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Home My WebLink About21812-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Offioe of the Building Inspector Town Hall Southold, N.Y. ~RTIFICATE OF OOuumANC"f No Z-22925 Date MARCH 30, 1994 THIS CERTIFIES that the buildin~ ADDITION Location of Propert~ 1320 HILL CREST DRIV~ ORIENT, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 13 Block 2 Lot 8.25 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 18, 1993 pursuant to which Building Permit No. 21812-Z dated DECEMBER 4, 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 DE~K ADDITION TO EXISTINO ONE FAMILY DWELLING "AS BUILT" The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED GARY E. & DORIS BLAIR N/A N/A N/A Rev. 1/81 /J Building Inspector FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. No 21812 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) oo, ...................... ........................ Permission Is hereby granted to: ~....~.~...~:,.~..,.~......~/..~....~......x..~ ~;~o~, ...2... ~:..®x.....'2..~ ....................................................... / ...~ ......... ~ ............. '.-.:~......z .............................. to ...... ~~.~..-.. ........... ~.. ............ ~.<, .......... ~.~ ....... ~....~ ................. .... /d~;..~ .................. ~.~ ........... ~~. .......... ~ .................................................. at premises Iooated at ............................. ../....~. ~ ......... . ./, .'~.../,../.L.......~ ."~../...'~. ........ ~.,..~...' ................. ..................................................... ~....~.-.. ........ ~./., .......................................................... CountF Tax Map No. 1000 Section ...... ./.., ............... Block .......................... LotNo ............................. pursuant to application dated ................ L~,,.-- ........................... 19.,..i?~., ..... and approved bythe / Building Inspector. Fee $..,.. ,~..~..'...,~., ..... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ~LL 765-1802 /U ~PLICATION FOR CERTIFICATE OF 0CC This application must be filled in by typewriter OR ink and submitted to the~uilding 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. Comereial 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 Vpre-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. 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, ~om~ercial $15.00 / Date ........... ~(/'.~ 1.~ ~. .................... New Construction ........... 01d Or Pre-existing Building ................. Location of yrope y ...................................................................... House No. Street Hamlet'f' or Owners Proper ty.. 9~V..s~.: ........... ~ ........ ~..~.. ~ ................. 0nwer co , y No 000, ..... ..... ' Subdivision . Filed Map Lot Permit ~o ................ Date Of Permit ................ Applicant ilealth Dept. Approval ........................ Underwriters Approval ............... Planning Board Approval equest for: Temporary Certificate ........... Final Ce~te ........... ~'ee Submitted: $ . . . .~..~.~..--~.. ................. , i.. ..... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH CALL ............. HAIL,TO: Approved ........... Permit No ......... · (Bu~Id~g Inspector) APPLICATION FOR BUILDING'PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter orin 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 muJt be drawn on the diagram which is part of this appli- cation. c. Thc 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 p6rpose 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 Bui,lding Zone Ordinance of the Town of Southbld, Suffolk County, New York, aj~l other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for r.g/fioval or d.~5~ition, as herein described. Th~ applicant agrees to comply with all applicable laws, ordinances, building.d,6de, t~ov, taCng.z.~gde, and re.~gulations, and to admit aut~°rized inspect°rs °n premises and in building f°r neces:~7, i~' ~~ ......... -- ' (~natub~ ~ if a co/rporat~.n~)_/7 . ' ' // (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 latest deed) If applicant is a corporation, signature of duly authoriied officer. (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 .................................................. CouhtyraxMapNo. 1000 Section .[3' Block ~ ...... i. Lot ~'~ Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) , State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~/~) ~ D ~OC~ '/~.c ~'f,i 5T~ b. Intended use and occupancy ..............' .......................................... april ) Additi ' ' ( whi · 3. Nature of work check ch cable: New Building .......... on .......... Alteration .... ; .... Repair .............. Removal Demolition .............. · ·..: ......... Other Work ............... , . (Descript'ion) 4. Estimated Cost ....... ' ~ :~ ..? .............................. Fee .3 : (to be paid on filing this application) 5. If dwelling, number of dwellink units ............... . Number of dwelling units on each floor · If garage, number of cars .... i .................... ' ............... 6. If business, co,rnmercial or mi.x~d occupancy, specify nature and extent of.each type of use 7 Dimensions oi existing structures if any: Front ~ Rear ............... ~ ..... Height Numl~er of Stories .... : ....................... Depth ............. Dimensions of same structure ~ith alterations or additions: Front ' Rear · . ..... [. · · Height ........ : ......... ... Number of Stories .......... 8. Di~o~im. ll~l[t~'~v const!ruction: Front ... ' ......... H *-'-'~' '" ~-..-...~,~'."~ mb ...... i .... : Rear ............... Depth ..... . eight ...... Nu er of Stones ....... ' ........ 9. Size of lot' Front ..'~. - ,, .......... ' ' . ........ ...... , ......... l~ear .................... Depth ............ 10. Date of Purchase ......... .......... ~ ......... ' ......... Name of Former Owner ........... I 1. Zone or use district in which pr~mises are situated ......... : ....... .12. D°es pr°p°sed construction violate any zoning law, ordinance or regulation: ................................ 13. Will 16t be regraded ....... ;; ................... Will excess fill be removed from premises: Yes No 14 fp ' · Name of Owner o remises .. ~ ........ , ........ Address ................... Phone No ............ :... Nme of Architect ..... ~ ..... " Address ..... Phone No ................. Name of Contractor ...... ~ .......... Address .... Phone No ................ 15.' I.s this property within ')00 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southoid Town Trustees Permit may be required. " PLOT DIAGRAM Locate clearly and distinctly all! buildings, Whether existing or proposed, and, indicate all set-back dinlension~ from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y2OtiGC COUNTY OF .~ .~.. ~( .~,. .... ......... ...... (Name of individual signing contract) above named. .... being duly sworn, deposes and says that he is the applicant He is the (Contractor agent corporate officer etc ) ' of said owner or owners, and is duly authorized to perform or have performed tlie said work and to make and file this application; that all statements contalnbd in this'application are t'rue to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. Sworn to before me this ............. Notary Public, ~~f~ ...... County C, fbto~ 765-~802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST []ROUGH PLBG. []FOUNDATION 2ND []INSULATION []FRAMING []FINAL REMARKS: DATE INSPECTOR HILL CREST DRIVE