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Home My WebLink About21632-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22654 Date OCTOBER 13~ 1993 THIS CERTIFIES that the buildin~ REPAIRS Location of Property 9475 MAIN ROAD House No. Street County Tax Map No. 1000 Section 122 Block 6 Subdivision Filed Map No. MATTITUCK ~ N.Y. Lot Hamlet 14 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 19r 1993 pursuant to which Building Permit No. 21632-Z dated SEPTEMBER it 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 REPAIRS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to JUNIUS HUB~/iRD (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PENDING - SEPT. 29~ 1993 N/A Rev. 1/81 FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAJ,.L SOUTHOLD, N.Y. N£ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21632 Z D~te,,,~.'/. ,/ ................................................ 19.?..."-~, ..- Permission Is hereby granted t~ ...... ......... ...... County Tax Map No. 1000 Section ...... .~'...,~-..,~¢x': .... Block .............. ~'.. ....... LotNo ............. ../~.....~... ..... pursuant to appJloatJon dated .......... :'~.,~',,~/~ .............................. 19...~....--,~... ...... and approved by the Building Inspector. Fee $..~,.~.~,)~¢=. · · ·. Rev. 6/30/80 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. C. Fees i. 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 Construction ........... Old Or Pre-existing Bu~lding.~ ......... Location of Property .... ~.~..f.~.. ........ ~7~....~ ..... i..i''I ?~ House No. Street Hamlet Onwer or Owners of Property ......................................... County Tax Map No 1000, Section..ff~.~ ...Block .~. ....... Lot./...~. ....... Subdivision ................................... . Filed Map ............ Lot .................. .... Permit No.~/~.~?~. ~%..Date Of Permit ...... Applicant ......... Health Dept. Approval ...................... Underwriters Approval .... .. ........ Planning Board Approval ..................... Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $..~ .~i.~..~. ................... FOUNDATION (1st) FOUNDATIO~I 2. f 2nd ) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FI:~AL ADDITIONA'L COM~IENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined -~.~./... ........... 19..~.,~ ^pproved .... q./¢. ........ 19 . e it No. Disapproved a/c ' APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY ................... CHECK .................... SEPTIC FORH .............. HAIL TO' UNDER~ltlTER$ CLrRTiR~AIE Date ................... 19... REQUIRED INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~e.ts 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 sti'eets 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 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 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 owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. ........ · . ............ Name of owner of premises . ."~./dA~, kJ'. ..... ..~..~.~.'.~..F' .~/. ................................... ' ........... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ' Plumber's License No ......................... Electric ap's License No. ~'~. ............ ~ c Other Trade's L~cense No ...................... I. Location of land on which proposed work will be done. ~. ltouse Number Street Hamlet t ......... County Tax Map No. 1000 Section · . ./.C~. & ...... Block. ~..O.&. ' Lot ~/ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intende.d use and occupancy of proposed construction: Existing use and occupancy ....... ,~/0. ...................................... b. Intended · 3. ~of work (check which applicable): New Building .......... Addition ~ .............. Removal .............. Demolition Alteration .......... .... : ......... Other Work ............... ' *~./~J-O. 3 (Description) 4. Estimated Cost .................................. Fee ...................................... 5. -- (to be paid on filing this application) If dwelling, number of dwelling units .... ~ ........ Number of dwelling units on each floor.. ~. ........ · Ifgara. ge, number of.cars . .. ................................................... ~ ..... 6. If business, commercial or mixed occunancv .... :c_ , ~ , z .... - .... · r ~, ow,.uy nature ana extent of each type of use .... ..~./'.~. ........ 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth Height ............... ~umber of Stories ...................... ' ................. ' .............. Dimensions of shine structur, with alterations or additions: Front ' ' ' .............. DD~mP tehns, i;~;; ~ . . ................ Rear .......... 8. '~. ,-.- ............ .Height ........... · ......... .. Number of Stories ......... ' ........ nure new construction: Front .............. Rear ....... De th Height ............... Number of Stories ....... P ............... 9. Size of lot: Front ................... ~ ·. Rear 10. Date of Purchase ...................... Depth ...................... ............................. Name of Former Owner ............... Il. Zone or use district in which premises are situated ....................................... 12. D°es pr°p°sed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... : .................... Will excess fill be~removed 14. Name of Owner of premises ............... Address . . from premises: Yes No ............... Phone No ................ 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 ........ · If yes, Southold Town Trustees Permit may be required. ' ... PLOT DIAG RA/Vl 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 corner lot. STATE OF NEW YORK, COUNTy OF. ~ ...... S.S ..... ~,Rrlf~ ~Ttq ,.,~ .~ C-{- ~ ~'4~. ~. ~.~..~. ~ ......... being duly sworn, deposes and says thatahe is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized 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 work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ dayof ..... ' ..... ,19~.Y Notary Public ..................... / ^ c' N~W PuMtc. Stale of New York No. ~79351 ~alified in Suflol~ Coun~ ~mission Expires ~c. County · · .~W. ,~d~. .............. (Signature of applicant) ·