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Home My WebLink About21228-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22209 Date MARCH 2~ 1993 THIS CERTIFIES that the building Location of Property 55 ROGERS RD. House No. County Tax Map No. 1000 Section 66 Subdivision ADDITION SOUTHOLD~ N.Y. Street Hamlet Block 2 Lot 20 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 19, 1993 pursuant to which Building Permit No. 21228-Z dated FEBRUARY 19, 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 PORCH ADDITION TO EXISTING ONE FAMILY DWEIJJNGAS APPLIED FOR The certificate is issued to TERESITA TAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A / ~uild-fn~ i~spector Rev. 1/81 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, buildimg 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 - $i00.00 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 $i5.00, Commercial $15.00 .............. New Construction ......... Old Or Pre-existing Building .......... Location of Property.[i..~.~.....:...~.~..~.~..~.~..~ .... i..ii[.'.~.'~(~t..~..~J.~ ......... House No. Street Hamlet Onwer or Owners of Property .... , ...................................... .. . . County Tax Map No 1000, Section....~.~ ...... Block .... .~?.~ ...... Lot .... ~). ............ Subdivision .................................... Filed Map ............ Lot ...................... Permit No. ~..(..~.'.~..~..~...Date Of Permit.. ~ .... Applicant./.~-.~.~v.~.,.~.~.. ~.~? ......... Health Dept Approval . Underwriters Approval ................... Planning Board Approval ........................ Request for: Temporary Certificate ..... Final C 'icate . OUNDA~ION (1st) OUNDAT!OU (2nd) OUGH FRAHE & .?LUMBING NSULATION PER N. Y. STATE ENERGY CODE FiX;AL ADDIT/OHAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF H£ALTH ..... SURVEY .............. .-¢. CIIECK · -D ............. SEPTIC FORH .............. CALL ' · ........ HAIL TO: a. TMs appLicatlon-mus( be completely filled in by typewriter or ih ink and submiited 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, relatioh"ship to adjoining premises or public streets or areas, and giving a detailed description df 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. c. No building shall be occupied or used in whole or in part for any purpose whatever until a Ceriificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance f a Bulldmg Permxt pursuant to the 3uilding 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. rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for riecessary ini~l~ections, f, ,, -, ,, /2 / x' · ( ': applicant, or name, if a corporation) ' (Maihng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. X/ame of owner of premises .~r.~-~'5.~ .~.~,,-. F/Y.I~B$. .............................................. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly autt?rized officer. (Name and title of corporate officer) B~llder's License No... [~ .o..'9. 1.../."~..~ ........ ~ PI tuber s Lmense No ......................... ; Electri?ian's License No "-- Other Trade's License No ...................... Location of land on which proposed work will be don~ .... .ow...:: .................. ..... House Num bet ' Hamlet County Tax Map No. I000 Section ...... ~:~ .(4:?. .......Block' O~ 'Lot .... ~...C>. .... Subdivision Mhp No ' ..................................... Filed ............... Lot ........ (Name) · · Slate existing use and occupancy of premises and intended use and occtipancy of proposed cohstruction: E,,'sth, guseandoecupanc,, .... .... 3. Natu[e of work (check which ipplicable): New Building .......... Addit on Repair .............. Removal .............. Demolition ....... ' ......... Alteration ......... ..... Other 4. Estimated Cost ?t,.,~..l~.O..i~ ~ ~ 5. (Description) .......................... Fee.../.,.~. I (to be paid on filing this application) 5. If dwelling, number of dwellin~g units ............... Number of dwelling units on each floor... · If garage, number of cars 6 If business commerc~ ~ ...... ' ......... . .............. . · , _..... ,a, m -.x? occupancy ....................................... 7 Dime~o: .... ,' , specify nature and extent of each t e of us ,a,,.,,a m uxlsang structures if any Front yp e Height Number of S~ories .......... ' ..... ~.ear .. . Depth wnens,ons of same structure w~th~.alterations or additions: Front Depth ................... !... Height ....... ' ................ Rear ............. Dim i of ti · ............ Number of Stories ...... ens OhS en re new construction: Front .... , · .... ~e'ght N mba of St ri ........... Rear ............... Depth f,ot:.F za',,..4, Re r ...... · .......... ....... ' ....... IZe 0 font ..... . ....... a · · Zoneor dii tinwhi h~p ~ i ~t ~11'''l~ame°tvOrmerOwner .~l. lq~l.~ use strc c r msesarasitue ' " · .... Does proposed construction violate any zoning law, ordinance or re"ulahon ............. Will lot be regraded ....... i .... · ~' ' ' ' ....... Name of Owner of premises .7~.~-~;~'~' ';~--~,], ...... ....W. dl ex,ess fill be re~moved~ from premises: ' Name of Contractor l~U~:Daq.(-r~,s~... · ..... Address ........ Phone Name of Architect ..., ...... i ........... ,, i ....... No..' .............. ..... · ...... ~Aaates.s ~4/~.4OrO .~..[ .~. ,.... Phone No. 7~,257. ,..5-~ ~?.O... Is this property within 300 feet of a czaai wet±and? *Yes' . · If yes, $outhold Town Trustees Permit may be requirg~.' .... ~o .......... .... PLOT DIAGRAM o tidings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether 9. 10. 11. 12. 13. 14. 15. Locate clearly and distinctly all property Hnes. Give street and block interior or comer lot2 ;FATE OF NEW YORK, :OUNTy OF ................. ....................................... being duly sworn, deposes and (Name of individual signing]contract) ' ' ' says that he is the applicant bore named ' i th . . ontractor, agent, corporate officer, etc.) · said OWner or owners, and is duly a~thorized to perform or have performed the said work and to make and file this 'plicafion; that all statements contalne¢ in this application are true to the best of his knowledge and belief; and that the ark will be performed in the manner set forth in the application filed therewith.' mm to before me this ' .............. ..... · No '~ ...... ~-~ ~ ~ ' . ............ Te~¢~~ (S:gnature of applicant) N AREA -' 12,124 9q. ft. ~0o ~q' SURVEY OF LOT1 BLOCK § "MAP OF BEIXEDON ESTATES" FI~EO MAR.. ~ t~4~ MAt=NO 1479 A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 - 66 - 02 - 20 Sca/e: FC--30' May 28,1992 Iy.$. LIC. NO, 49f~18 MAIN ROA[T'" SOUFItOLD~ N.Y. 11971 Prepared In occordance wilh the mia~mum ~.f#n.E, ard~ for lille surveys os established Oy me L.I.A.£.$. end ~l~proved and adopled for such use bi, The New York S/ale Land Tllle