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Home My WebLink About20609-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20771 Date JUNE 5~ 1992 THIS CERTIFIES that the building. ACCESSORY Location of Property 380 GAGENB LANDING ROAD House No. Street County Tax Map No. 1000 Section 70 Block 10 Subdivision Filed Map No. BOUTHOLD ~ N. Y. Hamlet Lot 19 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 4, 1992 pursuant to which Building Permit No. 20609-Z dated MAY 4, 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 SHED AS APPI./~D FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A JOHN & DINKA ANTICEV Build~ Inspecto'r ~/ Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT FI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COI~PLETION OF THE WORK AUTHORIZED) Ne-N? 20505Z Permission is hereby granted to: ..... .~.LL~ ....... 9.~......~..:....~ ........................... _ ~ ...~.~.....~:~..:..~.).~~ ......... . County Tox Map No. 1000 Section ..... ..~..,~....~. ........ Block ...... k..~. .......... Lot No....1...~.. ............... Building Inspector. approved by the Building Inspector Rev. 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 Healgh 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 "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 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. 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 - $i00.00 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, Con~ercial $15.00 ~ Date ........................ New Construction ........... Old Or Pre-existing Building .......... .... i i!i i.[~f~.~.(i~l~. ]~i'~.. Location of Property..~]~.e~.~g[.~..~.~A~.'~...~.~.?~!~.~ ~. Hamlet Onwer or Owners of Property ............ County Tax Map No 1000, Section .... .~..~. ..... Block ....... J.~. ...... Lot ..... ~.~ .............. Subdivision .................................... Filed Map ............ Lot ...................... ~ermit No ................ Date Of Permit ................ Applicant ............................. {ealth Dept. Approval .......................... Underwriters Approval ......................... ~lanning Board Approval ........................ (equest for: Temporary Certificate ........... Final Certicate ........... II~SPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 SCOTT L. HARRIS, Stq~ervisor' Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD MAY 29, 1992 JOl~l ANTICEV 1115-74th STREET B BROOKLYN, NY 11228 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: ~ An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xxx The check is ~'not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 20609-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. ?OUNDA'TION ( ls t) :OUNDATION (2nd) ~OUGH FRAME & .PLUMBING ;NSULATION PER N. Y. STATE ENERGY CODE FI~IAL .I ADDITIONA'L COMMENTS: LANDING F'40AD FORM NO. 1 ',~ ~ wAY ,a 992. :~ ii! TOWN OF SOUTHOLD !ii~'~ -- ~ 'ji ~!,~UILDING DEPARTMENT ~t3~L .............. :-,~,,~;, ~ ........ ~J'~'~' ~ TOWN HALL I ,~{~'2~¢}~;~J~OLD ~OUTHOLD, N.Y. 11971 TEL. 765-1802 Approved. ~. ~. 5 ., 19 ~. ee~it No. ~*. ~g ~. Disapproved a/~ ................................... ............ (Building Inspector) APPLICATION FOR BUILDING PER~IT BOARD OF HEALTH ......... 3 SETS q~-L,Xr~S . . CIIECK ~ .......... SEPTIC FORH .............. Date .................. 19... INSTRUCTIONS a. Ttfis 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- zatien. 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 3hal~ 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 ~hall 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 3uilding Zone Ordinance of the Town of South61d, 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. l?he applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspections. -- (Sigffature of applicant, or name, if a corporation) ., 7 H ,. ..... 1//::...~ .... ~,..,:...F.,.?.~. A..~.,. l/.22 g (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade s License No ...................... Location of land on which proposed work will be'done .................................................. House' ' ~' '~' '~' Number ...... .~..&..~ ¢..~/.5...~..ti .lq C~ ~.c~-..--- .................................................... ~ Hamle; County Tax Map No. 1000 Section .... .~..~. .......... Block /(-? Lot /<5~ Subdivision ..................................... Filed Map No ............... Lot . . . ./.d~. ........ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... .m..>/.~:.,0. ~'" ..... bi dd d p y '> · nten e use an occu aBC ............................ :... ............. ; .............. 3. Nature of work (check which aplplicable): New Building .......... Addition Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... , ,:.~,~., oO i (Description) 4. Estimated Cost..."~...~..'. 7 .......................... Fee ..... I (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... · Dimens ons of exmt~ng structure , ·. pth ............ Height Num,ber of Stories ' Dimensions of same structure wRh alterations or additions: Front ................. Rear ................ Depth ....................... Height ...................... Number of Stories .................... 8. Dimensions of entire new constr Iction: Front ............... Rear ............... Depth ............. Height ............... Num )er of Stories ...... , ........................................ ....... 9. Size of lot: Front ..................... Rear ...................... Depth ............. ......... 10. Date of Purchase .................... . ......... Name of Former Owner ............................. 11. Zone or use district in which pre: nises are situated 12. D°es proposed construction viol&re any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i .................. Will excess fill be removed from premises: Yes No 14 Name of Owner of premises i Address · ' ..................................... Phone No ................ Name of Architect .......... I ................ Address ................... Phone No ................ Name of Contractor ......... i ................ Address ................... Phone No ................ 15. Is this property within 3,00 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Tlown Trustees Permit may be required· PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions froth amber or description according to deed, and show street names and indicate whether property lines. Give street and block n interior or corner lot. ~TATE OF NEW YOR~, ~.. , S.~ :OUN ¥ OF ....... .... ............ (Name of individual signing contract) ~bove named. APPROVED AS NOTED .... 1'4Of trY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR I'HE FO[ LOWING INoPEC 1. }:OU~DATION TWO FOR POURED CONCRETE 2. ROMGH ~ FRAMING & PLUMBING 3. INSULATION 4,, FINAL CONSTRUCTION MtJST BE COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, STATE CONSTRUCTION ~ ENERGY COOES. NOT RESPONSIBLE FOR · DESIGN OR CONSTRUCTION ERRORS ... being duly sworn, deposes and says that he is the applicant [e is the ...~ ........................ (Contractor agent corporate officer etc ) f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this pplication; that all statements contain!ed in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner s~t forth in the application flied therewith. worn to before me this otary Public ..... ounty (Signature. of applicant) NO, 4