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Home My WebLink About21633-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22567 Date SEPTEMBER 2~ 1993 THIS CERTIFIES that the building. Location of Property 8620 MAIN ROAD House No. County Tax Map No. 1000 Section 31 Subdivision ADDITION EAST MARION~ N.Y. Street Hamlet Block 7 Let 5 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 24r 1993 pursuant to which Building Permit No. 21633-Z dated SEPTEMBER 1, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" The certificate is issued to ROBERT HAASE (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED _ Rev. 1/81 FORM NO.$ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N-o 21633 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN11L FULL COMPLE11ON OF THE WORK AUTHORIZED) CountfTaxMapUo. 1000 Section ...... .~....~, ............ Block ........ ~'~...-~.. ........ LotNo .......~...,'~,,,,'~, ........... pursuant to application dated .......................................................... 19 ................ and approved by the Building Inspector. ...... Rev. 6/30/80 Fo cm No. 6 TOWN oF SO T.OL BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 emgineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirement.~. 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, 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 - $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.OO Date ...... .~/.~/~. ~ .................... ... . . . . New Construction .......... Old Or Pre-existing Building .... · Location of Property ................................................ House No. Street 'Hamlet Onwer or Owners of Property .... J.~. ~.~.~-.I.~.~.~.~. ....................................... County Tax Map No 1000, Section ..... ~ .~ ...... Block ..... .~ ...... Lot . , ~'~ .. Subdivision .................................... Filed Map .......... Lot ....... .... Permit No.' ~ ..Date Of Permit ........ Applicant... ~.f~. .......... Health Dept. Approval .............. ................. .. . Underwriters Approval ................. Planning Board. Approval ........ . .... ~. ....... .. Request for: Temporary Certificate ........... Final Cerricate...~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 , (B uild/Jx4 *dTtfi sP ect or) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 BETS OF PLANS .......... gURVEY ~ .................. CIIECK .................... SEPTIC FORH .............. MAIL TO: Date ................... 19... INSTRUCTIONS a. Ttds application must be completely filled in by Wpewfiter 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 giving a detailed description of layout of property must be'drawn on the diagram which is part of this appli- cation. c. The work coverdd 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 Builrding 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 applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~('O.b .~C.~-....-3. :.. ~7'~Pt FA .5.~ .......... DA~.Y//19~,... ~ ~.~ (as on the tax roll or latest dee~.)~FO ~ FEE. /¢ ~ ~ ~ If applicant is a corporation, signature of duly authorized officer. N~ BUI~ING DEPAR~E~ AT 785-1802 9 AM ~ 4 PM FOR ~E .................................... : ......... FO~O~NG INSPE~IONS: (Name and title of co,orate officer) L FOUNDATION ~0 REQUIRED FOR POURED CONCfl~E Builder's License No .......................... 2. ROUGH - F~MING & PLUMBING 3. INSU~ON Plumber's License No ......................... 4. FINAL CONS~U~ON MUST BE COMP~E FOR C.O. Electrician's License No ....................... ALL ~N~RU~ON 8HA~ ME~ THE REQUIRffiE~ OF ~g N.Y. STA~ CONSffiU~ON & ,~ERGY Other Trade's License No ...................... CODES. N~ '~ R~IB~ FOR work will be' done. DESIGN OR ~N~U~ON ~EO88 1. Location of land on which proposed .......................... : ...................... .......... .. .g.Q ..................... .................... .. House Number Street Hamlet 000 S .on ..... ......... ...7 ............. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /v ~ b. Intended use and occupancy t~.t 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair . . Removal .............. Demolition ........... Other Work PSt~ (Description) 4. Estimated Cost O(2~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ · If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...... Height ...... z e · Number of Stories · 8. Dxmensmns of entire new constmctmn: Front .... f~...~.... Rear . .Z~....~. ...... Depth . .4'~.. .......... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...~..b.e.C.~..[v~t¢~.~.... Address .~.~..Z..~...'~.."~. ~..-~.'r.':~Vfione No. JT./.'q..q.;?.~..-?.7.~?. Name of Architect ........................... Address ................... Phone No ............... Name of Contractor .......................... Address .................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.....z~.... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW¥ORK, , ~, o S CO U NTY O F,~,. ~t.w' o. .......... ,[~.(} .~.O.~'.'~...q.r..~ ~. ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe ~ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this application; that all statements contained h this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ........ .~ ~ ~ ...... day of.GS~~ ....... 197$ ~o. 49513~ (Signatu~ of applic~t ) ~mmission ~s Mag ~, 19~