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Home My WebLink About21367-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22311 Date MAY 11, 1993 THIS CERTIFIES that the buildin~ Location of Property 325 HORTONS LANE House No. County Tax Map No. 1000 Section 63 Subdivision ADDITION Street Block 5 Filed Map No. SOUTBOLD, N.Y. Hamlet Lot 17 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 23, 1993 pursuant to which Building Permit No. 21367~Z dated APRIL 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 SHED ADDITION TO AN EXISTING ACCESSORY GARAGE AS APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ROBERT W. & CAROL R. BROWN PENDING - MAY 3, 1993 Rev. 1/8% TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°.N? 2136'{' Z Permission is hereby granted to: ....... ...'~...~..~_.~..-1 ............................................ ...~~ ......... ~:~. ................... ~/~ ~ .......... ,o ~~....~......~;~..~....~...~~~: .,"~ ~. ........... 0,.-o ' at premises located at .~..'~.~. ........ ~,....~ ....... ~~... ............ County Tax Map No. 1000 Section ._~......~..~....~ ..... Block ...... ..~..~. ....... Lot No....l...'~. ............... pursuant to application dated .... ~ ....... ..~:.....~L ............ , {9..c/..;~, and approved by the Building Inspector. ding Inspector Re~ 6/30/80 Form No 6 TOWN OF SOUTHOLD ~ ': Bur ,DI O ' APR 2 3 B93 ' TO~ ~LL ~ ~ 765-1802 ';~ i 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 f~rm). 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 2ilo 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-~onforming uses, or buildings and '¥re-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 Date ............ / .............................. New C struction ./.. ~ ' on ....... Old Or Pre-existing Building ................ Location of Property.. :~..'~.~ ................ .~.0~.O.~.~ ....... /.~: ......................... House No. Street Hamlet 3nweror Owners of Property.. . ~ ....... ~.~ .... Cubd~v~s~on .................................... F~led ~ap ............ Lot ~erm~t ~o ................ Dato Of Permit .............. .. ~pplican~ tealth Dept ~pproval Bnder~r~rers Approvai 'lanning Board Approval ........................ equest for: Temporary Certificate ........... Final Certicate ........... ee Submitted: $~ Y'--~'/X' ............................ ' :'~'~/~/~~ C0-L223 J I ' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FRAMING REMARKS: FOUNDATION ZND [ ] INSULATION [ ~FINAL FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & ,PLUMBING INSULATION PER N. STATE ENERGY CODE COM~gNT$ FINAL ADDITION[L COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~. ~,~(~9~,~ BUREAU OF ELECTRICITY ~-~ 85 JOHN STREET. HEW YORK, NEW YORK 1003E Date ~' '[~''[~ ~pplicationNo. onfile ~,~6~9:~/93 ~ 27~[~g THIS CERTIFIES THAT o~y t~ electrical equipment ~ ~serib~ be~w a~ intr~uced by t~ applicant ~m~ on the a~e application number in the prem~es of ~s examined on ~[~ 03 ~ ~_99~ and found to be in compliance with the Nafional Electdeal Code. $ XTU~E ~EC T E { WIT ES ~ FIX]URE$ RANGES C~KING DECKS ~V~ DISH WASHERS EXHAUST FANS $aEVl~ DI~ONNECT ] ~.oY [ S E E V I C ~ PANI,ILIIOARDSrl-3 CIR, 190 2'75 '£O~N IIARBOI1 $OIJ~'~19l, O, NY, 11971 GENERAL This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by th~ir'c(edentlais. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ^JJ 2 3 t993 Approved ~...~ .... 19~. Pemit No ............ Disapproved a/c ' (Building Inspector) APPLICATION FOR BUILDING PERMIT FORM NO. 1 · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 g~ARD OF HEALTH URV£Y ......... / CIIgCK ...... CALL ' }tAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 sti-eet~ 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 demolitiun, as herein describbd. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on premises and in building for necessary l'nspe~ //~/ .,~ . (Mailing address of applicant)' State whether applicant is owner, lessee, 'agent, architect, engineer, generai contractor, electrician, plumber or builder. Name of owner of premises . (as on the tax roll or latest deed) If applica~t is a corporation, signature of duly authorized officer.' · (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ............... . .......... Electrician s Lmense No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .......................... House Number Street Hamlet Con'nty Tax Map No. 1000 Section ' ; ...... Block ,, ,5-' ' Lot... /7 Subd v s on ................................ '. Filed Map No ............... Lot (Name) , Stat~ existing use and' occupancy of premises and intended use and occupancy of proposed construction: .-, ....... 7' '.:,' 7) .... ;: .... . b. Intended use and occupancy .... J~ .(~q~. ~ .... )~o~/'7 ~ '~ dZ~r/~ ' · Repair · t ........... ·.. Other Work ........ i ..... 4. stimated Cost ..... " escr on ~' ' .................... Fee..: .............. 5 If dwelling number of dwelling hails (to be paid on filing this application) · ' ................ Number of'dwelling units on each f/oor If garage number of cars ' ' 6 ' If busine'ss commercial ...................................................................... . .... or mixed specify nature and of us~ 7' ' . occupancy, extent of each type · Dimensions of existing structure's if Front ............ , ..... any: Rear ........... ................... Depth .............. . Height ............... Number of Stories ..... i... . · '...' .. D~mensmns .of sam_e_stmcture with alterations or additions: Fro-t ' ~f.5 ........ d, ..... '&'5 ............. Depth .... ~ I ~t . ,., ..................... ~ear..~ . · . ---- ......... i .... e~..~. ......... . ....... ,~.. Numbe · ' · . ' ....... 8. Dlmensmns of entire new construction rout . ~ r.? Stones ..... ~ ....... ,.~ ........ · ' ....... ~. ........ Depth .... ~:~. ......... Height ~ 1,9- t Num'ber of Stories 9 Size orlon.: Fro~t .7.~! .5. . '2.~ "' · . ...... , .... 10 Date of Purchase ............. Depth ,.. J ......... · ' .......... : ......... ' ........ .. Name of Former Owner 1 I. Zone or use district in ' ' ' . ............................. wh,ch prermses are situated 12. Does proposed construction violate anv zonin~ law ,,,m, ' . . _ ,~ -, ..... ,ante or regulation: .... , ............. . ........... 13. Will lot be regraded .. '.Z~.O .... : · · · Will ex 14. NameofOwnerofpremmes .'.f-O~6~"t?...b.{,.~.¥tA~0..?.Address.cessfill .... ' J' :..'.~. Nme of Architect ...... '~-g .5 Phone No. ?4X ! · .................. ' .... Address ................... Phone No ........... ..; .... Name of Contractor ......... ; ................ Address ..., .......... · ..... 1.5.' 19 th±s property w±thin 3!00 feet of a tidal wetland. *Yes ........ .Pho.i?~.No ............ ' .... · If yes, Southold %own Trustees Permit may be required. No.,.~ ..... .~.. : PLOT DIAGRAM ' Locate dearly and distinctly all !buildings, ~heth~r 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. i ~ ]TATE OF NEW YORK, , 30UNTy OF ........ . S.iS .... ~ ......... ' ........ being duly sworn, deposes and says that he is the applicant (Name of individual signin contract) hove named. , is the....... ................ (Contractor, agent, corporate officer, etc.) said owner or owners, and is dui cuthorized to perform or have performed the said work and to make and file this ~plication; that all statements contain'e in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner ,vorn to before me this ....................... day of. ~tary Public ' forth in the application filed therewith. .............. County ·. (Signature of applicant) ·