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Home My WebLink About20667-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21169 Date NOVEMBER 20, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 455 WEST SHORE DRIVE SQUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 80 Block 2 Lot I Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 22, 1992 pursuant to which Building Permit No. 20667-Z dated MAY 29, 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 SHED IN REAR YARD AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED SALVATORE J. DiSALVO ~~ ~uilding ~nspector Rev. 1/81 FOBM NO. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NgN? 20567Z Permission is hereby granted to: ..... .... ~o ....,~.....~. ........ ..~... .; ............ County Tax Map No. I000 Section c~ Block O~- Lot No ....... .~.../.. .......... pursuant to application dated ........ ~%~....~....~.. ......................... , 19...?..'~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 ~ ~' Form No. 46 TOWN OF SOUTIIOLD BUILDING DEPARTMENT Town ~LL ~' 5E?I 765-1802 APPLICATION FOR CERTIFICATE OF OCCUT 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 from Board of Fire Underwriters. 4. 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. ~. For existing buildings (prior to April 9, 1957) non-c~nforming 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 buildi~~ 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.Upda,ted Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ...... ~ ~w Construction.. · Old Or Pre-existing Building ................. 3cation of Property .... ~'4~'-~--~?~: ~'.. ?.~.~...~.~.1~. ................ ,.,..~../..~.~./.. ~Iouse No. ~ ~C~ Street Hamlet ,~ o~ o~ o~ ~o~v ~lu~ .~, D,' un~y Tax Map No 1000, Section. ~ Block bdivision ................. ~g~e ................... ~i~ ~p ............ ~o~ .......... . . ... ............. Date Of Permi~ ................ Applicanu.. al~h Depc Approval ' ' .......... Underwriters Approval annin~ Board Approval ........... ~ues~ for: Temporary Certificate ........... Final Certica~a ........... Submitted: .............................. &q ......... . ............ 'OUNDATION (1st) 'OUNDATIO:~ ~OUGH FRAME & -PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE FINAL ADD/TIONA'L COMMENTS: TEL.: 765-1802 Examined .... ~? ...... , 19 .~?'-. Approved .... ~'/'/~. ....... 19 .~.';'7 Permit No...'~..~.~...,'~... Disapproved a/c ................................ : .... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTH ......... 3 BETS OF PLANS .......... SURVEY ................... ClIECK .................... SEUTIC FORH .............. CALL ................... HAIL TO: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~o the Building Inspector, with 3 e~s 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. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 ;uilding Zone Ordinance of the Town of Southotd, 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 ali applicable laws, ordinances, building code, ho~sing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary~ (Mailing address of applicant) ;rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises~..¢..~.. ~' ~!" i i ' ii]] (as on the t~ roll or latest deed) f 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 .................................................. County Tax Map No. 1000 Section .................. ,;ck .... ~...~ ..... Lot .... .~...~ ........ Subdivision ~ o~-- ~ ~. ..................... ~ .............. Filed Map No ............... Lot ............... (Name) State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ~'~ff ~ : ' b. Intended use and occupancy e ~ ~ ' ' ' ', 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .... Repair .............. 'Rem?al ............. Demolition .............. Other Work 5~.~. ~'.~.'~'' 4 Estimated Cost o~°oo,, 0~ ·" (Description) (tob paid onfil' gthis ppli att n)' ' 5. IfdweIling, number of dwelling ~nits ............. Nub ofdw If ga ge b oft i ·. m er elling units on each floor If business commercial or mixeO occupancy specify nature and extent of each type of use 7 Dimension's et ' · .................... · existing structure? if any: Front Rear Height Numl~er of Stories ............................. Depth .. Dimensions of same structure wiih alterations or additions: Front ........... ................. Rear ................. Depth . ., .--~ ............... i' ' neign~ ................. ~ .....Number of Stories ..................... 8. Dimensions of entire new construction Front .Itor. . .a~. . .s~ r~A_ / ,~ · ~ ., ,.~.., l~' Heioht ~* ,, I . .. ..: .. ~.. ~x~:u, ............... Deprn ...*~...'..~. ..... ,, .......... r ....... ~'qum 0er of Stones ............... 9. Size of lot: Front ....... . ~.~t o~, '- ' ' '~> ;~' .............. '; 7.-: .............. I0. Date of Purchase .ig--.~.'~ i ......... ,~,u . .~. .... k.~,J .... ,~ ..... De~h .; .~.. t'.,~ .$.t ............ 11. · ........ ~ ....... ' ......... ~ame o~ pormer uwner h ¢.~.~..~.~./~.~..~ ........... Zone or use district in which prelnises are situated .......................... . ....... 12. Does proposed consn'uction violate an2 zoning law, ordinance or regulation. . ~. . ' ............ 13. Will lot be regraded . . a/o ........ ' ........... . ............... ...... ]~ · · ~'~ .......... WIll excess rill oe removed from premises: Yes ~ 14. Name of Owner of premises ... [~. (..~. fl?.o. ..... .. Address .~.ff.~..t~.-4,~. ~ .... Phone No.'7../.~..263,r .~..~..6_ .~. Name of Architect ....... - I] ............. ~.. .... Address ................... Phone No ............... Name of Contractor .......... i ................ Address .................. Phone ~ ........ . ....... 15. Is this property within 300 feet of a tidal wetland? '*Yes ...... No *'~ · If yes, Southold T6wn Trustees Permit may be required. ' ........ '". i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-ba~k dimensions from property lines. Give street and block n ~mber or descriptioh according to deed, and show street names and indicate whether interior or coruer lot. 'TATE OF NEW'yORK, ~ , ! ~ 'o rv .... ~ ./?.~..~.'~..r'.C.....~., '.. i .~.~./.~' ....... being duly (Name of individual signingI contract) bore named. sworn, deposes and says that he is the applicant e is the ........................ (Contractor agent, corp.orate officer, etc.) · ' , ~ , md ow.ncr or owners and is duly a~{thorized to perform or have performed the said work and to make and file this ~p ication, that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner seit forth in the application filed therewith. yom to before me this . No. 41-48650~) . /'~.~. ~,- ~../':..,,/.~4."FPX~...v. .;~../~..'~..-...' ....... _ Oualli!edl_nO. ueen. s. _C~q. tY--~v)/'~. ~ ~ , (~ ......... ,,,. ','''',:'' .. .... t;ommi.lon ~plresaoWi?, ~.:..' f" t~Ignature et appdcant) OVOW NI¥~I 0~0~ - ~ (~ ' ('ooI ',.I..d 'OS ~"Z9'OI A4 ,,0~' ,Bf ,g9 N (l~U~) 066l · ,0~ IO- '~N tlIl g l A , dO dV~ · .34/,:yo,