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Home My WebLink About21627-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22603 Date SEPTEMBER 22, 1993 THIS CERTIFIES that the building. ACCESSORY Location of Property 480 PACIFIC ST. & 11605 MAIN RD. MATTITUCK, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 141 Block 4 Lot 42 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16, 1993 pursuant to which Building Permit No. 21627-Z dated AUGUST 30~ 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 ACCESSORY SHED AS APPLIED FOR STELLA S. RADFORD The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FORM NO.'~ TOWN OF $OUTHOLD BUILDING DEPARTMENt TOWN HALL $OUTHOLD, N.Y. 216 ? Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ........................................................... 19. . County Tax Map No. 1000 Section ......... .,~.....~./... .... Block .......... ~ .......... Lot No.....~........~tt~.. ............ dated ...,'~..' ./...,~,. ............ i ............................ 19..~..,- .~. ........ and approved bythe pursuant to application Building Inspector. Fee $.,,.-~.~..,.,,~.... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 i% 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-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. 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 - $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 Da me... fj.%~.V -~ ........................... · - New Constructioa,..f..~. ..... Old O,r Pre-existing Building ....... Location of Pro%r~?v .... .~.~..'~..".'~'eNO.. '~.. ,7'~ ~1~.~.'.~... ..... ,--., .' .... z~ Street Onwer County Tax Map No 1000, Section .... /..¥.[ ..... Block ............. Lot.. t .............. Subdivision ....................... Filed Map ............ Lot ............... ~ .... ~. Permit No.~.J~.~..~..i~i~ ~i ~e~ii.~..~.~?~.~...Applicant..~~...~.~..~...~ Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ...................... .. Request for: Temporary Certificate ........... Final Certicate ........... APPLIC 'OUNDATIO:! ~OUGH FRAME & -PLUMBinG (2nd) ~I~SULATION PER N. Y. STATE ENERGY CODE FI;IAL ADDITIONA'L COMMENTS: AUG I 6 1993 SOi.i'fi ~OLrl FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197~1 TEL,: 765-1803 Exal 19.~. Approved · ~/.~ ....... 1 Disapproved a/c ..................................... -,- · (B.ufldin~mOector) ' APPLICATION FOR BUILD[NG'PERMIT .. INSTRUCTIONS a. This application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 2 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 street, or areas, and giving a detailed description of layout of property muir 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 I?y 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 inspectom on premises and..in building, for necessary inc~0~tions. ~p ,Ii . y ~ · --' .' . ~--~ u~t. t,~( '~pp leant, o~name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generai 'contractor, electrician, plumber or builder. N-~me of owner of premises ...................... /~ (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 ' ' Plu bet s Ltcense No ....... . ........ . ......... : Electrician's License No ....................... Other Trade's License No.. .................... Location of land on w rich proposed work will be done : Itouse Number Street Hamlet 'ap No.' /. yZ. . County Tax 1000 Section .... ' ........... Block ........... ;... Lot ................... Subdivision ........ . ............... . ....... j ...... Filed Map No ............... Lot ............... (N:une) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..1~...'~'...~¢,¢¢~... ........................... ' b. lnt=nded use and occupancy ] ........ '~ ~r ......... , ........ ~..' ..... '] '.';(' ·' '] ":' ..................... -i Nature of work (check whiclh applicable): New Buildin~ . . .1~..???~.. Addition .......... Alteration ....... Repair .............. Removal ............. Demolition .... : .......... Other Work .......... ff ' 4 E ti dC ' · s mate o " ....... i .............. ' ,. . escr o , · .......... ~ · Fee ..... 5 If d Iii mb f dwe :t (to be paid on filing this application) · we ng, nu er o ~g units ... Numb ·lfg b of ~ ............ er of dwelling units on each floor ..... arage, nuln er cars ..... .. ' ......... · uess, commerca or m~lxe oc pancy specify nature and 7 Di i ofexi ti gst ct '~' exte of.ca ........ uTes, if any: Fr nt R l~th ...... · ]Imens°ns s n ru o ............ . ear ............... e ... ' eight ............... Nmnber of Stories ..... ~ . D .......... Di io fshm tm e. ith It ' · ati dditi ....F' ........................................ mens nso es ctur w a er onsora ons: ront Depth ' R · ' Hight .................. ear ......... · ' i ' N b f St des ' ' ...... 8 Dime ................... e ........ ~ ......... ,.. um Pro o .......... ~. .structi F · · ' R ........ · H nsions of entire new coll on: ront ............. ear ............... e eight ............... Number of Stories ....... ..... D pth ............. Si oil t: b · ze o ront ...... i'" ......... ; R .. ' ........... ' ........................ .'~ ...... Dat of Purct ' ... ear ......... Depth ............... ' . ... Name of Former Owner .......... Zone or use district in wliich Premises are situated .................... Does proposed Construction olate any zonin aw, ordina ce or regulation . .. Will lot be regraded i. · ........................ ~.. .... fp .... i ..................... Will excess fill be removed from premises: Yes "- N ~ame ol Uwner o remises .l .......... , ........ Address ..; ...... , .......... Phone N Name o rchitect .... i ' . o.....fA .......... .... ; ................... Address .... . .' Phone No ..... Name of Contractor .... ~ ' " .............. · .......... hifi ' · · '~ ................... Address ................... Phone No .......... 15.' I.s this property wit 300 feet of a tidal wetland? *Yes ........ No ......... ' ..... · If yes, Southol~ Town Trustees Permit may be required. .. PLOT DIAGRAM Locate clearly and distinctly all buildings, Wheth&r existing or proposed, and. indicate all set-back dimensions Iron property lines. Give street and blo6k number or description according to deed, and show street names and indicate whethe interior or corner lot. 10. 11. .12· 13. 14. occuPa C r _ OF OCCUPANCY STATE OF NEW YOR~ covey oF .... (Name of individual si~ng contract) ....... above named. AP, PI~OI{EO AS ~OTED .. NOTU:Y BUILOI~G DEPAR~ AT · 765-1802 9 AM ~ 4 PM FOR THE FOt.41)WiNG ~NSPECTION~: 1. FOUNDATION ~0 REQUIRED FOR PQURED CONCRETE .2..ROUGH - FRAMING & PLUM~ING 3. ~NSULATION 4. FINAL. CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL. CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.~ STA~ CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS being duly sworn, depose~ and says tliat he is the applicant ~de is the ........... .. (b~ ...~.. ,..' .... , . . ontractor, agent, cor'porate officer, etc.) ' ' 3f said owner or owners, and is duly authorized to perform or }lave performed tlie said work and to make and file tliis lpplication: that all statements contained bi this application are true to the best of his knowledge and belief; and that the .york w~l be perfomed in the mannerlsct forth in tlie application filed therewith.' ~wom to before me this ] 4ora. Public, .~d~~-- ' ~ ~ - 8~ 4Z~_~ '. ' ~ ' (Signature of applicmt) ,/