HomeMy WebLinkAbout21680-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22618
Date SEPTEMBER 27~ 1993
THIS CERTIFIES that the buildin~ ACCESSORY
Location of Property 9280 NASSAU POINT ROAD CUTCHOGUE~ N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 118 Block 6 Lot 6
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 24, 1993 pursuant to which
Building Permit No. 21680~Z dated SEPTEMBER 27~ 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 STORAGE SHED "AS BUILT"
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
H. ELLSWORTH FULLER
N/A
FOI~M NO.$
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HAU.
SOUTHOLD, N.Y.
No_
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ...(F.~...7. ............................................
21680 Z
CountyTax Map No, 1000 Sectlon,,,,,/../,~.. .......... Block ......
pu~s~nt to appl~cation dated ........ ~,.~ ............................... 19..~ ....... and approved by ~he
Building Inspector,
Fee S.~~..
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
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 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.
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 - $i00.00
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, Con~ercial $15.00
Date Sept.
New Constructzon ........... Old Or Pre-existing Building .................
Location of Property 9280 NASSAU POINT ROAD C~TCHOGUE, N~W YORK
House No. Street Hamlet
0nwer or Owners of Property ...... ~{...~.I~.S.Wp.R.~...F.~..L.B.R ...................... .. . ....... .. ..... ..
County Tax Map No 1000, Section ...... I.I.8 .... Block...6 T~ 6
Subdivision ........................ Filed Map Lot
Permit No.~[~Q~ ......... Date Of Permit...97.27/.9.3. ...... Applicant LISA A. SCNILL
llealth Dept. Approval ...................... · .. . Underwriters Approval ..................... . . . .
Planning Board Approval ........
Request for: Temporary Certificate ........... Final Certicate ....
Fee Submitted: $ .2.5...0.0.
LIS~ A..SCHILL
APPLICANT
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
.FLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONA'L COMMENTS:
Examine//.~ . · ...... , 19 ?~.'
Approved..~.~¢. ..... , 197~. Permit
Disappr?ved. a/c ..............................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
BOARD OF HEALTH
3 SETS OF PLANS
SURV£Y
ClIECK
CALL
~ctor)
APPLICATION FOR BUILDING PERMIT
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 pubilc 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 Occupan'cy
shall have been granted by the Building Inspector·
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspecti, on~. ~-~ .
_ ....
(Sionatur~ of applicant, or name, if a ~);3(~;a}io'n') ....
~ .., TWOMEYt LATHAM, SHEA & KELLEY
: . .3.3..w....S.e. qqn. d..St...,...Bqx. 29.8~,..R~iy.e.r.h..efit. da. ~ .12.99]
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder.
....... ~Dpqicant ±s the attorney for owner of premises
Name of owner ofpremises H. EIlsworth Fuller
(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. ' '
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be'done ................................. i ................
Nassau Point Road Cutchogue
ltouse Number Street Hamlet
Cou'nty Tax Map No. 1000 Section -~ ~ 13.00 Block 06.00 · 006.
Subd v s on .i~la..P q~. N..a.s.s. au Point C2ub Pro. Re...rties
(Name) ...................
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy...P/(~i
b. Intended use and occupancy ....
'3. Nature of work (check which ap'plicable): New Building .......... Addition ....X. ..... Alteration ..........
Repair Rem6val Demolition Other Work
·"" (Description)
4 teac
· Estima ost ..... ~ ............... 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 mi.xed occupancy, specify nature and extent of.each type of use .....................
7 Dimensions ' ' ' ' if any: Front Rear Depth
· of ex,sang structures, ............................................
Height Number of Stories ' '
Dimensions of same structure w'ith alterations or additions: Front Rear
Depth ' Height Number of Stories
8. Dimensions of entire new construction Front ' Rear Depth
Height ............... NumJber of Stories ................................ '.
9 Size of lot: Front i ' Rear ' Depth
10 Date of Purchase ' ' Name of Former Owner
1 1 Zone or use district in which prdmises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: ..................
13. Will lot be regraded ....... '.. i ................... Will excess fill be removed from premises: Yes No
14 Name of Owner of premises Address Phone No
Name of Architect ' Address Phone No
Name of Contractor ' Address . Phone No '
15.' I~ this property within ~00 feet of a tidal wetland? *Yes ........ No .........
*If yes, Southold %,own~ Trustees Permit may be required.
.... I PLOT DIAGRAM
Locate clearly and distinctly all ibuildings, 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.
[:OI~ POIJ~ED CONC~ET[~
2, ROUGH.
ST~ JCT~oIq Ivllj ST
F~E COMPLEI'E FO~ C,O.
COMSTRUCTION SHALL MEET
..... ' ~ CONSTRUCTION & ENERGY
, ::~ M~ RESPONSIBLE FOR
";~ "~ ~ OR CONsTRUCTiON ERRORs
STATE OF ~EW YOR~ ~
COU~y OF ....... ~ ' ' .... ~. · .. ......... being duly sworn, deposep ~d says that he is the applicant
(Name of individual signigg contract)
above named.
t~He is the... .................. i (Con'~ntira~Lbr, age '
, corporate officer, etc. I
of said owner or owners, and is dul~ 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 manneriset forth in the application filed therewith.
Sworn to before me this ~
.......... :2d y of
No'tary Public,..d~.'. ~...~.~- '.~o~n~\~''~'' /"'~ . #
·- ,... ....
#0TARY PUBLIC, .StAle..~of N.,y_, . .. .....
. No, 4725089, Suffolk CouOI~., ·.
' Term ExpiI~s May 31, !9'..Y-~- ' . , .(Signatur~ of applicant) .
CERTIFIED TO'
JAMES I'~FFRON
BARBARA MICHELSON
FIRST AMERICAN TITLE ~ISURANCE
COMPANY OF NEW YORK
AOUEBOGUE ABSTRACT-CORP.
AREA = 1.261Acres
to tie lines
SURVEY OF
LOT 92
"AMENDED MAP A OF NASSAU POINT"
RLED AU~ 18, I~22 MAP NO. 156
A T NASSAU POINT
TOWN OF SOUTHOLD
SUFFOLK CO~JNTY, N Y
1000 - 118 - 06- 06
Scale: 1"= 50'
Sept. 16,1993
Prepored in occordonce with the minimum
stondurds for rifle surveys Os es/ob#shed
by the L.I.A.L.$. ond opproved and adopted
for such use by The New York Slate Lone
Title Associotion.
NO. 496i~
93- 267