes, No 14. Name of Owner of premises .~{[~.. · Address . .~,~-~.~..~. /~r [,','.d,~ Phone No. f.f.~'-' Name of Architect ......... ] ......... .~'.. ' " ~ ................ ..... Address ................. Phone No ........... ~.: .... Name of Contractor ........ , ................. Address ................... Phone No ........... 15.' I,s this property within 300 feet of a tidal wetland? *Yes ........ No ......... '' ' "' · If yes, Southold Town Trustees Permit may be required. · PLOT DIAGRAM Locate clearly and distinctly al buildings, Whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc] number or description according to deed, and show street names and indicate whether interior or corner lot. - STATE OF NEW YORK, i.S COUNTY OF . .~ ....... ~/..~... (Name of individ~l signing contract) ... being duly sworn, depose~ and says that he is the applicant above named. He is the . .:.... .................. : ...... . ........................................ . I (Contractor, agent, cor'porate 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 contailned in this'application are irue to the best of his knowledge and belief and that the work will be performed in the manner !set forth in the application filed therewith. Sworn to before me this .......... ..... - .... ? Notary Public, ....~..:-~.~. Count~/~ ,~ ~,//~/ · ~' Notar JOYCE M. ~ILKINS ' ' ~'~/,/· ~.~ otar~ Public, St4~te of Now York · . ...................... NO 4952246 Suffolk Cou _ · Term Exp res June 12, 197~~-- ' f (Signature of applicant) ·