The URL can be used to link to this page

Home My WebLink About21038-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22240 Date APRIL 5, 1993 THIS CERTIFIES that the building Location of Property 1355 BAY HOME ROAD House No. County Tax Map No. 1000 Section 56 Subdivision ALTERATION Street Block 5 Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 36 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 17, 1992 pursuant to which Building Permit No. 21038-Z dated OCTOBER 22, 1992 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 REMOVAL OF INTERIOR PARTITION ONLY¢ AS APPLIED FOR. The certificate is issued to BARB~LRA SELZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FOEM NO. O TOWN OF SOUTHOI-D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N_°N? BUil'DING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULl COMPLETION OF THE WORK AUTHORIZED) 21038 Z Dote ..Z~....-~... ................................ Permission is hereby grant, ed t~ ~. 5 ~B . ~ / ~ ~~.~ ~, ~r~m,~. ,.~,e~ ~, ..... ~.~...~....~ .............................. : ..................... ................................................. .............................................................................. co~ ,~ ~p uo. ~ooo s~t~o~ ....~ ........... ~k ..... ~ ........... lot ~o..~.~ .............. pumu~nt to ~ppllcotion dot~ ............. ~ ..................................... , i~ .... end e~rov~ ~ ~e Building Inspector. tor Rev. 6/30/80 Form No. 6 TOWN OF SOUTf~LD 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: 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. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% 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. Submi. t 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. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwellieg $25.00, Swi~raning 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 Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building ..... ~ ......... ~o~at:on of Property ...... (~.m..~ ........ ~, '-~ /Z · ...... ........ .... ., tIouse No. Street Hamlet On,er O ner of Property ..... .................................. ... . .. . County Tax Map No 1000, Section ..... ~.~.~. .... Block ................ Lot ............ Subdivision .................. ' · · Filed Map Lot Per,,lt No ................ ~,a,,_ O~ ,. ..... A,.,.1 ................ ~..5'~-~.... Health Dept. Approval ........ .~?~. .... Underwriters royal ...... .'~... ......... ........ App · ... Planning Board Approval ....... ,,J~.~. .......... Request for: Temporary Certificate ........... Final Certicate..~/~. ..... Fee Submitted: $ .... ~-'~P~]) ~, g3 7oz '. ....... OUNDATIO|! { 2nd ) 0UGH FRAHE & .PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 I~OARD OF' HEALTII 3 SET~ OF SURVEY ................... CttECK Approved .. Z,-- ...... , 1 Permit No. / Disapproved a c ............. (Bui~t'fng Inspector) APPLICATION FOR BUILDING PERMIT CALL ................... HAIL TO: Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .'ts 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 r ar~as,;and giving a detailed description of layout of property must he drawn on the diagram which is part of this appii- ation. ¢. The work covered by this application may not be c~mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued'a Budding Permit to the applicant. Such permit mil 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 lall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Dep~tment for the issuance o£ a Building Permit pursuant to the uilding Zone Ordinance of the ,T. own of Southold, Suffolk County, New York, and other applicable laws, Ordinances or egulations, for the construction o£ buildings, additions or alterations, or for removal or demolition, as herein described; he applicant agrees to comply with aH applicable laws, ordinances building code, h~sing code, and regutati6ns, and to lmit authorized inspectors on premises and ~n building for necessary i)2¢~ctions. { / .. (Mailing address of applicant) tare whether apt}lic, ant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .......... , .... ame of owner of premises ... :. .., .......... ': ~ .... (as on,tlie tax roll or latest deed) ........................ applicant is a corporation 5ig~¢tt¢[~, qf,, dluly~.uthorized officer· (Name and title of corporate officer) Builder's License No ................... Plumber's License No ......................... Electricia ,n,',s License No. Other Trade's License No ...................... Location of land on which proposed work will be d~ne ........... . . ..................................... . ............... llouse Number Street Hamlet tyT pN Coun ax bid o. 1000 Section ............ Block ............. Lot ......... Subdivision Filed Map No. . Lot (Name) ..... . .......... State existing use and occupancy of premises and intended use and occupancy of proposed constrnction: L Existing use and occupancy ....... · ·../..'9e.._2 J[.~/(.~, .,¢¢,.g..¢~,:.,,',6~ '. Intended use and occupancy . ;. ?-,~..~/~'_~ % ' '*~"~':";' ,*~' Locate clearly and distinctly all bfiildings, property lines. Give street and block number or !nterior or comer lot. 3. check wh P cable): New Building .. ~ ..... . ....... ....... Addition ..... · ~ ·, ','. - ,--.~ , ova/ .............Dm~olition· · . Other Work .¢/~rr~a~ or'/.trertor, r~h~ ? f~r~ ......... 4. Estimated Cost (Description) i'°' · .... Fee ..... · ~ / (to be paid on filim.,, this application) 5. If dwelhng, number of dwelling uhits ........... Number ofdweUing nnits on each floor.. · Ifgarage, numberofcars ..... i ...~ ........ · ............. 6. If business, commercial o,- -,;--,,, ~ 7. ' ....... ~ 9ccnpancy, specify nature and extent of each type of use ...DO, ............ Dimensions of existing Stmctures,l it' any: Fro t ............. Height ............... Numbbr ol'Stories ........... .. Rear .............. Depth ............ Dzmensions of same structure, witl~ alterations or additions: Front ................. Depth i ................. Rear ................... 8 ...................... Hell;hr ................... Number · Dimensions of entire new constru&ion: Front · · of Stories ...................... '~ Rear . .'"rzx.. Depth Height ~ Num b~r of Stories ................ Size of lot: Front .......... 10. DateofPurchase ..iO/~.'q~.~i:':'":' Rear ...................... Devtk, ..... a. . . . · .... : ....... Na ,e ct' Fo=er Owner . b.4c, bez:~ ........... 11. Zone or use district ,n which Prethise, are situated... Y '~t/'0)Si~'~ ..... 12. Does proposed construction viO~at~ any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded .... ~ . . . 14. Name of Owner of premis~s'~ ',~--~12.--5 ....... Wdl e~e~ss_fill be..~rem, over from premises: Yes No Name of Architect L~/Tg.~--~"'~n~,-~, ~'2/' 2L,'.,t}ddress ~F~./7.~ST~ .~,,~.. Phone No.o9~,2~-. ....... ----.~. ,..'-,'C..-'~.., .~l'c, Rr/~,%C~ddressb¢.~.~ .~. ~t'.tTL iV',l:a' Phone No/~.~.'-(~.~,'' Name of Contractor ........ 3 { ............. Address .............. Phone No ..... Is this property within 00 feet of a 't'idal wetland? *Yes.'.~..'. · If yes, Southold To~n Trustees Permit may be require~.' · No ......... PLOT DIAGRAM Whether existing or proposed, and. indicate all set-back dimensions from descripfio~ according to deed, and show street names and indicate whether API~tO~D AS NOTCh 7654802 9 AM TO 4 PM ~OR THE FOLLOWING INSPECTIONS. FOR POURED CONCRE'r~ 2. ROUGH ~ FRAMING & PLU~/~hx,G 3. INSULATION 4. ~tNAL CONSTRUCTION MUST 8~ COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENT$ OF THE N,Y, STATE CONSIRUC~ON & ENERGY CODES. N~ RESPONSIBLE FOR DESIGN OR CON~U~ION ERRORS 'ATE OF NE~,~f'O~_f'''' ,/, S S )um¥ OF.,X,,_~...TZ~./.K.' · ., . ....... o.a .... (Name of ind~idual signing ~ontract) .... being dul~ sworn, deposes and says that he is the applicant )vt named. . ...................... .... . said OWner or owners, and is duly authorized to perform or have performed'the said work and to mke nd i lication: that all statements containedi in this application are tree to the best of his knowledge and belief; and that the 'k will be pcrfo~ed in the manner set ~forth in the application filed therewitli. )m to before mc th~s, . .... ' ' :[) .... ~-~:... County ~ Publl~ ~sm of N~ /' ' No, 4879606 , . .'.~~ ' QuMifled In Surfak ~u~ I ~ ~ ~ ff ' - ~ ..................... .,, ~mmi~lon E~i~ O~ ( 19~ (Signature of applicant)