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Home My WebLink About21066-zFORM' N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21136 Date NOVEMBER 6, 1992 THIS CERTIFIES that the buildin~ ADDITION Location of Property 2920 ALBERTSON LANE GREENPORT, N.Y. House No. Street Hamlet C~unty Tax Map No. 1000 SecLion 52 Block 4 Lot 1.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 5~ 1992 pursuant to which Building Permit No. 21066-Z dated NOVEMBER 6, 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 DECK ADDITION "AS BUILT" TO AN EXISTING ONE FAMILY DWELLING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A GEORGE COSTELLO SR. Rev. 1/81 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) No-No. ~10511Z Permission is hereby granted to: j/ .~...~....~.~.....~:.~ ...... !..~..~..~..~;. ~o..~.~....~....~.~.....~.....~........~...~ ...... ~ ....... ~~.~~ C~ ~.~..~ ............... .~ ......... ~ ..... ~ ..... ~ ........ ~...~. ........ ~ ........... ~ ....... _ ................. ot p~,~i,o~ ~oted ot ..~.~.....~~....~ ......... ~~~ ....................... ...................... .......... ............................................................................................... Coun~ Tox Map No. 1000 Section ...... ~.[.~ ..... 81~k ...... ~ ........ Lot No ..... .~.~ ............. pu~uont to oppllcotion ~ot~ ..... ~~,.,..~ ............... , 19.~.~ o~d opprov~ by Building Inspector. Fee $....~.,.. ............... Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802z ': 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: 1. Final survey of property w~th accurate location of all buildings, property lines, streets, and unusual natural or topographic features. Z. Final Approval from Health Dept. of water supply and sewerage-disposal(S_9 form). 3. Approval of electrical installation f~om Board of Fire Underwriters. · 4. Sworn statement from plumber certifying that the solder l]sed in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial b~ilding, multiple residences an~ 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-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 an~'~ 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. Fees I. 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. Cer.tificate 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. T.emporary Certificate of Occupancy - Residential $15.00, Commercial $15o00 .' .. ' ..... :u Construction....~ ....... Old Or Pre-existing Building ................. '''' ,cation of Property:..~. ?.~.? .... ~..~.~/~.~ ..... ~..~. ~ ~,~{--~ ," .... ouse . Street ................. ............ war or Owners of Property....~.~ ~£ ~o"-V~)IO ~nty Ta~ ~ap ~o ~ooo, Section .... 0..~..~ .. ~.~,. .~..% ~dlviaion ' .... Filed Map Lot .......... Date Of Permit... ...Applicant... ~a,,,~ ~lth Dept. Approval .......................... Underwriters Approval .......... · nntng Board Approval ' ues't for: Temporary Certificate ........... Final .... Certicate ....... Submitted: $ ..... :~ .......... APPLICANT OUNDA~ION (1st) OUNDATION ( 2nd ) OUGH FRA~-IE & -PLUMBING 1;SULATIO~! PER N. Y. STATE ENERGY CODE Fi~;AL ADDITIONAL COMMENTS 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined.../~).~.'~,,N~ .Lc., 19~J ~ Approved . }0~ .~..~.., 19~ .~. Pernfit No..~-..I.9.~..~...~ Received ........... ,19.., Disapproved a/c ..................................... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ..... /.¢~'. ......... , 19 ?.~. 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 cove)ed 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 shail be kept on the pr?nises available for inspection throughout the work. e. No building sh~t!l 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 Ordinanc~ 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) State whether applicant is~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ~ EC)J~ ~ E ..... ~..,...O~.~..~..T. E~-Ld>. ~.. 5..~.,. ............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of dnly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plmnber's License No ...... /V/Zt ............... Electrician's License No. ,~Co ff~. ?..L-E, CT.¢-. ) ~.. Trade's License No .... ~//~ .............. Other Location of land on which proposed work will be done .................................................. .... ...... ..... ......... }louse Number Street 't't~(n'l;t" County Tax Map No. 1000 Section .... O~ ........ Block ... ~ ............. Lot .~ .~.~.. J ........ 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 . . 0.~.~ . ~ ~ ~ ,~.. ~.~.~k~ ] N ~ ..................................... b. Intended use and occupancy h g.~ .~ B.D.I.[I.0 M ~ ....... ' .... t ~ ,~,., r~' 'e~a ~*~ h" Iteration .......... Repair .............. Removal .............. Demolition .............. er Vork ............... Sr i (Description) 4. Estimated Cost ......... /~:~.O~t:~..'w ................. Fee i (to be paid on filing this application) 5. If dwelling, number of dwelling un!its .... N/~s ....... Nmnber of dwelling units on eacb floor...,6///3 If garage, hum bet of cars .... -f'.WO ...... ' ........ If business, commercial or mixed Occupancy, specify nature and extent of each type of use .... IX.~ .............. 7. Dimensions of existing structures, if any: Front .... -Y.O .t ....... Rear Height ............... Numbe~r of Stories ...-r'.~.O ................. ' ' :. ........... Dimensious'of same structure withlalterhtions or additions: Front Depth ...................... I Helght ...................... Number of Stories .................... 8. Dimensions of entire new construclion: Front e t , .... .~a ... ..... Rear ... c~(o ........ Depth . .~.~/ .......... Height ............... Number of Stories . .ON~ .'.W. LT.I~..L? .fiT]. .... i ./) ............. ; ............. 9. Size of lot Front ..... .~.~.t ........... Rear ..... .oqO.~. ........... epth ...~c~.[ ............... 10. Date of Purchase . .~0~Nig. EP,,I...t.c~q.c{ ......... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..... ?x ~-,S.I.D ~ 19.171 P~ ¢-,- ............................... 12. Does proposed construction violatel any zoning law, ordinance or regulation: ..,k[O .......................... 13. Will lot be fegraded ...... ¥_F-.-%. ! .... , ............. Will excess fill be removed from premises: ~ No 14. Name of Owner of premises .~[c?gc~£. ~..CP.SiT~CJ~0Address G~,r,.-~.,.o..~.T ..... Phone No...~.~'2 7.0.6 ~.:~.. Name of Architect .......... fi///~ .......... Address .... ~.~ ............ Phone No .... ~.//q ........ Name of Contractor ~.o$.T.~LkD. ~/~.~I IN.~- ..... Address .C~ ~.e~lB. ~...(P,.17 ..... Phone No..~.Q~.: .L/.~.~.... [5. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .~'~7... *If yes, Southold Town Trust~es Permit maybe required. .. I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whetber nterior or corner lot. -cb 76B~'~802 9 AM TO ~ PM FOR THE FOLLO~A/~[~[; ~NSPECTtOP,~S: FOR POURED CONCRETE 2, ~OUGH ~ FRAMING & PLUMBIN~ 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR ALL CONSTRUCTION SHALL MEET TNE REOUIREMENTS OF TH~ N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ATE OF NEW YORK, ~UNTY OF .. ~..q .F Pp.q ~c,,. ..... S.S ............ G.r p.e (Name of individual signing cintract) ~.. being duly sworn, deposes and says that im is the applicant )ye nauled. is the ....... DkMt~.~. ,e,... I .................................................... ~ (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly au.~orized to perform or have performed tbe said work and to make and file tiffs ,lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be performed in the manner set forth in the application filed therewith. >ru to before me this .......... 3 .......... day of...~!lh~J .... County (Signature of applicant)