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Home My WebLink About20701-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22085 Date JANUARY 7~ 1992 THIS CERTIFIES that the building. ADDITION Location of Property 3290 PINE NECK ROAD SOUTHOLD, N.Y. House No. Street Hamlet County T~x Map No. 1000 Section 70 Block 12 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 5, 1992 pursuant to which Building Permit No. 20701-Z dated JUNE 9{ 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 EXISTING ONE FAMILY DWELLING AS APPLIED 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 RICHARD & ANNA PEDDLE Rev. 1/81 //Bui ding Inspector FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No-No. 20701Z Permission iS hereby grant.~d.~_e~......~' .................... at p rem ~;;;[ ~;.~.....~....~...~.. ....... ..~./....~..~... ...... ...~...~..~..C....~.......~.C~.., ............................ ................................................. z. ..~.~.~,:-.~..,~.. .......... ~..., ........................................... .............................. County Tax Map No. 1000 Section ..... 7~.... ........ Block ...... /....2r ......... Lot No ........ ~.~... ......... pursuant to application dated .......... f~.......~... ................. , 19...~....J~, and approved by the Building Inspector. ~ Building Inspector Rev. 6/30/80 JAN -. 5 i 59',¢ 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, s~reets, 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. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 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 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 New Construction ........... Old Or Pre-existing Building ................. Location of Property House No. Street Hamlet · ...... 0nwer or Owners of Property... ~ ........ ~ ...... ~ ....... .~ . . " County Tax Map No 1000, Section. ............. Block ........... Lot ................... Subdivision .................................... Filed Map ............ Lot ........... ~ermit No ................ Date Of Permit ................ Applicant ............................. Realth Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ ~eqnest for: Temporary Certificate .......... f Final Certicate .... ~ee Submitted: $ ~ ............. C 0 ~..~ ~ 0 8~ ' APPLI CANT FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ! ~~TJON ZND [ ] INSULATION []FINAL REMARKS: ~~~~:J:~:~r~~ kl\li JUN -~1992 ."!'! Examined .... ~./~. ..... Approved ..... ~ ..... TOWN Or SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... Received ........... ,19... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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- cation. 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 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 any purpose whatever until ~ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanee of a Building Permit pursuant to the 9uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildinjs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil~ding code, housing code, and regulations, and to admit authorized inspectors on premises and in build~g for necessary~¢~_~ions. ~7 ~ (Signature of applicant, or intone, if a corporat'on) a..4,/, ............... (Mailing address of applicant) State whether applicant is owner, les~see, agent, architect, engineer, general contractor, electrician, plumb~ AP~IIOYED AS NOTED (as on the tax roll or lat~j'I~JBuILDiNG DEPAR~M~ENT AT If applicant is a corporation, signature of duly authorized officer. (Name and tiQe of corporate officer) OCCUPANCY OR Builder's License No. /. ~..C~.. '~..,,~...~...---.... USE IS UNLAWFUl. -- .WITHOUT CERTIFICATE Plumber's License No ................... OF OCCUPANCY Electrician s Lice se No. 765-1802 9AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: . ' 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRE~,E 2, ROUGH - FRAMING'&'PLUMBING 3. INSU~LA~ON · 4 FINAL ,CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR Other Trade's License No ....... ~ .............. .~ , DES)GN OR COPJi~TRUC~OI~E~IORJ; ~ Location of land on which proposed wor~k will be done c~2 ~O../:~: ~)~.~C.</~,. ................. :., ....... ................. : ...... House Number Street Hamlet County Tax Map No. i000 Section . ~.~ ............ Block . .t .~ ......... Lot.. D .............. Subdivision ................................ Filed Map No. . .~ ....... Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~ C. ~ .................................................. b. Intended use and occupancy .'&?. ......... q .................................................. 3. Nature of work (check which applicable): New Building ........... Addition Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... I (Descrip'tion) 4 Estimated Cost c~ .C>. CD.. ~ -'--' Fee ,' ~ (to be paid on filing this application) / 5. If dwelling, number of dwelling units .. / Number of dwelling unitsIon each floor.., If garage number of cars '-"' ' 6. If business, commercial or mixed occupancy, specify nature and extent of eacl~ type of use .__...-~......_.~ ... Depth..~..c~" Damansmns of exmt~ng structures, ~f any. Front .... ~.¥ ........ Rear X.~ ..... : ...... Height ,~ ~ { . Number of Stories . I t{.4-. ' Dimensions of same structure with alterations or additions: Front ............. , ....Rea., ................. Depth..~-~.~ t-~.c. ............. Height .~'~..~..e .............. Number of Stories..../. f.~-. ........... 8. Dimensions of entire new construction: Front ..... ~. a. ,~ e. ·. Rear ~.. ¢-..~ .e ,I ...... Depth .~ .~.' ?.. C .... ~ . Height ............... Number of Stones ............................. I ............... 9. Size of lot: Front . (~. ~_~, ............ Rear./.YD. ( .............. Depth t ~.(>~:~1~; !0, Date of Purchase ............................. Name of Former Owner ~q~},~,,* .~.!/a, YP, o~.YF~,~ 11. Zone or use district in which premises are si[uated ·, '. ~- ' .... ' ' 12. Does proposed construction violate any zoning law, ordinance or regulation', t~/.c~ .] .".; .: ) ' .'. 13. Wilt lot be regraded . ~ ......... ~,.,.., .... ~,~., ...,.. Wdl excess fill be removed from premises: 14. Name of Owner of premises .,~}.~r.~ .Jr. t. q~{o~.d.~.~q/~-Address~.r~.e; ;.. ~ .... /. · · Phone No.q..~47.-.'.~7~ NameofArchitect ..... ~"7....== .............. Addi'ess -i-.- · .... i" PhoneNo, of Contractor ~.~ ~--~ ~.../.~..*-.r. .... ' ....... Name ~ ......... Address <~/Z~,,¥~o Jo(. ..... i. , Phone No ' ,- PLOT DIAGRAM ) " ; "~ Locate clearly and distinctly all buildings, whether existing or proposed, and, ind,'ic~ite' all set,15'~ ~nsi~)ns property lines. Give street and block number or description according to deed, and sho~) ~treet names and }~dicate whether interior or corner lot. STATE__OF NEW YORK, S.S COU~OF. ...... ~ .... · ..~..~..~. ,.. [~t.~.,~m,[>, .................... being duly sworn, depoJses and says that he is the applicant (Name of individual ~ning contract) ~bove namea. iqe is the ........................................ i ........................... (Contractor, agent, corporate officer, etc.)' ~f said owner or owners, ~d is duly author~ed to perform or have perfomed the shid work and to m~e ~d file this ~pplicafion; that all statements contained ~ this application are true to the best of hi~ knowledge and belief; ~d that the ~ork will be perfomed in the m~ner set forth in the application filed therewith. ~wom to before me this ........ ~ .~..'~'....day of .~~ .......... , 19 N~ Pu~lio, Sm~ of N~Y~ · .o. 49513~ i' Oual~ In Surfak Cou~ ~ ~m~l~ ~lm May 2~ ~9 ....... 0'0~ c, ~. F--- ~ ,,.4 U3 ..... -h ...... <- -. 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