HomeMy WebLinkAbout21318-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22698 Date NOVEMBER 4, 1993
THIS CERTIFIES that the building. ACCESSORY
Location of Property 265 RYDER FARM LANE
House No. Street
County Tax Map No. 1000 Section 15 Block 8
Subdivision Filed Map No.
ORIENT, N.Y.
Hamlet
Lot 2
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed ia this office dated APRIL 2, 1993 pursuant to which
Building Permit No. 21318-Z dated APRIL 8~ 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 GARDEN SHED AS APPLIED FOR.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEP~RTMENT OF NER~TH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
GEORGE & MARY ELLEN LONG
Rev. 1/81
/ Building Inspector
TWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N_~? 21318 Z
Permission is hereby gran_.ted to:
4~~..~...~.....~..~
.... ~./ ........ ,...~....../..~. ............
~......:~.~
at premises located at ........... ~.~.. ......... /.~~.....~?...~..../.'~....~.~"~,~-....
co..~, To~ Mop No. ,ooo Sec,,on .... /..~.~ ....... B,oc~ ...... ~ .......... Lot.o ......... ~ ........
Building Inspector.
Building Inspector
Rev. 6/30/80
Form No. 6
TOW]N 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.
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
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.O0
/ Date .....................
;ew Coastr %/ · · . ' ...................
uctzon ........... Old~ Pre-existing Bultdin~ ............
,ocation of Property....~..~...~,~..~.~.[~ .......... '~~
House No. S eet .............
or Owsers of Pro ertv..
-7 ........ ~' z' "/~' · ................
:Ounty Tax Map No 1000, Seltion...~.~ ....... B~ock..~....~. .... .~....L'o~..k,.~ .................
ubdivision .......................... Filea
.......... Map ............ Lot ......................
ermit No...~../.~./.~.~.Date Of Permit... i./~.-?~-/Z,~... ..... Applicant ........................
ealth Dept. Approval ...................
· Underwriters Approval
lanning Board Approval ......... ~ ..............
equest for: Temporary Certificate ......... Final Certicate.
...........
765-1802
BUILDING DEPT.
INSPECTION
REMARKS:
-~OUI~DA'TION (1st)
'OUNDATIO:;
~UGH FRAME &
.PLUMBING
~SULATION PER N. Y.
STATE ENERGY
CODE
FI~IAL
ADDITIONA'L COMMENTS:
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
APPROVED AS NOTED
FEE'.?~'~ BY: C. ~/e"
NOTIFY BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWIHG INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
hed
A charming andpracttcal addition to your backyard landscape.
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Examined ................ , 19...
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
3 SETS OF PLAaS ..........
SURVEY ...................
CHECK ....................
SEPTIC FORH ..............
t, OK~FY,
CALL ...................
MAIL TO:
Approved. ~ .B., 19~.fPermit No..~./...J~./. ~. -~
Disapproved a/c ................................ 2 ....
(Building Inspector)
APPLICATION FOS SUILDIN~ PE~IT
Date . . ~.~ ..........
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 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
shill 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 ins~ .~.~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder·
,.-... ......................
Name of owner of premises ./:/ fT':T'.. .
/' 0 (a~on t~ tax roll or latest ~cde'~)
If applicant is a corporation, signature of duly authorized officer. ~/
(Name and title of corpor.a~ officer)
Builder's License No .................... ~..
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done .............................. , .....................
:... .... ................ ....................
House Number U Street 4-Iamlet
County Tax Map No. 1000 Section .../.".~?~.. .......... Block . .~. .............. Lot...~.: ..............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction:
· xlst,ng use and occupancy ....... ;?/::.} ................ "'":'"'"' ":'' '': :)'~'~,',::'~;4 .............
b. Intended use and occupancy . . . ././~"Y. :7./. ..................... ?.,i .':....' ...... '. ~,,~'~ ...............
3. Nature of work. (cheeSe which aCplicable): New Building ...... ~... Addition . .' ..... °... A~teration . ..
Repair .............. Rem,oval .............. Demolition .............. Other Work ............
. (D ripti )
4. Estimated Cost ............................. .r~;· .t~)... Fee .......................... 3 ..~/.< ~..
i (to be paid on filing this application)
5. If dwelling, number of dwellingl units ............... Number of dwelling units on each floor ................
If garage, number of cars i '
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 Nurnber of Stories
Dimensions of same structure ~/ith alterations or additions' Front ....... . .......... Rear ...............
Depth .... I · ' "
.............. t ' ' Height ...................... Number of Stories ......................
8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ..... . .........
Height Number of Stories '
Size of lot: Front ' Rear Depth
Date of Purchase .................... . ......... Name of Former Owner ..........................
Zone or use district in which pr~mises are situated ' '
Does proposed construction vioiate any zoning law, ordinance or regulation: ...........................
Will lot be regraded ........ ~ ................... Will excess fill be removed from premises: Yes No
Nhme of Owner of premises I
· ' i ................. Ad~lress ................... Phone No ...............
Name of Architect ......... ; ....... ' ... Address ................... Phone No ................
Name of Contractor ........ 2 ................. Address ........ . ........... Phone No ................
Is this property within h
~00 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold Town Trustees Permit may be required.
i PLOT DIAGRAM
whether ~xisting or proposed, and, indicate all set-back dimensions from
description according to deed, and show street names and indicate whether
10.
11.
12.
'13.
14.
15.
Locate clearly and distinctly alli buildings,
property hnes. Give street and block ~number or
interior or corner lot.
STATE OF N~CT'YO,~I~/o //~- ,~ S
~ :
.... .~.c~ ~.~ ~..~.. ~..~.. ............... being duly sworn, deposes and says that he is the applicant
· (NamOof individual signing~contract)
above named·
' (Contractor, agent, corporate officer, etc.)
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 manneri set forth in the application filed therewith.
Sworn to before me this