HomeMy WebLinkAbout21339-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22266
Date APRIL 16, 1993
THIS CERTIFIES that the buildin~
Location of Property 8960 COX LANE
House No.
County Tax Map No. 1000 Section 83
subdivision
ADDITION
Street
Block 3
Filed Map No.
CUTCHOGUE~ N.Y.
Hamlet
Lot 3.1
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 15, 1993 pursuant to which
Building Permit No. 21339-Z dated APRIL 16~ 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
GREGORY A. & SUSAN G. BOYD
Building ~n s~ec~t or
Rev. 1/81
!~O~ NO. ~
TOWN OF $OUTI"IOLD
BUILDING DEPARTMENT
TOWN HALl.
$OUTHOLD, No Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~N°. 313~Z
..'~..~../:.~.~../../...q2_5 -
~...~..~ ...... .~ ....... :.:_..4~....~~........~ ........
o, ,,e~,, L~, ...~.~.~~...~~, ................................................
...................................... ......................................
~aun~ To~ ~ap No. ,000 ~,c,ion .f.'....X.. ........... ~,~ ....~ .............. Lot No..]...'.....L .........
pursuant to application dated .......... ..~..,./.....,,/. ................... , 19 and approved by the
Building Inspector.
Building In,sl:~ctor
Rev. 6/30/80
~U~DA'TION (1st)
fOUnDATIOn'; ( 2nd )
~OUGH FRAME &
.PLUMBING
~SULATION FER N. Y.
STATE ENERGY
CODE
FI:~AL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined ................ , 19 ...
Approved ..~...f.~.., 19~ff. Permit No..~.
Disapproved. a/c ................................ 2 ....
(Building Inspector)
BOARD OF HEALTH
SURVEY .
SEPTIC FORH
CALL ...................
HAIL TO:
APPLICATION FOR BUILDING PERM IT
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 sffeets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
e. 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 i~sued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
¢. 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 describbd.
The appilcant 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.
(Signatur9 of applicant, or name, if a corporation
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber o~r builder·
Name of owner of premises ' ,
(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 ....... .~.~..tr.~. .............
Plumber's License No.
Electrician's License No.
Other Trade's License No ......................
Location of land on which proposed work will be done ................................. : ................
ox' ' ....
· ....... .............
House Number Street Hamlet
cmmty Tax Map No. 1000 Section .... ' .~. i~. .......... Block ..... .~. ' Lot.
Subdivision ........ . ............................. Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~lO~.
b. Intended use and occupancy ........... /, ............................. ,.... ..............
· 3. Nature ofw..ork (check which qPphcable): New Building .: ........ Addition .......... Alteration .... ; .....
Repair ............ Removal .............. Demolition . ..: .... Other Work .....
4 Estimated Cost .~./.t~.~.O.: [ ' ?. ~..~.,. (Description)
(to be paid on filing this application)
5. If dwelling, number of dwellin~ units ............... Number Of dwelling units on each floor ......
If garage number of cars i '- .........
6. c ~a r x ccupancy, specify nature and extent of.each type of use .............
7. oi ex~srmg structures, ffany: Front ............... Rear .............. Depth ........
Height ............... Number of Stories ' ' '
D~mensmns of same structure with alterations or additions. Front D ............
..... · · ..~ .ne,gm ................... ,..NumberofStories ........ ' 2 ......
8. v~menmons oIenOre new construction: Front .............. ~ Rear ............... Depth ...............
Height ............... Nurober of Stories ........................
9. Size of lot: Front ......... , ~ ....... Reai'... Depth
10. Date of Purchase I ............................................
.... · .... ~. · .. ................ N f Former Owner ................
amc' ' o
11. Zone or use restrict ~n which pr~m~ses are situated ......... ' ..... : ' '. .....
.12. Does proposed construction violate any zoning law, ordina ce or regulation: .........................
13. be regraded.. ..... : ·. · · Will excess fill be removed from premises: Yes No
14 }p ................
· Name of Owner o remises; ................... Address . ... Phone No .........
Name of Architect .......................... Address ................... Phone No .................
Name of Contractor ......................... Address ................... Phone No ................
15.' I~ this property within 300 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold rown 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 gumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
COUNTY_OF .............. .. . S S
· . 'vi
~...i ........ '..' ......... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named·
..
He is the .
~ (Contractor agent corporate officer ete ) ...............
of said owner or owners, and is duly iauthonzed to perform or have performed the said work and to make and file this
application; that all statements contaified in this'application are t'rue to the best of his knowledge and belief; and that the
work will be performed in the manner ~et forth in the application filed therewith. '
Sworn to before me' this
. ir- .
....... t.. ........ U.'>x. '...day of. i-Y~ .... '..' .... 19 ?.3
· : ::~. ~2ounty -
·
' ' No. 4952246, Suffo k County., , ' . ' (Signature of applicant) ·
Term Expires June' ~'2, 19
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be fiflled 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 Oompliance from architect or engineer
responsible for the building.
'6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and'
-pre-existing" land uses:
i. 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 ull~zng 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 t9 accessory building $25.00. Businesses $50.00.
2.Certificate of Occupancy on Pre-existing Building - $100.00
3.Copy of Certificate of Occupancy - 45.00 over 5 years - $10.00
4.Updated Certificate of Occupancy - $50.00
5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
·
~ Date .............
Yew Construction ........... Old Or Pre-existing Building .................
~ocation of Property .................................................... . .....
House No. Street Hamlet
~nwer or Owners of Pro crt ~ ~ Y ~" + ~$ g~
p y .......... O
~.ounty Tax Map No 1000, Section ............ Block ......... Lot .... ° ......
ubdivision .......................... Filed
~. ~..~:~.' .' :~:~ ' Map ............
ermit No. . Of Permit pplicant. ...
ealth Dept. Approval.. ' - ~ --
........................ Underwriters Approval ..............
lanning Board Approval
~-q~est for: Temporary Certificate ........... Final Certicate.
~-e Submitted: $ .~.