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Home My WebLink About21086-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22648 Date OCTOBER 8, 1993 THIS CERTIFIES that the building County Tax Map No. Subdivision ALTERATION & ADDITION Location of Property 455 HOBSON DRIVE LAUREL~ NEW YORK House No. Street Hamlet 1000 Section 122 Block 6 Lot 24 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NO%~E14BER 10~ 1992 pursuant to which Building Permit No. 21086-Z dated NOVEMBER 17~ 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 ALTERATIONS TO EXISTING STOOP & RAMP ADDITIONAS ~PLIEDFOR The certificate is issued to MADDIE MILES (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /J Building Inspector Rev. 1/81 leO~.M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N N? 21086Z Permission is hereby granted to: ~/ ~ , , // at premises located at ..... .~..~'7-..~.....~...~..'~.x~J~.~. ......................................................... County Tax Map No. 1000 Section ........ .'~..~....~-~. Block .......... ~. ...... Lot No ........'~...~ ..... .../.../.~/'/~/./.. d~ ..... 19..c~'....%~and approved by the pursuant to application dated .. ~,.~.... .................................... , Building Inspector. Fee $....c,~....~,4(..~ Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~ 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY .... A. ~his application must be filled in by t~pewriter 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 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. 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. 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. tf a Certificate of Occupancy is denied, the Building Inspector shall state the reason~ therefor in writing to the applicant. C." 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. Certificate of Occupancy on Pre-existing Building - $100.O0 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.O0 New Cgnstruction. A%g¢r~tioo Old Or Pre-existing Building ................. Locatio'n of Property .4~ ~o.n D.r~ye. L.a.u.r.e. 1.,. House No. ~ Street Hamlet Onwer or Owners of Property Maddie Miles County Tax Map No 1000, Section....l~ ......... Block..6. ............ . Lot...2~4. ................. Subdivision ................................... . Filed Map ............ Lot ..................... . Permit No....2~l.OJ~.fg ....... Date Of Permit ............. · .. Applicant ............................ . Health Dept. Approval .......................... Underwriters Approval ......................... Planning Bo rd Approval Request for: Temporary. Certificate ........... Final Certicate ....... .... Fee Submitted: Maddie Miles APPLICANT' 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. I N.~U~TION i~NAL DATE INSPECTOR~~ OU~DATIO:I (lst) 0UGH FRAi-IE & -PLUMBING IISULATIO:! PER N. Y. STATE EIlERGY CODE · It !1 ADDITIO}IA'L COMHEHTS: FORM NO. 1 TOWN OF SOUTHOLD i~?,;~, i ~ ..~i BUILDING DEPARTMENT TOWN' HALL SOUTHOLD, N,Y, 11971 /~.~ TEL.: 765-1802 ·~? ........ , 19~./..~'""' Examined Approved..d//.~./..'~. ....... 19 .~.. Permit No. 2/0 o~ ~ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FOd~tl "'~ bb/C'14;""'~' ...... CALL ...... MAIL TO: Date ...... 0. .......... 19 .~.~. a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 set's 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 pact 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 inspe/c~ions. , /9 --' (Signa~e~f applicant, or name, if a corporation) . .......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, el.ectrician, plumber or builder. Name of owner of premises .... ff~.ad~, d.(~...].~ ;/~. S ..................................................... (as on the tax roll or latest deed) If a~plicant is a corporation, signaCare of duly authorized officer. ..... ...... :..i ...... (J ' (Name and title of corporate officer) Builder's License No...~. ~,..q.0.q. :. ~..~. ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ....................... ....... .................. vt..4t. .......... House Number Street Hamlet County Tax Map No. lO00 Section ..... l¢.4 ........ Block ....... --~. .......... Lot ...... ~.--.ti .......... 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 :~., I IQ. ~,al/~vtu ';: "' ' ~' ':'~ !' :i" ' ~' b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. RemoVal ...... , ........ Demolition .............. Other Work ............... 4. Estimated Cost ........... --: ..................... Fee f ...... ' i (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" fJj'' ./t~'.... '. ....................... . ............................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...t{//~L ...... ~ ........ 7. Dimensions ~f existing structures,! if any: Front .... ct.."/~ ~ ..... ; Rear ... ~.'7., ,.[. ......Depth...~.,.~ ......... Height . lB. ............ mumbler of Stories.. I'. ...................... Dtmens,ons of same structure with alterations or add,trans. Front .... ~..~.~.~. ........ Rear..i&~,~i ...... Depth ....... g~,~n,,rL ......... i. Height ....3. a.~ t.~ ............ Number of Stories... ,~.~.% .&. ...... ~,..' .... 8. D~mensmns of enttre new construthon: Front ............... Rear ............... Depth ............... Height .............. Humbler of Stories '.~... i 9 Size of lot: Front ' Rear. ,' Depth I0 Date of Purchase ~ Name of Former Owner 1 I. Zone or use district in which preniises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ............. Will excess fill be removed from premises: Yes 14. NameofOwnerofpremises ..~A.+ha..~.}~_~ .... Address ~,hg~A ~.~,- ....... PhoneNo ~(4f:.~rj~.(.I.N'. Name of Architect , ~a~o~4 ph~,., x~,, N. ame of Contractor ....... h[tx.w.. ~.~.(~Lc ...... Address ................... Phqn¢ No..'7~.t/.qT..~.~i~. .... , 15. xs this property within 3D0 feet of a tidal wetland? *Yes ........ No.~ ..... *If yes, Southold T.~n Trustees Permit may be required. ... i PLOT DIAGRAM Locate clearly and distinctly all. buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block n~ tmber or description according to deed, and show street names and indicate whether interior or corner lot. AP~J~O~/~*D AS NOTEO __ NOTIFy 765-1802 .,:1 AM TO z~l P~M'-KOR THE · FOL/,OWING IN~:~FCTiQr.:iS. FOR POURED CONCFiF:T[ 3 INSIJI 4. FINAL CONSTRUcTIoN MUST BE COMPLET[: FOR C.O, ALI. CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUcTIoN & ENERGy CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS COUNTY OF../~:~ TC..t~qfl. '? , ........ ,& ,k, .... o . c . . .:' . ................. being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) above named. is the ~ ~; ; ; 'te officer, etc.) a nt, cop ra )f said owner or owners, and is duly autho~z~t to--t~o and to make and file this rm or have performed the said work~ lpplication; that all statements contain,~ed in this application are true to the best of his knowledge and belief; and that the ,york will be performed in the manner set forth in the application filed therewith. gworn to before me this ~ ! , , uomml~mn I~xpires uecemn!r 8, 19~ .~) ' (Signature of applicant) '1 'M~SEL' M/LES AT MATTITUCK ~0F°