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Home My WebLink About20637-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20784 Date JUNE 12~ 1992 THIS CERTIFIES that the building Location of Property 415 CLARK ROAD House No. County Tax Map No. 1000 Section 51 Subdivision ACCESSORY SOUTHOLD, N.Y. Street Hamlet Block 3 Lot 21 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 13~ 1992 pursuant to which Building Permit No. 20637-Z dated MAY 20{ 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 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 AT,~X & EUGENIA SPIRIDAKIS FO~M NO. ~ 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? 20637Z i 9..~...,z- Dote ....... ..~.... ........................... , / Permission is hereby granted to: .... ~.../~..~.,~./.~ z..~.~ ~..,.~. ............................. ..... ................................ · . .~o ~ w', ~ ...................... ~..~ ~,~,~,~// ~ ........................ ~.~/~.~ .................................. ~ ............. ./(....~./,~..~,~.. ........................................... County Tax Map No. 1000 Section ....... ..~.../. ........... Block ..... .~...~... ........... Lot No .......... ..~.~.. ....... pursuant to application dated ............ ~ .~.~. .................................... , 19...~...~., and approvc~ by the Building Inspector. // B6ildl.g I~tor Rev. 6/30/80 TOWN OF SOUTiIOLD BUILDING DEPARTNENT TOWN HALL / ~ 765-tg02 ~ ~PLICATION 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: 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. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I% 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. B. 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 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 ate ..... aw Construction ........... Old Or Pre-existing Building ................. House No. ' ........... Street Hamlet'~' ~ .... ~wer or Owners of Property /~. ~ ~.~ ~.1 ~. " ' · ... .~g.I ......................... .unty Tax Map No 1000, Section. dP / .... ~. ....... Biock ..... O.~. ....... not ...... .O..~ .......... bdivision .................................... Filed Map ........... Lot .............. .......... Underwriters Approval. . ................. inning Board Approval .... ~.~. ............... 'uest for: Temporary Certificate ........... Final Certicate.~~' FOUNDATION 2. ROUGH (2nd) FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE Fi;;AL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y'. 11971 i ~:f~i ' TEL.: 765-1802 Examined· !']' ' ~" "!.'..' .... 19¢.25-. ·..d//.,h2. .... ..... 19 ~z<. Permit No. Approved Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS SURVEY ................... CIlECK .................... SEPTIC FORH .............. C^LL ~'~,~.~ .~.. ,2 A~ .... HAIL TO: · /(/Bu'fldin~, Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .................. 19 a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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- ation. · c, The work covered by this application may not be c~)mmenced before issuance of Building Permit. ~ Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hallq0e 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 i~ave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding 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 code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspqctions. -- (Signature of applZant, or name, if a corporation) . .4IL ....... G (Mailing address of applicant) ltate whether applicant is , lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,lame of owner of premises . ~.~..~>~. ~..O,..G~...~3.~,....~g% .~?.~..~. ~ ~: .~/~: Z,J ...... -,~=~.~. ~. , . (as on the t~ roll or latesP~~~ 0 ~ ~ ,app,icant is a corporation, signature of duly authorized officer : FEE: f~.,,~ .~~ NOTIR BU,~ING DEPARTMENT AT 765-1~2 9 AM ~ 4 PM FOR ~E (Name and title of corporate officer) Builder's License No ....................... 4 lumbers Lmense No. OCCUPANCY OR USE ~S BNLAWFUL ~lec~ri0ian's U~.~ N~ .................. g~HO~ CERTIFICATE oa~ T~&'~ U~.~ ~ .................... OF OCCUPANCY FOLLOWING INSPECTIONS: 1. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CDDES. NOT RESPONSIBLE FOR · Location of land on which proposed work will be d'one. , .]4.1.~... ,Ck-..A..P~..¢..~..?. B:E~I~'~S~U~toN. ER[tORS' . House Number Street Hamlet · County Tax Map No. 1000 Section . 0&'l Block O.~ Lot .O.~4 .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy 3. Nature of work (check which aplSlicable): New lmilding .... ~. ..... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition . ~ ........ Other Work ................ 4. Estimated Cos ................. Fee ................. i (to be paid on filing this application) 5. If dwelling, number of dwelling ulnits ............... Number of dwelling units on each floor ................ If garage number of cars ' 6 If business ' ' .............................................................. · , commercial or mixed !occupancy, specify nature and extent of each type of use 7 Dimensions of existing structures if any Front .C/.O. Rear .~¢.. ................ ' ~'J '~-' Height Numb'er of Stories Dimensions of same structure witl~ alterations or additions: Front Rear Depth i He ght ................................... .................... ,' · Number of Stories · Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Num b~r of Stories 9. Size of lot: Front ''" i ........ Rear ........ O ............. Depth ...................... 10. Date of Purchase . ~'7./~Lff~.~ i Nam e o f Fo rm e r Own er ~r~l,v.j~.~. ~_. ~v.O.~,q,qr~e/V~' 11. Zone or usc district in which p~enlises an: situated 12. Does proposed construction wolat9 any zoning law, ordinance or regulation: .......................... 13. Will lot be regraded ........... , ................ Will excess fill be removed from premises: Yes 14. Name of Owner of premises ..... I ............... Address ................... Phone No ........... Name of Architect ............ i ............... Address ................... Phone No ................ Name of Contractor ....... l ............... Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold To~n Trustees Permit may be required. ". i PLOT DIAGRAM Locate clearly and distinctly all bt~ildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or descriptioi~ according to deed, and show street names and indicate whether interior or corner lot. ;TATE OF NEW '~3,.~1~/° ~ :oum'¥ or :. [ ... s.s ......... ~ ..... ' · k ............ being duly sworn, deposes and says that he is the applicant (Name~ o f indMdual~signing contract ~ bore named~.~ .,~- ~ %' ', ' i (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly autliorized to perform or have performed the said work and to m~e and file this )plication; that all statements contained ~l this application are true to the best of his knowledge and belief; and that the ork will be perfomed in the m~ne~et f~rth in the application filed therewith. ~om to before me this ..... ota~ ubl . ... ~ ...... .~ nty '~~~ ~412~,~ffo~um · · (Signature of applicant)