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Home My WebLink About20528-z~'ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20764 Date JUNE t, 1992 THIS CERTIFIES that the building. REPAIR Location of Property 1060 MOORES LANE NORTH House No. Street County Tax Map No. 1000 Section 33 Block ~ Subdivision Filed Map No. GREENPORT, N.Y. Hamlet Lot 43 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 6, 1992 pursuant to which Building Permit No. 20528-Z dated APRIL 8~ 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 REPAIR FIRE DAMAGE TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. CARL & RUTH NELSON (owners) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PENDING - MAY 7~ 1992 N/A Building Inspector Rev. 1/81 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? 20528Z Date 19..~....~ Permission is hereby granted to: A t, ....~.~.g....~....~~~.. ...~..~..~..~. .................................................. ...~.~.~.....~..:~..:....~.~...~..~.~ ........ ~ ~o ...~~....~...~.~..~.....~~.....~..~.~ ............. ..~..~.~.,...~.:...~~..~_~~...-.-- ~ - ~.,~, ~-~-- ~. ~-- .................. ~ ....................... ~ ............. at premises located at ../....O....~...?......~.~...~..,..~...: ........ .~-~q,~2.~..., .............. County Tax Map No. 1000 Section ...... (~..~,~ ..... Block ...... .(~...~.. ....... Lot No, ..,,~,.,~,,. ............. . pursuant to application dated ...~......~. .......................... , 19.~....~T.., and approved by the Building Inspector. Fee $...~... ................ Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN I~LL 765-1802 A~PLICATION 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: 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 ~roperly 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 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, Commercial $15.00 - . ..... 7' -- ~--.., / fM.~. ,-. ....... New Construction ........... Old Or Pre-existin~ BuildinR.'....~... -- ...... oration of Pronert,,.... House No.' S ..... '~ ........... ! .......... - . ......... . County Tax Map No 1000, Section .... .~.~.: ..... Block ..... ..~..-. ...... Lot....~...~. .............. Subdivision ..................... Filed ............... Map ............ Lot ......... ~ ............ Permit No. ...Date O£ Permit ........ pplicant ...... ~f. . ....... Heal t, D pt A, prov 1 ..~j~/ .~.~,.~.. ~ e . ~ a ........ d rite Appro al Planning Board Approval ........ Request for: Temporary Ccrtificate ......... Final Certicate..~..~/~ Pee Submitted: $ ........................... ~.~. q 3~65 .. , Co ~0~ ~ ~PnICA~T FOU~ D A T I_~ON (1st) FOUNDATIOII (2nd) 2. ROUGH FRAME & -PLUMBING 3. INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COM~jE~;TS . !' ,~i, 'APR - 7 992, .... Approved .~... ~..., 19 ~. Permit No.a~ ~. Disapproved a/c .................................. ............. (Building Inspector) APPLIGATION FO~ BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TQWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 SETS OF PLA;tS . .. ~ ...... SURVEY . . SEPTIC . HAlL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 zts 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 areas, ~.nd gxvmg a detailed description of layout of property must be drawn on the diagram which is part of thi~)pli- ¢. Thee work covered by this application may not be cbmmenced before issuance of Building Permit. d. Ubon approval o£ this application, the Building Inspector will issued a Building 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 mil have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance df a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to :[mit authorize~inspecto; on premises and in building for necessar~ inspections. ~ (Signature of applic'an}j ;; ~l~m'e} ii ~ ~;~'~a~io'n') .... (Mailing ad/dress of applicant) tare whether applicant is owner, lessee, agent, architect engineer oener-I .... '-~-* ' (as on the t.w~ roll or latest deed) ' appticgn'ois a 7~rporat~,~sj?jFX~%e of duly auti~rized officer. .tie corporate o 2r) · Bu e/r's Lice ! 0 Plumber's License No ......................... Electrician's License No. ~,l 7 !.~D.. .~.-. .~:' Otlier Trade's License No ...................... Location of land or~ wh ch proposed work w be d'(~ne . house Numoer Street i~' '~ ~ 't'~t' ~'~ County Map No. lO00Sce,on .... ........ B,ock .......... ........... Subdivision ................ (}q'allt~" ............... Filed Map No... ~ ) ~ ............ Lot ............... State existing use and occupancy of premises and intend~ed use and .occupancy ~f proposed construction: b. Intended use and occupancy ....... /. / - ' ' 3. Nature ofwor,l~-(check which a ' . . · ' . / Pphcable): New Budding .......... Addition .......... Alteration .......... 4. Estimated Cost. - . ---~-..i. (Desc tion) ' (t paid fill ~ thi ppli ) , o be on n. s a cation 5. If dwelling, number of dwelling [mits ............... .Number of dxvelling units on each floor .' ..... . ...... ·If garage, number of cars ....... . ........... · ..... . .... 6. Di usiness, commercial or m~xed occnpancy, specify nature and extent of each type of use ..................... 7. H mensions of existing structure~, if any: Front ............... "Rear .............. Depth ..... eight ............... Number of Stories ......... . .......... ens ohs of same structure w~ittt alterations or additions: Front ................. Rear .................. Depth ......... . .......... I. · Hmght ...................... Number of Stories .......... * 8 Dime io ofc tn ti Fro ............ · ns ns nhre new cons tc on: nt ................ 'Rear .............. Depth .............. Height ............... Number of Stories ............ , ................ 9. Size of lot: Front ........... ! ........... Rear.. .Depth ............. t ........ 10. Date of Purchase ........ i .................. ................. Name of Former Owne~: . 11. Zone or use district in which prelnises are situated ...... ' ......................... truc on w an zoning law, ordinance or regulation: .......................... 13 ....... ..... · + ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises · 4 · · · · . ............ Address Phone No. Name of Architect ' ' ................................. .......... ~ ........... Address , ' .... · .................. Phone No ................ Name of Contractor ......... ~ ................ Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold T6wn Trustees Permit may be required. 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 nt~mber or descr/plio~, according to deed, and show street names and indicate whether interior or comer lot. FEE: ~_. BY: NOTIFY 8D¢.DING OEPARTMENT AT 765-1802 9 AM TO 4 P~ FOR 'rH~ FOLLOWING 1NSPFC 1, FOLJND,~TIO('~ WVO (~EQLJIRED FOR POUBED CONC~Ut'~ 2. ROLIGH - FR,~X~VIING g ~'L.UM(~ING 3. INSULATION 4. FINAL, CON~iTRLIC'f~ON ~JILIST BE COMPLET~ FOR C.O ALL CONSTRUCTION SHALL MEET THE REQDIREMSNT~ OF THE N,Y. STATL CONSTRUCTION & ENERGY COOES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ATE OF NEW YORK ,_ i ,, ~ ' ..... t ....... ~ ..... being duly sworn, deposes and says that he is the applicant (Name of individual signingjcontract) . ls the ...., ............. , ........ I (C ............................................... ,, ontractor, agent, corporate officer, etc.) said owner or owners, and is duly a6thorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the bes't of his knowledge and belief; and that the ~rk will be performed in the manner sci forth in the application filed therewith. 'om to before me thi~. i Qualified In Suffolk Coun~r ~ Commission Expires May 22, 1{~ ~, '