HomeMy WebLinkAbout20584-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20742
Date MAY 19~ 1992
THIS CERTIFIES that the buildin~
Location of Property 56863 MAIN ROAD
House No.
County Tax Map No. 1000 Section 63
Subdivision
ACCESSORY
SOUTHOLD, N.Y.
Street Hamlet
Block 3 Lot 17.3~
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 24~ 1992 pursuant to which
Building Permit No. 20584-Z dated APRIL 24t 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 STORAGE SI~ED 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
WALTER & CAMILLE ROHR
//~/~Bu~nC~ginspector
Rev. 1/81
lvOBl~ NO. ~1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST 8E KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°_N?
Permission is hereby granted to:
~.~ .................. .~.~...~' ................................
~....~.:~..:..:.,~.~._.~.,,~ ........ ,
~ .................................... ~.; ............ ~ ............... : ...................................... ~_...: ...................
o, premises located o, .~.~. · ......... .~. ........ ~q~rr~....~..: ....... ~~..~ ................
County Tox Map No. 1000 Section ..... ..~k..~ ......Block ...... ..~...~. ...... Lot No...!..'].:...~. ..........
pursuant to application dated ...~ ...... ..~.....~ .................. , 19.~.~and approved by the
Building Inspector.
Building Inspector
Re~ 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION 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.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
'Tpre-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.
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.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 $15.00
Date ...~-f~/.~ ..............................
New Construction..~.~gq. .... Old Or Pre-existing Building .................
Location of Property~.~.~Di~..~ .................................... ~9l~. ........
House No. Street Hamlet
Onwer or Owners of Property..~.~.~. ~..~>.~7~.c~.. ,~P~. ...................................
County Tax Map No 1000, Section..Q~. ....... Block ..... ~. ......... Lot .... ~. ............
Subdivision7 ................................... Filed Map,~..~..~..Lot ...... ~.~. ...........
Permit No..~..~.~. ~ .~. .... Date Of Permit....~,/.~/~ .~r'..Applicant...~.~.~...~ .........
Health Dept. Approval ........................ . . Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate. ~/
~Fee Submitted: $..~.~] ~.~ . . .
?OUNDATIO~!
(2ndl
~OUGH FRAME &
-PLUMBING
INSULATION PER N.
STATE E~/ERGY
CODE
FI:IAL
ADDITIO~I~L COMMENTS:
-y.
Wood Design
Peconic, NY
765-3090
Finest Quality
Storage Sheds
~ Gazebos
Playhouses ~ i'
Dog Houses ?:,',','-:
and other Wood Products
Immediate delivery from inventory
3 to 4 weeks on Cusfom Orders
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180~
Examined ' .~'..q.., 19~..~-
Approved .'~..q.., 19~[..~. Permit No.°~..°..~.~.. ~..~.
Disapproved a/c ....................................
................................
(Buildino Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .........
~:3- SETS OF PLANS ...........
~$URVEY .............. ~-...
jCI1EC~ ....................
SEPTIC FORH ..............
CALL .........
HAIL TO:
INSTRUCTIONS
'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.
th. 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, ordinance~building code, ho~tsing code, and regulations, and to
admit authorized inspectors on premises and in building for necess~Fy, Aj~ctiops. / ) J ~ w
. ....
--' ~.~ignatureXof applicant, or name, if a corporation)
.. ......
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........... 6q. .................................... .m ............... , .....................
Name of owner ofpremises ,~. ~. ,~.*. ~...~. ,C/~.O:~,,,//.~.....~..~.l~.~/~.
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly auth~orized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
House Number Street Hamlet
County Tax Map No. 1000 Section . .O..6. ~3. ........... Block ....'~.. ............. Lot .... /.'?:~. ...........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~.£l.~/a..45....0..o9.~4~. 6~-, ........................................
b. Intended use and occupancy .. . ~?R. VA. ~-.~..~.. ~, ........... ,-~i;:';~ ~ ................ .......
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Rem6val .............. Demolition .............. Other Work
//.~ i '(Description)
4. Estimated Cost ...... .c~ O~.*. ? .................... Fee..
(to be paid on filing this application)
5. If dwelling, number of dwelling drifts ............... Number of dwelling units on each floor ................
If garage number of cars I.
6. If business, co mercml or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structurei, ifany: Front ............... Rear .............. Depth ...............
Height ' Number of Stories
Dimensions of Same structure wiih alterations or additions: Front ................. Rear ..................
Depth .................... !. Height ...................... Number of Stories. .. ? ............
8. Dimensions of entire new constrnction: Front . / ~ .......
.. (& ......... Rear .. t/~ .......... Depth . ~. ............
Height ¢ / Nu ~ f St
.............. m er o ories .............. ...... -
9. Size of lot: Front ./.Z .1.,.o.~.... !, .......... Rear../~,,.x%,.3 ~ ............. Depth ~.~D. 4 :./..~ ............
10. DateofPurchase .</.!.ol.~.~..i. . NameofFormerOwner .]"oh,¥ a. Id~.l.-i. tLee,., r3
................ · ................. 7... p.cq .~.e..s..
1 I. Zone or use district in which prefldses are situated ......................
12. Does proposed constructmn wolate any zomng law, ordinance or regulation: ................................
13. Will lot be regraded ... ~,.O... i · · .; · ..~ ·..~ ..... Will excess fill be removed from ~remises' y~
14. Name of Owner of premises .t:o.~ ~ 'Pi .~....~9.t'( (<. ....Addres~-&-.'.~ ~. ~.~../~.~.f~i~. ~ e~one No.'. ~.d.~..~.~
Name of Architect .......... , ................ Address .................. Phone No ...............
Name of Contractor ......... ~ ................ Address ................... Phone No ............... :
15. Is this property within 3~0 feet of a tidal wetland? *Yes ........ No .... k~....
· If yes, Southold T~wn Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from
property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether
interior or corner lot.
APPROVED AiS NOTED
NOTIFY BHILDING D~'PA~:~
7654802 9 AM TO ~, PM FOR THE
FOtLOWING INSPECTIONS:
1, FOUNDATIO~ ~O REQUIRED
FOR POURED CONCRETE
2 RO~GH . FRAMING & PLUMBING
4 ~ ~;,~AI CONSTRUCTION MUST
F;F (;r~MPI,ET~ FORiC,O
TI~ ;~()HIR[I~flFNTS~ OF THE N.~
SI~'t'~ ~;LW~h~UCTION & ENERGY
CODES. o,~rF¢ RFSPi~)NSIBLE FOR
DESIGh' OF{ CONS FRUCTtON ERRORS
STATE OF NEW YORK,
COUNTY OF S.
(Name of individual signinl': contract)
above named.
being duly sworn, deposes and says that he is the applicant
He is the.'
i (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this
application; that all statements containled in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner s~t forth in the application filed therewith.
Sworn to before me this
· ¢ .... ~.. ,~.. Crx .day of ~ 1~ ~'-
- \\. ...... ...... , .....
/ '-" D,//
Notary Public, ~..~..¥~. ,.. ~. ,/.~x~.. ~ . County //] //
- _ M. WILKINS
Notary Pnbllo0 State of
No. 4952246, Suffolk CountY
Term Expires June i2, 19.~_g; .
(Signature of applicant)
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