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Home My WebLink About21554-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22470 Date July 26~ 1993 THIS CERTIFIES that the buildin~ Location of Property 27835 ROUTE 25 House No. County Tax Map No. 1000 Section 18 Subdivision Filed Map No. ADDITION ORIENT~ N.Y. Street Hamlet Block 4 Lot 5 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 15~ 1993 pursuant to which Building Permit No. 21554-Z dated JULY 23~ 1993 was issued, and conforms to all of the requirements of th9 applicable provisions of the law. The occupancy for which this certificate is issued is DECK ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" & ALTER AN EXISTING GARAGE INTO A DEN & BATHROOM AS APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS 'CERTIFICATION DATED Rev. STANLEY DROSKOSKI PENDING - JULY 23~ 1993 - ~u~ldin~ Inspector FORM NO.3 BUILDING DEPARTMEN~ TOWN HALL SOUTHOLD, N.Y. N_o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21554 Z Permission Is hereby granted to: ......... ~~....~~..~.~.~.z: ............. ....... ~z~.~ ....... ~.:..~. .............................. ....... ........... ........... ..... ~........~ .............. ~c......,~.~.~.z.z-.z.~. .............. ~ ........ ~r.~ ........................ .... .z~..~..~..~ ........................................................................................................................................... at premises located at .......... ,..~.,. 2..~..~.,~ ....... ~....~....~ ............................................................... CounlyTaxMapNo. 1000 Section ...... Z..~.. ........... Block ....... ~. ...........LotNo ......,~ ............... p~rs~ont to a,~p,,oa,~on dated ................... ~./..~ ....................... 1~....~4 ..... and a~,~rov~ by ~e Building Inspector. Fee $.....,¢"~....~. ~ ..... Rev. 6/80/80 Form No. 6 TOWN OF SOUTHOIJ] BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 requirement~. B. 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 si~ned 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. Busin. esses $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 $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Bull.ding..~.., ...... . ...... · · House No. Street Hamlet Onwer or Owners of Property .............................................. County Tax Map No 1000, Section.../.~.. ....... Block ..... ~.[ ........ Lot ...................... Subdivision ................................ Filed Map ............ Lot ...................... Health Dept. Approval ..................... Underwriters Approval Planning Board. Approval ........... . .'. ........ . Request for: Temporary Certificate ........... Final Certicate .... ~... FeoSubm tted. $ .............. /7/ ' --/'/' ........ · " . ............... ¢o ~- ' o? ~ q"7o ' ~-~ O~ 0 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11071 TEL.: 765-1802 Examined ..... .~ .~.~..~. ..... 19~-~ ^pproved ...... .... , lg? ..Pe mit Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ROARD OF HEALTH ......... 3 SETS OF PL.'t~$ ......... SURVEY ................... ClIECK .................... CALL E~I~ IN~A~ON ~ C~RED IN ~ ~pu~ON ~O BE~. a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 s~ts 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 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 all applicable laws, ordinances, b,?}ding code, ho/aging code/and re.~ulations, and to admit authorized inspectors on premises and in building for necessary i~{s~l{ectiogi. /' ~ · / . ? ............. - . '~' (Signatu~Sf apl~ant, or name, if a corporation! '~ ~ '~ ~'- i~ 2- . I qo (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or late~K~lffil') BUILDING O~P~I~IENT AT If applicant is a corporation, signature of duly authorized officer. 765-1802 ~ AM 110 4 PM FOR FOLLOWING INSPECTIONS: (Name and title of corporate officer) Builder s Lzcense No ...... Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4 FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET 'THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR r)FStGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done .................................................. . . :. ...... . :z. .:. . .... : ....... :. ./:. . :. . ., ....... .x. ...... : ......... · Itouse Number Street Hamlet County Tax Map No. 1000 Section ./.~'..' ........... Block ....... ¢ ..... '... Lot..:' .~.. ............ Subdivision ........ . ............................ '. Filed Map No ............... Lot ............... (Name) 2: State existing use and occupancy of premises and intended use and occupancy ofl>roposed construction: a Exist ,.u, · · o eanaoccupancy ....... ~,~ ._:e'e~v''r ....... /..' .........~. ...... ~r'-:: ..... ~' ............... . b Intended use and occupancy ...... .x.~Jt/..~..z~...~... ......... ''''. f. :. .................. ........... · 3. Nature of work (check which applicable): New Building .... Addition ..... Alteration .. ~.. Repair ........ ./ .... Removal .............. Demolition .... : ......... Other Work ............... 4. Estimated Cost ....................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ...... Number ofdwelhng' umts' on each floor... .............. IF garage number of cars ' 6. If business, commercial or mix '.d occupancy, specify nature and extent of,each type of use ..................... 7. Dimensions of existing structu] es, if any: Front ............... Rear .............. Depth .............. Height Nu nber of Stories ' Dimensions of shme structure ~ithalterations oradditinns: Front Rear ........ Depth Height :. · · Number of Stories ' ........ 8 Dimensions of entire new cons ruction: Front . Rear Depth Height ............... Nm abet of Stories ........................ , .................... .;'. ........ 9 ';5~zc Rear ............................ Depth 10. Date of Purchase .......... . ......... Name of Former Owner ........... 11. Zone or use district in which pi ; n'i e's'a'r;'sltuated .... ' ........' ..... 12. Does proposed construction vi( late any zoning law, ordina ce or regulation: 13. Will 10t be regraded ....... ; ' .................... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises . ~ . Address Phone No Name of Architect ~ Address Phone No Name of Contractor Address Phone No ' 15.' I.s this property within 1300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southoid ~own Trustees Permit may be required. i · PLOT DIAGRAM Locate clearly and distinctly alii bmldmg% Whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block aumber or description according to deed, and show street names and indicate whether interior or corner lot. · ' ( STATE OF NE~ ,B~O.RKtB[x ] I / . I . coV rr-v v. SrS _ , ' ' : '.t ,(~d~e dfin~]d~al signi,'' '~;n' iiicij" ......... being duly sworn, deposes =d says that he is the applicant above namedi: ' Sworn to before me~-thi~ ,. ~ ~ n ' ' . / - . NO. 4879805 I'''w_/ ' / . { / ~ ' (Signature of applic~t) Commission E~ires December ~; 19~ . , . .