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Home My WebLink About20920-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall SouthoId, N.Y. CERTIFICATE OF OCCUPANCY No Z-20967 Date AUGUST 25r 1992 THIS CERTIFIES that the buildin~ REPAIR Location of Property 51750 MAIN ROAD House No. County Tax Map No. 1000 Section 63 Block 6 Subdivision Filed Map No. SOUTHOLD~ N.Y. Street Hamlet Lot 4 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 21, 1992 pursuant to which Building Permit No. 20920-Z dated AUGUST 24~ 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 E/liSTING ONE FAMILY DWELLING AS APPLIED FOR, The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DF/~ARTMENT OF HE/LLTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~LFXANDER KOKE & WILLIAM RUSCH -~ y ylldfng I-r~spector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERA~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NgN9 2092111Z ~te ...~4.-~.....r'.. ......... ~..~ ............... , ,~.~..~ / Permission is hereby gronted to: ..... ~:~..../..~:..~....~.. '~-~ ~. ....~.~....~..-.~.:....~..c~.~.~ ........... ,o%~.~...~.~t..~.:...~....~,....~.....~.~...~.~. ................................................................................ ~ ,,,i,e,,~,,~ ~,..;;~.~ ........ ~..~:....~.., ....... ~~ ......................... pursuant to oppJtcation datedII ~,~,~d~,~q.,~,.....,,..~...] .............. , lg?L..~.,, and approved by the Building Inspector. Budding Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FORCERTIFICATE OF OCCUPANCY A. 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 f~om Board of Fire Underwriters. 4. Sworn skatement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial b~ilding, 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 Vpre-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'~ 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 ever 5 years - $i0.00 4. .UPdated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.O0 ,ew Construction ........... Ol'd Or Pre-existing Building .... 7~ocatton of Property :... ~.t 7-~.-~ ................ ~/~'-~' ....... ~~. .... .... House Ne. Street Hamlet Inwer or Owners of Property ............................... ubdivi.sion.. [ .................. '. .... ~ ........ Filed Map ............ Lot ...................... strait No..'~ .... Date Ofm ,/Permit''~l'''~'/g' ..... Appli¢ nt..J~...~.~ ealth Dept. Approval .......... ,//.~-~.~- ........... Underwriters Approval.. -~z/.~J .................. ..... ....... '... equest £or: Temporary Cert±fieate ........... Final Certicate ee Submitted: ............................. ......... ............. OUNDA'TIO.N { 1 st) OUNDATION (2nd) ,OUGH FRAME & .PLUMBING 2~SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 19~ .~. Permit No..~J.O..~..~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH 3 SETS OF PLANS gURVEY .................. ClIECK SEPTIC FORH ............. CALL ./~-- HAIL TO: a. Tlds application must be completely filled in by Wpewriter 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 lochtion of lot and of buildings on premises, relationship to adjoining premises or public streete 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 tkis 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 appl~cant. 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 am) 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 Bu~ding 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecltions. ...... ~.4//~. ~~..~/_,-~¢~..,~... -- , (Signature of applicant, or name, if a corporation) / ~ . ... (Mailing address of a,15plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ' (as on the tax roll or latest deed)" V ¥ If applicant is a corporation, signature of duly auth~orized officer. ' DATE: ~ .......... /~..,.. NOTIFY BUILDING DEPARTMENT AT ~/ (Name and title of corporat~ officer) 765.1802 9 AM TO 4 PM FOR THE ~o~ow, Ns ,N~PEC~IONS: Builder's License NO.../i.g~¢. ~ ........ '. FOUNDA/'ON ~O ~EOUIREO ' 1 FOR POURED CONCRETE Plumber's License No ........ ~ ............. , C~ ~"~[~., 3.2' ROUGH.- FRAM,NG , PLUMB,NG Electrician's License No ....... ~ ....... ~2¢~ Other Trade's License No . t',/' ....... 7t ..... I. Location of land on which proposed work will be'don~~ ............ ...S.. 7.~..a .................... ~/~.~ ................. ' ........... 5~ ....... House Number Street Hamlet County Tax l~ap No. 1000 Section ...... ~ ........ Block .................. Lot ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. - isting use and occupancy .... ........ .......... b. Intended use and occupancy ....'""~"'"'"":-''~- n ~,,~w... ~'v..~,'t~. :/.,>w.. ,~... :-:..-._ :<.~,¢~ _., ....... 'propertYinterior °r c°rner II°t'lines' Give street and b Io cxk~number, or description__ ' ~ ~-~ace°rding_ to deedland, s~ street 3. Nature of w,ot/lr~check which applicable): New Building .......... Addition .......... Alteration ......... Repair ...r .......... Removal .............. Demolition .............. Other Work .............. .. Il pti°n) 4. Estimated Cost ...... ~.~'0~. ....................... Fee .................................... : ! (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 ....................................................................... 6. If business, commercial or mixed occupancy, specify natum and exteht of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ............... ~ ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................ : ............................... 9. Size of lot: Front ...................... Rear ...................... Depth 10. Date of Purchase .................... . ......... Name of Former Owner ............................. 1 I. Zone or use district in which premises 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 No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No. . Name of Contractor .......................... Address ................... Phone No ................ 15. Is chis property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from names and indicate whether ¢ toe-co~ STATE OF NETM YORK.. .... .S ' · coum'Y OF ...... } ....................- .N~.. ,~M~7'~/(/~ ......... being duly sworn, deposes and says that he is thp applicant (Name of individual signing contract) ' ., above named· '.-: e is the ................ (Contractor, agent, corporate officer, etc.) . of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be perfo/med in the manner set forth in the application filed therewith. Sworn to before me this .......... ...... · , et~a.~t, yom \\~, Il,., ' /I /~,.~*-.. . s,,,. ....... 3DJ'VI& ........ Ou.llfled in Suff~k County, .~....h...~-~ ~c// (Sigmlture of applicant)