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Home My WebLink About21382-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22443 Date JULY Bt 1993 THIS CERTIFIES that the building ADDITION Location of Property 825 ~?JTI41Y.I. ROAD EXTENSION SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 55 Block 6 Lo% 15.20 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 30, 1993 pursuant to which Building Permit No. 21382-Z dated APRIL 30~ 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 APPLIED FOR The certificate is issued to MATTHEW G. KIERNAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A , /~ l~ding Inspect Rev. 1/81 FO~ NO. ~B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERA41T ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-°N'? 2138~. Z Permission is hereby granted to: ..~ _ ~...~.~..~~~.,~.....~.. ~.~~~ ........,., .~i~ ....... I.....?..Y.I./ ...... ,o ..~a:.......~ ...... ~.~ ....... ~..~.o.....~....~.~... ~o~ ~ ~ ~o. ,00o ~,,o~7~ff.. ~,~ ..... ~.~ ........ ~o,,o ..... ~.~.~... Building Inspector. Building I~tor Rev. 6/30/80 Form No. 6 TOWN OF $OUTtlOLD BUILDING DEPARTMENT TOWN HALL i65-1802 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: I. 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. Con~nercial 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. 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 Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees i. Certificate of Occupancy - New dweiling $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, Conmmrcial $15.00 ........ ~.. Old Or Pre-existing Building ................. , House No. Street ' Hamlet ' ' Onwer or Owners of Property... ~ County Tax Map No i000, Section. 07..~. n]n~ ~ ~,.~.. Subdivision ..... . .... Filed Map ........ Lot .. . Permit No..~. !.~-~.~-.~....Date Of Permit....~/..~DT.~.~...Applicant.~..~.,...~.:...~.,~..~ Dept Approval Uuderwriters Approval Health ............... Plauning Board Approval ........... i ........ Request for: Temporary Certificate ........... Final Certicate.. FOUNDATION ( ls t ) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL ADDITION~L COMMENTS: 765-XS02 BUILDING DEPT. INSPECTION REMARKS: FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~ULATION / FRAMING [~ FINAL DATE INSPECTOR m x '3. Nature of work (check which applicable): New Buildin~ Repair Add'''e'''''~''~' ~ ~ ~ ~"" ' ' ' · · Remora' · ......... ~r on .~.~ut ~ ~,~.. Alteration .... ~ ' -~ ......... ~ .............. Demolition ..... · .... Other Work ........... 5.. 4. Estimated Cost ... ) '3 ~ . ' ~ ,~ · (Description) ............. Fee .... ....,7. ...................... 5. If dwelling, number of. (to be paid on filing this application) If garage number of cars ............... Number of dwelling units each floor · on 6 If business commercial or mix ............................ · ' . , .cupancy, specify nature and extent of each type of use ................. "' ' 7. Dimensions of existing structures ~: Front Height Rear ............... ~ .... Nmnber :tories ............................. Depth Dimensions of shine structure with .................... · ~ns or additions: Front ................. Depth .............. 8 Dimensions of entire new construction: ................. ' .... ~ ......... ...... · ................. Rear .. . ....... Number of Stories ' Hight ............. ; Rear pth e ............... Number of Stories ............... De ....... 9 Size of lot: Froht I0 Date of Purchase ' Depth 11. Zone or use district in which premises are situated... Former Owner ............................. 12. D°es pr°posed construction violate any zoning law, or regulation: ..... 13. Will lot be regraded ...... : ............... cess fill be removed from premises: Yes No 14. Name of Owner of premises . Name of Architect ............... .... Address Phone No ' Address ............. ' ............... ' Name of Contractor ...................... · ...... Phone No .... . .... Address ..... .x~ ....... ..... Phone . ' .......;' 15.' Is this property within 300 feet of a tidal wetland? *Y~s .... *If yes, Southold Town Trustees Permit may be require~.' ... ao ......... .... PLOT DIAGRAM Locate clearly and distinctly all buildings, ~heth~r 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. STATE OF NEW YORK, JOUNTY OF ........... (Name of individual signing contract) ' ' bore nan~ed. outractor, agent, core, orate officer, etc.) ....... f said owner or owners, and is duly anthorized to perform or have performed the said work and to make and file this 3plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. ' .yom to before me this Notary Public, .qt~te of New ¥o~ No. 4952246, Suffolk County ' ,~ ' (Signature of applicant) . Term Expires June 12, 19_.~,-~ · . .\n.%. ~ :UO]l~n.tlsuoo posod~ldjo ~3u~dn33o puu osn p~puo~tq ptm s~s~djo ~3u~dn3~o p~ osn ~ups~xo ol~lS ., ........ ; ...... 1o~ ....... : ...... , '°N d~R PoI[~ '. ......... ................... ' ........ uom~pqns ..... .... .... ..... ..... ~ '~'.~':"' uop~oS 000[ 'ON de~ xe& 4tin,oD ~°ItU~UH i JoqtunN osnoI-I . (~oogjo olulo~oo JO gild pu~ omeN) . .uoo[]Jo po~poqmu X[np jo ,znleu~is ,uoD~lodJo2 e si lueoHdd~ Jl (poop lsoluI zo Jim x~l uopHnq Jo zoqmnid 'u~[ap~29p 'zo~3~z~uo3 '[mou9~ 'aoom~uo '~oollqoz~ '~u9~ 'oosso[ 'zoun~o st (luuo[Idd~ Jo ssozpp~ ~.mlm~) . ....... 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