The URL can be used to link to this page

Home My WebLink About20554-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20914 Date AUGUST 5r 1992 THIS CERTIFIES that the buildin~ Location of Property 380 House No. County Tax Map No. 1000 Section Subdivision ACCESSORY WICKS ROAD NEW SUFFOLK~ NY Street Hamlet 110 Block 8 Lot 17 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 10~ 1992 pursuant to which Building Permit No. 20554-Z dated APRIL 16~ 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 BUILDING IN REAR YARD AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 JOSEPH & MONI~UE ROBIN N/A N/A Bu~ing tnspe'ct--o g TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERAAIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~PLETION OF THE WORK AUTHORIZED) NON? 2055~,Z Permission is hereby granted to: ~ ....... _~.~.~ .................. ~.....~...~:. ....... :..~.~...o...~ .............. '"v'H ............. T.] .................................... 7';,' ............. 'i ......................... <5"""~'";;'2[ .......................... o, premises located o, .....~...~,~......~..,~..~......~... ......... ~.~...~.~ ........................... County Tax Mop No. 1000 Section ...... ~..(....~.. ......... Block ..... .(~.~. .......... Lot No .....!..~. ............... pursuant to application dated .......... !...~. ....................... , 19.~...~..., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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.' Bo For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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 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 - $100.00 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 New Construction ........... Old Or Pr~e-e~isting B~_~lding...l .............. ~ Location of Property:..~.%~..~.~.~ .... ~.~.~' ...~.~....~.~..~.~ ........... ' House No. Street ~ HaMlet Onwer or Owners of Property ........ ~ .... --~ ~0..~ .......... ~ .. County Tax Map No 1000, SectiLn..J.I..~l.~.g'?..Bl°ck..:~..~.~"'..~ ..... Lot..~:.~.?.~i~..~ ..... '' Subdivision .' . . Filed Map Lot ~. ~. .......... ~ ~ .- . I .-.~.~Applicant.?.~.~ ~. Permit No. XO.~.~..~..Date Of Permit.~'~'~.~. ~C~.../~. ..... tlealth Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval .................. ...... Request for: Temporary Certificate ........... Final Certicate ........... ?OUNDATIo.~ ( ls t) '~OUNDATIO:! _~. IOUGH FRAME & (2nd) .PLUMBING INSULATION PER N. Y. STATE E~:ERGY CODE FI:;AL ADDITIONAL COMME~;TS ...... BOARD OF HEAL'flt FORM NO. 1 3 SETS OF TOWN OF SOUTHOLD BUILDING DEPARTMENT CIIECK TOWN HALL SEPTIC FORH SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~OT ~ FY; Examined, '~- .... ,~ ~o: .......... .......... · . ~r~ ~?~7 ' :,' "'~,.~,o~ ........ ~J ~ ........ ' ' ~ APPLIOATIOM FOR BUILDING PERMIT ~[[ ~ APR I 0 1992 ~/ , Date .................. , 19... INSTRUCTIONS a. Tl~s application must be completely filled in by ~pewdter or in ink and submitted to the Build~g Inspector, with 3 2ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan show~g location of lot and of buildMgs on premises, relationship to adjoining premises or pubic streets ,r areas, and givMg a det~led description of layout of property must bc drawn on the diagram which is pa~ of this app,- etlon. c. The work covered by tMs application may not be cbmmenced before issu~ce of Building Permit. d. Upon approval of this application, the Building Inspector will issued ~ Building Pe~it to the applicant. Such pe~it h~l be kept on the premises avaQablc for inspection throughout the work. e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy hall have been granted by the Building Inspector. ~PLICATION IS HBRBBY MADB to the Buildh~g Dep~ment for the issuance of a Building Pe~it pursuant to the ~ilding Zone Ordinance of the Town of Southold, Suffolk County, N~w York, ~d other app~cable ~ws, Ord~ces or ~egulations, for the construction of hurtings, additions or'alterations, or for removal or demolition, as here~ 'he app~cant agrees to comply with aU applicable laws, ordinances, building code, housing cod. e, and r~gmlatio~s, and t~ dmit authorized ~specto~ on premises and ~ build~g for necessa~ inspe~ns. / ~ / __ . .... ~..