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Home My WebLink About21656-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22627 Date SEPTEMBER 29, 1993 THIS CERTIFIES that the building ADDITION Location of Property 425 LONG CREEK DRIVE House No. Street County Tax Map No. 1000 Section 55 Block 3 Subdivision Filed Map No. SOUTHOLD~ N.Y. Hamlet Lot 24 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 31~ 1993 pursuant to which Building Permit No. 21656-Z dated SEPTEMBER 11~ 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 (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A PETER R. & LAUREEN S. DOBSON Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPAI~TMEi~ TOWN HALL SOUTHOLD, N.Y. N~ 21656 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .~...~/..~.... ~/..~..~,... ~ ................. .. ~..~... ~.~.... ,~/~,.... ~,.,. ................... . ......... ......................................................... ~~.~.....~.,. .................................................................. CounlyJax Map No. 1000 Section,,,,, ,~-.~ ...... Block ....... ~ ............. LotNo ....... ,,,~.,~, ......... pursuant to application dated .,,.~.../.~ ......................................... 19..... ,~.,.~...., Building Inspector. Fee $... Z .~¢..'..~-,/~,,.. and approved by the Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL APPLICATION FOR CERTIFICATE O~ OCCUPANCY lOV~ This application must be filled in by typew~ter OR ink and submitted to the building inspector with the following: for new building o~e~use: 1. Final survey of propertf with accu~te locati~of ail buildings, property lines, 2. Final Approval from Health Dept/ of water s~pply 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. Co~ercial 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 buildingp 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 Location of Property .... O../~.C~. l~/i .q~tP~ 2./ House No. Street County Tax Map No 1000, Section.O~.~.,.q.~ .... Block. OB,..O..O. ..... Lot..O. ...... O. ....... Health Dept. Approval ..................... . ....Underwriters Approval ..................... . . . . Planning Board Approval ....................... . Request for: Temporary Certificate ........... Final Certicate.. ~. .. .............. ¢ 7 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ F~INAL [ ] FRAMING REMARKS: INSPECTOR '~Y i ELD i~S!~ECTION FOUI~DATION (1st) FOUNDATION 2. ROUGH FRAME & (2nd) PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIOMA'L COM~fENTS: FORM NO. 1 .................. ,~ TOWN OF SOUTHOLD IF~"~"~:?~;L'~' ~'';, BUILDING DEPARTMENT [~ I'~\,! '~.:~!.? ?' TOWN HALL ~I i.J~ , SOUTHOLD, N.Y. 11971 ~ :,~'~ .i~; 3 I ~%~ TEL.: 765-1~02 Disapproved a/c ..................................... ector) APPLICATION FOR BUILDING PER~IT B~ARD OF REALTH ......... 3 SETS OF PLANS ......... SURVEY CIIECK ......... . SEpTic For ,, ."'"'"' CALL ......... · .... MAIL TO: Date ................... 19... 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 giving a detailed description of layout of property mu~t 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 Bui/ding 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 p~t 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 South61d, ·Suffolk County, New York, and other applicable I,aws, 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, b,.u.it~g code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary,ifiSlX~ns, r~ . -- ' (J' (Signatur~ of applicant or name, if a corporation) '-/~. X ~ .~. c.. ~4.~F,, ~r ./~/Z-....~o..~7~..c. ~ .... (Mailing address of applicant) Stat~ whether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. Name of owner of premises . .~..~./?.~..~... ~ .~.Of'~.,~.~ ..f~'...../~t~. J~... 4~.~..t//~../¢.t4../~...~.,,..~..O...r~'.q .,~<..... (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 ..... ' , .......... Electncmn s L~cense No ....................... Other Trade's License No ...................... I. Location of land on which proposed work ~ done ..................... ' ....... .... 5. .... ........... .' ............... · ltouse Number Street Elamlet Connty Tax Map No. 1000 Section . ,O..~..~..i (.-20 ....... Block . .O.~, ~O.... i... Lot.. ~. o~.~.,..O..0.O ..... Subdivision .~//.~/~. ,F'~. ~0.~... , .~..,~. ~.((. ' Filed Map No. s..~'~'./..~'~. 7. ..... Lot ...~..: ........ ' (Name) 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Extstmg use and occupancy .... ~.../ff.~. ¢.~... ~O ~ ~-.'/..... ~.,f~'.. O~.~f-..~. .~...' ' ' ' .. b. Intended use .',nd occupanoy [ ...... i ........ /~./.. ¢.. ~ ..... U.$.~. . .(.t..,~..C../¢.,,~.,~..6..rT~?~. ...... · 3.Nature of work (check WinCh apphcable): New Building . 2 ........ Addition .......... Alteration, .......... Repair .............. Remo~,al ... Demolition . Other Work .ff3'/~57A,,t. ~,/~-~.~ 4. Estimated Cost ~.OM.~i ~..,~1;,.'..~.O~. ~ (Description) i: (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits .... fl .......... . Number 0[ dwelling units on each floor .... · If garage, number of cars ..... i ....... ~ ...... . . .. '' ....... 6. I~f business, commercial or mi.xedioccupancy' specify nature and extent of.each type of use ............ 7. Dimensions of existing structures, if any: Front....~'.~..~ ...... Rear ... ~. t~ ..... ' ....... Height ..... .~ g ...... Numl~er of Stories , ~. ~ . . . Depth..~.~ ......... ~D~m,e. ns~ons ?f~s~me structure wi~h alterations or additions: Front . d-/.~, ~ . Rear ~.2' k' ........... 8. mensmns o~ entire ~ const~ctlon: Front...ly/..~. ...... : Rear...lq., Fa .e ..... Depth . Height .... L ]. ~ ....... Numbter of Stories ~ .... 9. Size of lot' Front D'e~h '... ' ......... I0. Date of'Purchase ......... . ......... Name of Fo . . 11. Zone or use district in which pre ises are situated .... 4r2t'~-cO. Or ?. ..................... ' .12. Does proposed construction viola;te any zoning law, ordina ce or regulation: ..... .A<. O ....................... ....................... ............... ^edress ................... Phone No ................ Name of Contractor ......... i ............... Address ............. . ...... Phone No ............... tS. 'rs th~.s property w~tth±n 390 feet of a t±dal wetland? *Yes ,K . · ~If yes, Southold T. pwn Trustees Permit may be requ~_r~cl. .... No ......... .-. j 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 interior or corner lot. deed, and show street names and indicate whether STATE OF NEW YOR~, ,- ....... '~')~" '~-'/~/~'' "' '~'..~.~ ~. q.~ ......... being duly sworn, deposes =d says that he is the applicant (Name of individual signing contract) ' above named. . ' He~....... .................. [ ........... . ....................................................... j . I (Contractor, agent, corporate officer, etc.) ~ owner or ow~, ~d ~s dulyiauthonzed to perfom or have perfomed the said work and to m~e and fi~e this application; that all statements contaihed ~ this'application are /rue to the best of his knowledge and belief; and that the work will be perfomed in the manner ~et forth in the application filed therewith. Sworn to before me this ~