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Home My WebLink About21250-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22194 Date MARCH 17~ 1993 THIS CERTIFIES that the building. Location of Property 390 House No. County Tax Map No. 1000 Section subdivision ALTERATION HENRY'S LANE, PECONIC, NY Street Hamlet 74 Block ~ Lot 34 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 25~ 1993 pursuant to which Building Permit No. 21250-Z dated MARCH 2~ 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 ALTERATIONS TO CONVERT EXISTING ATTACHED GARAGE TO HABITABLE SPACE "AS BUILT". The certificate is issued to of the aforesaid building. JOHN SKABRY & WIFE (owner$)~-~~) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. 2372 MARCH 5~ 1993 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev, 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) o, 21250Z Permission is hereby granted to: at premises located at .,.,~,,,,.~,..~,....::,,'~,, ,~~......~ .......................................................... County Tox Mop No. 1000 Section ...~......~.... ......... Block ...... .~.... .......... Lot No..~....~.... ........ pursuant to application dated ..... ...~.~..;~... I9..~.....-~. and approved by the Building Inspector. Rev. 6/30/80 FEB 2 61993 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, 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, Commercial $15.00 New Construchion ........... Old Or Pre-existing Building ............... Locat'on o P p rty ' House No. Street Hamlet Onwer or Owners of Property .... .~.~.~.~.~ ..... ¥.'.~..~.4...~. .................................... County Tax M~p No 1000, Section... Subdivision.. . . ... .i .... Filed ..... Lot ................... . . No..'.~. ........... Date Of Permit. ~-~/~/~-'~ .... Health Dept. Approval .......................... Underwriters Appro~al~..~...=~. ~.'.~.....~.~...z~ P~anning Board Approval Request for: Temporary Certificate ..... Fee Submitted: {OUNDATION __., (_1st) 4', [OUNDATIO~ (2nd) IOUGH FRAME-& .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMME 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~'NAL DATE ~///~'~/~-~ t_o+ 55 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... ' SEPTIC FORM .............. .......... Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT CALL ............. .... Date ~ ~ ~..~. 19 q5 INSTRUCTIONS a. This 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 streets or .areas, and gi,~ing 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 atppficable Laws, Ordinances or Regulations, for the construction of bui/dings, additions or alterations, or for removal or clkngolition, as herein described. The applicant agrees to comply with an applical21e laws, ordinances, build/hag~ode, hff~?i~ ~ode, and regulations, and to admit authorized inspectors on premises and in building for necessary insp~///L ... :?... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ................................................................................ Name of owner of premises..."---?...~.. .... .~..,~...~..~..../.~. .......................... : .................... , · (~s on the tax roll or latest deed) If applicaht is a corporation, signature of duly auth~orized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License.No ...................... · _z¢~ /J~,~ ~,' Location of land on which proposed work will be done ..... .......... :'7.7. ........ ................ ........ : ............ ......................... House Number Street Hamlet . County Tax Map No. 1000 Section ~7/ Block ~' Lot Subdivision ./~. ~... ~P~....~.~/4.(0x'.....~q...~J] ..... Filed Map No .... ¢(.ff./ ....... Lot....~.~. ......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................. b. Intended use and occupancy . . : ~" property lines. Give street and block interior or corner lot. 3. Naiure of work (check which ' ' ' apphcable): New Building .......... Addition . Alteration .......... Repair .......... .~j/. RemOval ... ........... Demolition ...... . ........ Other Work ............... Estimated Cost ....... ~'s ..... i ..... "~' ............ '~ ~' o~ (Description) 4. ~/,Ztg~ , · ........ Fee ......................... (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits / ... Number of dwelling units on each floor / ........ i., · If garage, number of cars ..... i../ .......... ' ........ '. ' ..... 6. If business, co,mmercial or mixed occupancy, specify nat,u,,re and extent of each type of use ................... 7. Dimensions. ct exJ&ting/structure~, if any'. Front .................. / (4.. . Rear . /~. . Depth .. . ~.~ ........ ' Hmght ....... ~.. ...... Number of Stories . /. .......................................... ' Dimensions of same structure with alterations or additions: Front ... -/~. ...... Rear ./~.. Depth ......... ~ ....... ~.. Height ..... .~. .............. ~'u~ber of Stories ....... /.i.. i. 8. Dimensions ofentir~ new construction: Front ..... /~. ....... Rear.../~. ......... Depth .. ~..~. ......... Height ....... ~ ...... Number of Stories .... ' .../. . . . ' ' 9. Size of lot' Front Z~/'..2 L Rear "~' '/)',~ ' "~' ..... ')~f~b ............... · , ..... :~' '/'i)'-~.' ......................... ~epm ...6...c,, ............... 10. Date of Purchase .... ~.~..V'.: i..'7..7..~.... .........Name of Former Owner . . .~.~./'.S../.~.t~.6....d>. (,,q/~...~... 11. Zone or use district in which pre~nises are situated ...................................................... 12. Does proposed construction vi~o]at~ any zoning law, ordinance or regulation: .... .~.~ ...................... 13. Will lot be regraded .... '...gl},fi ................... Will excess fill be removed from premises: Yes 14. ma~ne of Owner of premises . ~. 0.hbtJ.. ~J.~.~.~/~. Add~ess ...~.~..O-~..h). t¢ ...... Phone No..~..~..~. ~.7. f~... Name of Architect .......... i ................ Address ................... Phone No ................ Name of COntractor ......... i .............. Address ................... Phone No ................ 15. Is this proper~y within 300 feet of a tidal wetland? *Yes ........ No..~ .... · If yes, Southold T6wn Trustees Permit may be required. PLOT DIAGRAM Locate cleai'ly and distinctly all buildings, whether existing or proposed, and~ indicate all ~et-back dimensions from, ~mber or description according to deed, and show street names and indicate wh~thel STATE OF NEW YORK, C'OUNTY OF ......... S.~ .......... ,.. ./. ............ (Name of individual signin~ ~ontract) above named. AP,,PRO~D AS NOTED · FEE./~,t~ BY'~ ' '-- N~I~ ~I[~NG D~PAR~E~ 765-1802 9 AM TO 4 PM~R THE FOLLOWING INSPECTIONS: 1. FOUNDATJOi~ '[~IO REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4, FINAL CONSTRUCTION MtJST 8E COMPLETE FOR C.O. ALL CONSTRUOTION 8HALL M~ET THE 8EOUI~EMENT8 OF THE STATE CONSTRUCTION & ENERGY OODES. N~ ~ESPONSIBLE DESIGN OR CONST~U~ION ESRO~8 · being duly sworn, deposes and says that he is the applicant ,'. (Contractor , ageJt ................ , corporate officer , e't; .') ............................ of said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. 3worn to before me this ~ ......... ~>~ .~a ,-2Y~w. ...... day of..~.~...Jz~4...ce4.. ..... ,19 ¢3~.. // Notary Publ~, ~ate ~.{ NOW Yolk / (Signature of applicant) No. 4822563 Suffolk Count~ (~ Term Exp res December 31, 19L! ~7