~ .~i..~ ,~.d~ ............... . .Z~..:~&. ~ ~ ~ r~.~.~./~g~./?x ~... (Mailing address of applicant) irate whether applicant is owner, lessee, agent, architect, engineer, general Contractor, electrician, plumber or builder. qameofownerofpre,nises .... ~O.I)td..~.o..~¢.p6. j~...~..~..F' ...................................... .. . .. (as on the tw.x roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........... /... '~.-.... Plumber's License NO .......................... . _://~/0/o"/- ]O Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ?,/1.<'.~.',5..~..o,,t:?. t),. ed ~ ¢~...~. ~.E~.o.~..~....~. ~..l.l?.~.~ .... ......3. ga. ........................ W;,.c..~. ~,o.~l ............... .~.~ .,..~¥.~. :,<... ................ tlouse Number Street Hamlet County Tax Map No. 1000 Section ..... /.4gal;ce'.° ....... Block .. ~,,~..o.. ,. ........ Lot..~t.T..o. tT.o .......... 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 . .'~'..~n ./{~ .'..~.g,O.'f~g.~/V// ............................................... b. Intended usc and occupancy ...,~.'~F,~..~.~.~.~.-. .................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... AAteration .... ...... Repair .............. Removal .............. Demolition ............ Other Work . . ..~/~ b ....... 4 Estimated Cost ~,'.~07. ' Fee ' ' ~ (to be paid on filing this application) 5. If dwelling, number of dwelling u0its . ~:.~ ~,. ....... . Number of dwelling units on each floor ....... . ....... . . .Ifgarage, numberofcars ~?.~ ................................................................. 6. If business, commercial or mixed ~ccnpancy, specify nature and extent of each type of us~ .................... 7 Dimensions of existing stmctures~ if any' Front Rear Depth Height Number of Stories D~ensions of same stmcturz wit~ alterations or additions: Front ................. Rear ................. Depth ..................... ~. Height ...................... Number of Stories ........... ~ ,~ ....... 8. Dimensions of entire new constn~'etion: Front . .~O.ff ........ Rear /~ ~ .......... Depth .,/~ ....... Height ............... Number of Stories ............................................. 9. Size el' lot: Front . ~ ~. ~ ~ '~O ~ ...... /.~ ~ .... ~ .......... Rear .................. Depth ........... 10. Date of Purchase ... I~. =~e.~ ............... Name of Fenner Owner ~.E: ~FF~ ........... Zo " l 1 I. ne or usc district in wlfich premises are situated .... , ............................................. I2 Does proposed ' ' ' ' ordinance or regulation: . construction wola~o any zomng law, ................................ 13. W~I lot be regraded .......... } .................. Will excess fill bo removed from premises: Yes No 14 N~o of Owner of premises ' Address Phone No N~e of Architect ........... [ ................ Address ................... Phone No ................ N~e of Contractor ; Address Phone No 15. Za th~s property within 300 feet of a tidaZ w~tZand? *Yes ........ No..~ ..... ill y~s, SouthoZd ~wn Trustees Permit may be required, ; PLOT DIAG,~ Locate clearly and distinctly ~1 ~uildings, whether existing or proposed, and, indicate ~1 set-back d~ensions from prope.y Enes. Give stroot =d block ~umb~r or descfiptio~ accor~Mg to deed, and show street ~es an~ indicate whether " ~ ~ ; ' ; " ' ' " ~ ( ' I '' I ;TATE OF NE~YORK, "~ S 'OU~ F ~~ ................ (Name of individual sign ng contract) being duly sworn, deposes and says that lie is the applicant bore named. · e is the (Contractor , agent , corporate officer, etc, ) f said owner or owners, and..~is,~lu!:, authorized to perform or have performed tile said work and to make and file this ~plication; that all statements conte ined in this application are true to the best of his knowledge and belief; and that the, ork will be perfo~ed in thc manne~set forth in the alSplication filed therewith., uom to before me this ~ r ] ~ ............ ..... .. ........... :.... ~ (S~gnature of applicant) ~TARY PUBU~ ~A~ OF NEW YOnK . aO. 4~'1'(6716~60 QUAUFIED IN QUEENS CO.