The URL can be used to link to this page

Home My WebLink About21055-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21t18 Date OCTOBER 29, 1992 THIS CERTIFIES that the building Location of Property 3980 BAYSHORE ROAD House No. County Tax Map No. 1000 Section 53 Subdivision ACCESSORY GREENPORT, N.Y. Street Hamlet Block 6 Lot 32 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 26, 1992 ~ursuant to which Building Permit No. 21055-Z dated OCTOBER 28, 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 ACCESSORY SHED IN THE REAR YARD AS APPLIED FOR. 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 ANTON & ANTOINETTE MRAKOVCIC /~/ " ing Inspector Rev. 1/81 I~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°N.o 210~iZ Dote ........... ~ .......... , ..... Permission is hereby granted to: ...~..&~:~: ......... ~.~..~.~.~./.~ .......... ..... ~..z..:.../.~ .......... Z~:.~ ...... ~ .................. ..... ~:.~./.~.~,....~:x..: ....... ../../.4~Z.. ..~ ....... Z./..,e.~.:~.:.,,.:. ...... ...~..~: ......................................................................................................... at premises located at ............. ..~....?....~..~.. ......... .~.../.....~'..~.~.....~.~..~. ....................................... .................................................... ~.....~..~~ .......... ~ .~..... ....................................... .................................................. L_.~e~<....~~.~./~.....) .................................... County Tax Map No. 1000 Section ....~....'~...~... ......... Block ...... ..~/J~. ......... Lot No. ..... ~...~.. ............ pu.ua., ,o opp,ca.on dot~ .............. /..~.//g.~.. ...................... , ~.~ a.d app,o~e by ,.e Building Inspector. Fee $ ........................ / J~dild',ng Insl:~ctor Rev. 6/30/80 Form No. 6 TOWN OF SOUT[[OLD BUILDINC, DEPARTMENT TOWN ILALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY h i w sub,s.bt 'to > building y of property with accurate lOCation off nl~'h.~'~ ~'~ streets, and Unusual natural or topographic features. ........ ~zngs,~ P~Operty, ~i~es, 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. Co~ercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code C~m~pliance from archiuec~ or engineer responsible for the building. ~6.Submi~ Planning Board Approval of COmpleted site plan requirements. ;. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and , Pre-exxstlng 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 sh~ll state ~he reasons therefor in writing to the applicant, :. Fees 1. Certificate of Occupancy ~ New dwelling $25.00, Addikions ~o dwelling $25.00, Aitera¢ions ¢o dwelling $25.00, Swimming pool $25.00, Accessory buiiding $25.00 Additions to accessory building $25.00. Businesses $50.00. ' 2. Certificate of Occupancy on Pre~existing Building - $100.00 3. Copy of Cer¢ificate of Occupancy _ $5.00 OVer 5 yea~s - $I0.00 4. Updated Certificate of Occupancy _ $50.00 ~. Temporary Certificate of Occupancy - Residential $15.00, Co~erciai $15.00 ew Construction .... ~.. Old Or Pre-existing Building ................. ocation of Property.j~O ~FSNO~- ~O ...................... . House No. ' ' ' '' Street ...... ' ....... ,wer or Owners of Property .... ~''~ ...... l ................. ~/qmlet ~.~;..............~0~.. ~0, ~'~ ,unty Ta~ Map No i000,' Section...e,~.. .... Block ..... ~ ....... Lot ,~:, ''' , ..... - ....... ?mit No.~?'.' --~c ~ ~ /1~/~_ ' · / ..v~.,./ akth Dept. Approva2 ..... ........ ' ............. Underwriters Approval./ ... d App ............ arming Boar royal . '' ques~ for: Temporary Certificate. Final Ccrticate .... ~ .... e Submitted: $. ~)~ O0 Co A&I/)I ............... ~PPI.YcAt,~ ........... 7L' FORM NO. 1 TOWN OF SOUTHOLD ", '> ~) , BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ............ , Approved.../.~./4. C ...... 19?.'2'TPermit No.. .Disapproved a/c ..................................... /(Btlffdino Inspector) INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK~ .................... SEPTIC FORH .............. CALL ................... MAIL TO: Date ........ /~./ff... -, 19 f~f~ 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 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 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 inspections. ., ~ .................. --- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) Slate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , ........................ iJ~,0~ .It~ NOTED' '." Name or owner ofpremises _,f..ff./f.Y-ON' ,/~/~/X'OVC C 9~m/O/~[Y~ ~ (as on the tax roll or latest ~,~. ~, ~_.,. ~, 5~5~. If applicant is a corporation, signature of du~e~u[~o~~ ~ff~.~ 0~ N~ BUILOING DE~E~ AT ........ · ......... <~/.~ .......... 5~?Y ~ .97v , FOLLOWIN~ INSPE~ON$: (Name and title of comorate offi~ fi~ ~ ~,~ ~}~ ~ 1. FOUNDATION - ~OREQUIRED Builder s License No ....... ~. '~ ~,.~.~.~ .~,~ ~,~,~a~2. ROUGH F~MING & Plumuer s License mo ........ /.': ............... . FINAL - CON~RU~ION MUST Electrician's License No .... ~. q~¢Tq. ~.'¥.~5.~ '~ ~t~:~/~ ALL CONSTRU~ON 8HA~ MEET THE REQUIREMEN~ OF THE Other Trade's License No. . ~ STATE CONSTRU~ION & ENERGY ............... CODES. N~ RESPONSIBLE FOR 1. Location of ]and on which proposed work will be done .............OES!GN OR CONSTRU~ION ERRORS ? o ............... C .............. House Number Street Hamlet Cou,tx T~ ~p Xo. 100o s~otio, ..... ~ ........ mo~ .. 6 .............. ~o~..~ ............. SuMirisio~ ~(:~r,k ~ ~f~fe~' Xo [~/~ Lot [~/~ ............ ~"(9'~h~) ................ mi~d ~p . : .... - ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy D ¢ 3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration .......... Repair .............. Removal ............. Demolition ......... Other Work ff~.'~tq..~#TV 4. Estimated Cost .. ~. ~)~* 00 (Description) .......... ~ ......................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling 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 .... if any: Front Rear · Dimensions of existing structure~ .............................. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wilh alterations or additions: Front ................. Rear .................. Depth .................... .i · Height ............. · ........ Num her of Stories 8, Dimensions of entire new constraction: Front ...... /.~. t. .... Rear ....... .../~...t .... Dep"th'i ~ ~.' Height .. ~ .~ .......... ~umber of Stories /. .... . i .. 9. Sizeoflot Front /~.~6- [ R~r /~,5-; ............ ~'~'~ .... i,'~'tz; .......... 10. DateofPurchase ...~?~.~.e.~../.9'..~.. ........ .,Nam, e of Former Owner ~:.~;/~6~:{(i.~.~>:,~.).~o,-,~/ ..... 11. Zone or use district in which premises are ~i*uated A'.o-~ ~en-/-;a_/ ........... 12. Does proposed constructi, o~n violq,te any zoning law, ordinance or regulation: . ~ .......... 13. Will lot be regraded .../.~.t~.~r~.¢-~.O.a~.%-5_D:~.C,C_g ....... Will excess fill be removed from premises: 14. Name of Owner of premises/fi~.zbt~../~g#~Vg~q... Address,q~'.SP.~..m~a~.....~ Phone No (')'(g.).3..~?- 97.~-. Name of Architect . A,~ .... o · ,,, ,, · ...... Name of Contractor ' Address Phone No 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... ~If yes, $outhold T~wn Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly ~Jl ~uildings, whether existing or proposed, and~ indicate ~1 set-back dimensions from prope~y Hnes. Giw street and block number or description according to deed, and show street names and indicate whethe~ interior or corner lot. p , i STATE OF NEW Y¢~K, ' SS COU~y OF .... ~:~e~.$ .... ', ......... ...... (Name of individual signing contract) lbove named. being duly sworn, deposes and says that he is the applicant ............ da ....... 19 ?..~ Q¥ollf[od in Queens Coun~/ Certificate Flied in New Ygrk (7ounty qotary Pu!hc., .~.~7. ~ ..... County emm,,~,o. ~x~,r.,~ (Signature of applicant) MR. JOHN J GIALITI$ Notary Public, ~tote of New York ~woru to before me this i (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this tpplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner sot forth in the application filed therewith.