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Home My WebLink About20923-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20976 Date AUGUST 27~ 1992 THIS CERTIFIES that the building. Location of Property i500 HENRY LANE House No. County Tax Map No. 1000 Section 74 Subdivision ADDITION PECONICr N.Y. Street Block 2 Lot Filed Map No. Lot No. Hamlet 24 conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26~ 1992 pursuant to which Building Permit ~). 20923-Z dated AUGUST 26~ 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 DECK ADDITION TO AN EXIBTING ONE FAMILY DWRV~.INGkS BUILT The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MARIETTA L. SILVESTRE B iiding nspeetor 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°. 209231Z Dote ........... ...~...~..~...~. ............................... / Permission is hereby granted to: .... ~.~ ~.,..~ ~... ~..:... ~/..x...~ ~ ........... ......... L~oo....../Y..~...~..'.~....~ .............. ---- ..... ~.~,. ............... ./. ....... .?,4 ................................... . ~ . 7 ';';.",.~";.i i i ....... ;,;'; ......... ;;..../;. '//./ Z-/,.;;;. .......... /~'. '/J ....... ~".;. : ........ ;-',".;.".;..: ........................... ';" ot p~,~,es focoted ,t .......... Z~.°...°.. ...... ~..<.~.../../..~.....~ ..................................................... ~r__~,~/~_/ .~:Z', ~. ..................................... .~ ....... ~~......./......../..~../..~.,a..~...,J. .................................. County Tax Map No. I000 Section ....... .~.....~/.. ........ Block .....I~....~:.. ........ Lot No ........ ,fi...~... ....... pursuant to application dated .................. '"~/--~.~...~..~.. ...................... , 192..~.., and approved by the Building Inspector. Fee $...~ :.....~.. ..... Bul~or ' * Rev. 6/30/80 Form No. 6 TOWN OF SOUTtlOLD BUILDING DEPARTMENT TOWN HALL 765-1802 · APPLICATION FOR CERTIFICATE 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: I. 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, e 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 qses: 1. .Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application end's 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. 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 - $I0.00 . 4. ~Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 / Date ........ ~/. ........... ~.~ew Construction ..... /.. .... Old Or Pre-existing Building ....... · .... ...... /'1 · Location of Propertyl /~-~ ........ ~.~. ~ ~..~. ~..~. '.o House No. Street Hamlet )nwer or Owners of Property ........................ · · .. .. ..... . :ounty Tax Map No 1000, Section ..... ~.'~..?....Block ........ ~ .... Lot ....... ~.'~ ......... :ubdiviston... , ........ .... 'ermit No ................ Data Of Permit ................ Applicant ............................. {ealth Dept Approval . . Underwriters Approval . . 'la,ning Board Approval.. ................... . · · request for: Temporary Certificate ........... Final Certicate ........... 'ee~,Submitted:$~ ..... ' ..................... ....]~/~ ..... / ~'~ . ' APPLICANT \pproved ................. 19 . Permit No...o~.. ?.~fl..~.. Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 .. . 9Buildino Inspector) APPLICATION FOR BUILDING PERM IT BOARD OF HEALTH ......... URVEY .......... [ CIIECK ..... SEPTIC FORH ............. NOT I ~¥: CALL .................. HAIL TO: Date ......... ' ......... 19 INSTRUCTIONS a. Tlds application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ts 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, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~tion. c. The work covered by th. is application may not be commenced before issuance 0f Building Permit. d. Upon approval of this application, the Building Inspector will ispued 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 untiI a Certificate of Occupancy roll 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 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 all applicable laws, ordinances, building code2 housing code, and regulations, and to imit authorized inspectors on premises and in building for necessaw insl;~7~/gns~'7 . -- : (Si~,n,~Yure of applicant, or r~ame, if a coj~poration) tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.. · 6,,.,' Ju ~: ~ AP.PROVED AS NOTED ................. ~' ........................ 'i>~ ............... ~,,, ~ ...,,_.,.~.... _ .__..__ .......... ~ .............................. ~ ~:. ~,:~ [~Y:,~ ~. (as on the tax rolI or latest de~l~ BUILDING, DEPA~ENT AT applfc ntisacorporation, signatureofdulyau~zedo~yer.70NCY 0R FOLLOWfNG lNSPECTIONS;765'lEO29AM~4PMFORTHE I, ~OUNDATION - ~OREQUIRED ........................................... FOR POURED ~NCR~E (Name and title of co~orate ofOc~ [C~ H[ll AIAtrH/ 2 IS ,NSu~TION Plumber's License No ......................... Iect c,an's icense ............. 0CCUP^NCY Other Trade's License No ...................... ALI.. CONSTRUCTION SHALL NIEEI THE REQUIREMENTS OF TIlE STATE CONSTRUCTION & ENERG~ CODES. NOT RESPONSIBLE roi; DESIGN OR CONSTRUCTION ERROR~c Location of land on which proposed work, will be' done ................................................. .......... ..... ........ ..... ...... .......... Ilouse Number Street ~ Hamlet . ...... ~ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existin,, use and occur>anc ........... Rep~J~ .............. Removal .............. Demolition .............. Other Wor~~ r(Descnptlon 4. Estimated Cost ....... ~. :.~ .................... Fee ................................... (to be paid on filing this application) 5. If dwelling, number 0f dwelling units ..... ~ ....' ..... Number of dwelling units on each floor ............. . If garage, number of c~s ...................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............. Height ............... Number of Stories ...................................................... D~mensions of same structure with alterations or additions: Front ................. Rear ................ Dept~ ...................... HeiSt ...................... Number of Stories .............. ':. .... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... ~umber of Stories ............. ,.. v ? ..... ~ ...................... ~ ........ 9. Size of lot: Front ...... ~O. ~t ~ t ...... Rear ....... ].~.... ~ .... Depth ..... f~.*. A ~.-. 10. Date of Purchase ............... : ..... ......... Name of Fo~er Owner ............ : .............. 11. Zone or use district in which premises are situated ................................................... 12. Does proposed construction violate ~ny zoning law, ordinance or regulation: ................ . .............. 13. Will lot be regraded ...... ...................... Will excess fill be removed from premises: Yes 14. N~e of Owner of premises .... ~t [ ~.~. Addr¢ss./¥~. ] ~ .... Phone No. ~ ~. ~5. Is th&s property w~thin 300 feat of a t~daZ wetland? *Yes ........ No *If yes, Southold Town Trustees Permit may be required. PLOT DIAG ~ Locate clearly ~d distinctly ~1 build~gs, whether existing or proposed, ~d, indicate ~1 set-hack d~emions fro prope~y ~nes. Give street ~d block number or description accord~g to deed, and show street nines and indicate whe~, ~tefior or comer lot. STATE OF NEW YOlk, ~ -- COUN-rY OF ...... S.S . , ... ~.. .L...............,.....-.U' being duly sworn, deposes and says that he is the applican (Name of individual signing contract) ~bove name. ~fe is tim ............................... ~.~ .............................................. , (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly authorized to perform or have performed the said work and to m~e and file thJ ~pplication; that ail statements contained M this application are true to thc best of his knowledge and belief; and that th york w~l be perfomed in }~e~anner set forth in the application filed therewith. ;worn to before me this/" /. ~ "( g t~;';;~''ppl ·