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Home My WebLink About21509-zFORM NO. 4 ToWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22449 Date JULY 8~ 1995 THIS CERTIFIES that the building. ADDITION Location of Property 805 PRIVATE ROAD #21 SOUTEOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 9 Lot 36 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 21, 1993 pursuant to which Building Permit No. 21509-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 DWELLING "AS BUILT" The certificate is issued to ARTHUR T. HUBBARD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /J Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22448 Date JULY 8, 1993 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 805 PRIVATE ROAD #21 SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 9 Lot 36 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JIFNE 21, 1993 pursuant to which Building Permit No. 21509-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 ACCESSORY STORAGE SHED "AS BUILT" ARTHUR T. HUBBARD The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N£ 21509 Z Permission Is hereby granted to; ~~.x~....../~ .......... - ~~ ,, CountyTox Map No. 1000 Section .~......"~..~... ....... Block ......... ~ ............ Lot No....~,...~.. ............ pursuant to application dated ..........~ ......... ..~..../ ........ 19.....~...~...., and approved bythe Building Inspector. Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 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/~0 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 i~spect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicaht. 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 ...... .~..~J~ f~ ...................... New Construction. O1~ Or Pre-existing Building ....... House No. Street Hamlet Onwer or Owners of Property... ~.~.~..~..~. [/.-~.~...~...~.~.~..~. ................................... . County Tax Map No i000, Section .... .~..~..~....Block .... ~. .......... LOt ..... ~.~ ............. Subdivision .................................... Filed Map ............ Lot ................. ... . . Permit No...~..I.~P9 .~.~.Date Of Perm~'t ............... ~.~ Applicant~...~f'~.../.~.~~.~ Health Dept. Approval .......................... Underwriters Approval ........................ . Planning Board Approval ........................ Request for: - Temporary Certificate ........... Final Certicate ......... .~.~ ~ Fee Submitted: $. , ~ .......... ~.~ u)[ TOWN of Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL' 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~his 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 $15.00 New Construction .......... · Old Or Pre-existing Building .............. . .. Location of Property ..................... .~../ .............................. House No. Street Hamlet County Tax Map No I000, Section .............. Block .............. Lot ................. Subdivision .................................... Filed Map ............ Lot ...................... Permit No .............. ~.Date Of ........... Health Dept. Approval .......................... Underwriters Approval .................... Planning Board Approval........... ............ . Request for: Fee Submitt;d: , ..... Co Temporary Certificate ........... Final Ce~ticate ....... .... ..... APPLICANT FOUNDA'TION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITION[L COMMENTS: [ I I I I I I I I OCCUPANCY OR USE I$ UNLAW~.UL WITHOUT CERTIFICATE OF OCCUPANCY 0 . / ~,,~.-. ~~ ~/ 1 76S-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ~ST [ ] ROUGH PLBG. REMARKS: FOUNDATION 2ND [ ] ~JLATION / FRAMING [ ~ FINAL TOWN Ol:: ,SOUTHOLD ~ ~ORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11973 TEL.: 765-1803 Examined ................ ,19 ... Approved~~' '~...d~. .... 19~. Permit No..~../...~-..~.q - Disapproved. a/c ' (Building Inspector) APPLICATION FOR BUILDING' PERMIT f./ ....... ~ 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 sti'eets 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 may not 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 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, housing ~ode, and regulations, and admit autff;rized inspect°rs °n premises and in building f°r neces.S~n~~if i corporation)ii fo. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem - . ..................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officerJ (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be'done .... . ............................................. ox ' 7,0 ''..C'o' -rre&o ' . ........ House Number Street Hamlet Cou'nty Tax Map No. 1000 Section ...O..~..~. ....... Block ....... ~ ..... t... Lot...~.g ............ Subdivision ' Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and oc,~ancy of proposed construction: · 3.Nature of work (ch~.ck which applicable): New Building .... Addition .......... Alter~iork~ -~i ~. .... Repair ........... Removal ............ Demolition ...: ...... OtheL2;~prk.,._.~.~..'~gJ.~ . 4. Estimated Cos, .... .-'~../.~.~..~:.~?~...~. ............... Fee..7..~,~.~...---~://.fi/~-/~.,~: .... .~'~* .... (to be paid on filing this application) 5. If dwelling, number of dwel}ing units ............... . Number of dwelling units on each floor ................ · If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy specify~nature~a~nd extent of.each type of use ............ ; ........ 7. Dimensionso~'~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 ............... Number of Stories ............ ;~ ........................................ 9. Size ofiot: i-~ont ..... /.,.77..~../ .......... Rear .... /.~...~.': ?.>. ........ Depth .../?.~?,..~('. ........... 10. Date of Purchase . ./?/.~..~ .................... Name of Former Owner . . .~..~;x..~. ~ ................... 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....,'~.?. ......................... 13. Will lot be regraded ....... :_...~ ............... Will exces~fill be removed from premises: Yes 14. Name of Owner of premises . ~ :/'"~...~..~...~ ....... Address .J/.~2. ~".~2 ~ O ?. (... Phone No. ,,7..~..~..~..,.~. ?. ~'... r' Name of Architect ........................... Address ......... ~..~:") ..... Phone No ................ Name of Contractor .......................... Address ................... PhoRe No ................ IS 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 all buildings, whether existing or proposed, and indicate all set-back dimensions from street names and indicate whether 15. property lines. Give s interior or corner lot. :reet and blo~c~,~number or description according ~o deed, and show STATE OF NEWYOPM~ o o ' COUNTY OF ... °'° .<.'-" '-- ................... ,,,, l can, (Name of individual signing contract) above named· He is the 0~ (Contractor, agent, cofporate officer, etc.) of said owner or owners, ~d is duly authorized to perfo~ or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ....... ~.( ~ ..... '...day of.)~ .... ' ...... 19 ~ ~ ~/,~,...i/~ ~ ~' / ~ ~ Nota~ Public, Slate of N~ ~ ' ~ -- / '~'' '~ ~ .... ~ .... - No ¢9513~ ' ~ ~ ~._ / (~,gnature o~applic~t)