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Home My WebLink About21295-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22283 Date APRIL 28, 1993 THIS CERTIFIES that the building Location of Property 54280 MAIN ROAD House No. Street County Tax Map No. 1000 Section 61 Block 4 Subdivision Filed Map No. ADDITION SOUTHOLD, N.Y. Hamlet Lot 22 Lot No. conforms substantially to the AppLication for BuiLding Permit heretofore filed in this office dated MARCH 29, 1993 pursuant to which Building Permit No. 21295-Z dated APRIL ir 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 FIRE-RESISTANT PARTITION ADDITION IN AN EXISTING STRUCTURE AS APPLIED FOR. The certificate is issued to of the aforesaid building. PUDGE CORP (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ~i~ding Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N~N.° 21295 Z Dote Permission is hereby granted to: ..... ~L..~.u,...~.I .................................. ~ ~ .......... ,~ ~. ,,~ ~..~ .......... ,o .~_~__~....-.~_~....£~....~.....~ ....... at premises loc' a~ted at .~../~.'...~....~...O........~.~?,~,~J .... ~ ................. County Tax Map No. 1000 Section ...... .,~,.,~.! ........ Block 0 c~ Lot No. ~- ~ pursuant to application dated ....... .~.t.(;~....~.......~....~ .............. , 19,~..'~, and approved by the Building Inspector. Fee Building Insl~ctor Rev. 6/30/80 Form No. 6 TOWN OF SOU~HOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in~ by gypewriter 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 f~rm). 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. B. For existing buildings (prior to April 9, 1957) non-~onforming 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. t 2. A properly completed application and a consent to ~inspect signed by the applicant. · If a Certificate of Occupancy is denied, the B~il~ing 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, Swinm~ing 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 .... ~.~..~. ! ! .... ~.~ ...... ~..~.~ ~ ......... New Construction .... ~ .... Old Or Pre-existing Building ............... Location of Property~.~.~.~.~.o~.'~'~ .~..~{.~..~ .~.?..~..~ House No. Street Hamlet )nwer or Owners of Property.....~..o.,~.~g .... ~.: ............... ]ounty Tax Map No 1000, Section .......... Block .......... Lot %-- ;ubdivision ........................... Filed Map ....... Lot .................... rmlt No...--~.7 .~ .Date Of Permit ~..~Z/ ~ .f?.~.~..Applicant..~.~..~..~ ............... [ealth Dept. Approval ....... ~ ...~ .......... Underwriters Appr~~~[ ....... lanning Board Approval -~-- equest for: ee Submitted: $...~-~..,. Temporary Certificate ........... Final Certicate.. . APPLICANT ' FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD . BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 · ...k~,,.,~. I., Examined APPr°~ed -' '~... ] ..... 19'~a Permit No ~..( .~.9.~ ..-~. Disapproved a/c . . .: ................................. _. (Building Inspector) APPLICATION FOR BUILDIb, IG PERMIT , BOA'RD Of' HEALTH ......... 3 SETS Of' PLANS ......... SURVEY .................. CIIECK ................... SEPTIC FOR,H ............. CALL .................. HAIL TO: Date..~..?. ,~. .......... 19 .~Y. INSTRUCTIONS , a. This application must be completely filled in by typewriter or in ink and submitted to the Bhilding Inspector, with 3 s~ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets pr 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 Lnspection throughout the w6rk. 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. - (Signature of ~plicant, or name, if a corporation) (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 latest deed) If applic~r~// ' ' 'T/~is a c?rporation, signature of duly autl?rized officer. ~" Name and(Ta.7 a title of(~7orporate officer) '' C~Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be' done....Z~, t~2..~...~'~,~.~.. ~¢.~ ¢~ ................... ................... ........... House 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 intendcd use and occupancy of proposed construction: d .-,- a. Existing use and occupancy ... ' ' ' T:.. b. ]n~ended use and occupancy ..~...C~F. " ? .................. .:: ...... 3. Nature of work !check which applicable): New Buildin ...' ........ >~ddition .......... Alteration ..... '...'., Repair ............. Re~noval .............. Demolition .... '.'...; ..... Other Work ............. 4. Estimated Cost . ...,...,...,...,...~... .... i ' ' ./.~.~.. (Description) , · ........ Fee 5 Ifd elli n[ (to be paid on filing this application) · w ng, number of dwelli g units ....... Nun4b Ifg numb of cars " old Iii its achfl arage, er I ...... ' er we ngun on, e oor .......... 6 Ifb i '''[~ ................................. ............ il i ........ ncy cify nd f t typ of us ............... 7' us ness, commerc a orm xe occupa , spe nature a extent o eac~ e e ........ Dim nsionsofe i ti ' if F '.. · e x s ngstructu}-es, any: ront ..... ' ........ · .... Hight N ' be fSt ' · . · ....... Rear ...', .......... Depth e ....... 0 ....... um r o orles .... . . ' .............. Dimensio of :ira with It ti ddit ..... ' ........................................ ns s estructure a era onsora . OhS: Front ' D pth ' Hight Rear ......... 8 ' ' f . , . · ........... Number of Stories . ·. · Dlmenmons o entire new cons ruction: Front ......... ', Rear . Height ............... Nu~nber of Stories ...................... v ................. · Size of lot. Front i · . r, ..................................... ........ ............ ,-,ear.. . .. 10. Date of Purchase i : ................ Depth ........... fF ........... I 1 di .......... ~ ................... Name o ormer Owner ............ hpr ' · · · Zone or use strict in whic emises are s,tuated ............... ' ............... 12 r~,, o, ............. 6l .................................. i3' tmn vi ate any zonin aw, ordinance or regulation: ............... · Will lot be regraded ...... .] ............... 14 Nam f O fp ..................... Will fill N ~ · excess be removed from premises: Yes o · N e o wnero remises ..~ .................. Address ...... . Phone No .......... · ame of Architect ......... [ ............. . ..... fC i ................. Address ................... Phone No ............ ; . · ~ .. Add ' · Name o ontractor ........................ tess .................... Phone No... ............ :. ty 1.5. Is th±s proper within 000 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Town Trustees Permit may be required. ... I PLOT DIAGRAM Locat.e. clea~.y and distinctly allI buildings, whether existing or proposed, and, indicate all set-bac ' · .pr~op.erty lines, tJl.ve street and block aumber or description according to deed and sh ..... + ....... k, .dtr~..en~mns, from ' I FOLI.OW~NG ]TATE OF NEW,--Y-ORKJx ~) /t ~ i ' FOF~ Pf)UHED CONCF~EY~ 2, ROUG[~ - F[~AIV][MG 8: P~IJM~ING , . ' .(Nameofindividualsignin ;contract) ' oove namea. t'~' fl ~ '' Tt~E ~'~EOUtRF'~tI~)NYS OF THE N.V. [e~sthe,,, ................ ~,(~ .... ; ................ Z[Y~"[:,~.;ONST[?HCI'ION & ENERGY (Contractor a ent cot )orate off' "~Cg~ ~' ~J't' ' ~f~ ',ONSIBtE · ~:0 ~ ...... f said owner or owners, ~d is duly utho-,z-,~ +~ ~ t , .... · u l,enorm or nave perrormeO the smd work and to m~e and file this pplication; that all statements contained ~ this application are true ork will be perfo~ed in ~ to the best of his knowledge and belief; and the manner set forth in the application filed therewith, that the worn to before me this , . ·, County '. - Qualified In Suffdk Coun~ ~ ~ ' ' ~mmisslon Expires Oe~m~r 8~ ~g~/ ~ . V (Signature of applicant)