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Home My WebLink About20712-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20808 Date JUNE 19, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 900 MINNEHAHA BLVD. SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 2 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 9~ 1992 pursuant to which Building Permit No. 20712-Z dated JUNE 11~ 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 EXISTING ACCESBQRY SHEB AB ~PPLIE~ FOR. The certificate is issued to (owner) of the aforesaid building~ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 LONGRICE INVESTORS, INC. N/A · 0~,~ 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) NH? ~071~ Z Permission is hereby granted to: ..... ~. ~ .,.~..~<~...~..: ................... ........................................... ..~...~.~ ........ ~.../.: ...................................................................... .................................... _~.~.~....~....~.-/.~. ~.~...... ~.. ............................................ County Tax Map No. 1000 Section ..... Z.~... .......... Block .:....~...~... ......... Lot No......'~..~.. ............. pursuant to application dated ............. ..~.....~.. ............... , 19..~...~., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 1% 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-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. C. 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 Date ....... ~ .~... ~.~..~..~. ............. ~ · New Construction .......... Old Or Pre-existing Building...~. ............ Location of Property ................................ House No. Street Hamlet Onwer or Owners of Property ..... .~..,~.~. ~...~...~.~..~...~. ........................... . County Tax Map No 1000, Section .... ..~.Z .... Block ~ ~ · . ................Lot.. .................. Subdivision ................................. .. . Filed Map ............ Lot ...................... Permit No.~0.~ .... ~Date Of Permit ............... Applicant ........... Health Dept. Approval ......... ~"~'/~''~'iiiiiilUnderwriters Approval..~7~'iiiiil..iil..'il. Planning Board Approval ..... ~/~t ........ Request for: Tempora~Certificate ........... Final Certicate..y ...... Fee Submitted: $ .... .~.P..~.f..~. ............. ' ...~ .~.~..~.i' ...~.~ APPBICANT '" c0M 0 0 ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTIi ......... 3 SETS OF PLANS .......... SURVEY · . SEPTIC FORH .............. Approved ..... ~/t~ ...... 19f4~.Permit No..~..,2/.2:-...~. Disapproved a/c ..................................... ' ' . /Y .... ........... . (B)dldin~ Inspector) / APPLICATION FOR BUILDING PERMIT ~.. .~. Date ......... , INSTRUCTIONS NOTIPY: CALL ................... NAIL TO: a. This 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 publi~ streets ]r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- zation. 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 ~b, ail 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 3uil,ding 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. rhe applicant agrees to comply with all applicable laws, ordinances, building code, JCousing code, and regulations, and to ~dmit authorized inspectors on premises and hi building for necessary inspectio~ / --' ( ignature of applicant, or name', ~ 'a 'c'or~;ation) (Mailing address of applicant) State whether alpplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ .......................................................................... Name of owner of premises..../~...~...(3-~..(~..~L..~, d. L/~.~..~.q .~._..~' //j,3 (as on the tax roll or latest deed) ~PJ~J~0I/FJ) ~$ NOT[D If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .x'N 0~.C[~PAJ~C~ 0~ , ' ..... ............... 'US[ NLA LffUL Plumber s ~icense No ...... . :~.q. .......... WJT~0~J'J~C[ T]FIGAT[ Electrician s License No ........ .~. ......... 0F OCCUPANCY Other Trade's License No ...................... DATE: ~.R #~ FEE: ~'~,~,,'' (J'~ --BY:~ NOTIFY BUILDING DEPARTMENT AT 765-1802 ~ AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2~ ROUGH o FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C.Q ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. Location of land on which proposed work will be' done ............... ,,->.,. ~,. ., ,, -- ~ CODES. NOT I:iE~ti~ISIBLE FOR .... I..' .U~. ....... ]~..(..A.~C.~ ......... .~.t ~..~. ........... .~..~. ~(~ gO.N.S.-~.q~, fT.1O.N. ~. ~. ~9.R.S. House Number Street Hanilet County Tax Map No. lO00 Section .... ~.7 ......... Block ~ Lot ~.. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) !. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .,. .~..~ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition ........ ~. Alteration .~ .~. ...... Repair ......... ._~. Removal .............. Demolition .............. Other Work..~..'~lt~J~). .... _ ~..Q ~'r~ ' ' ~,~/.. _. (Description) 4. ~stimated Cost (~..c~. '--~ -ff,:./t.,, ~ .... i .......................... Fee ...... , .t.~..c~. ,.~'M ....................... I (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor If garage number of cars ! ................ 6. If business, commercial or mixeld occupancy, specify nat,ure and extent of each type of use ............ 7. Dimensionsofe~s,tingstructurCs if any Front . .1.~ ~ p,~,. /~'~" r-,,,.,,,, t~'i ...... 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 ... R t~g~' · .. ear .............. Depth ....... Height ................ Number of Stories ....... ! ..... Size of lot: Front t · Re-r .... tit~: ~,'~ ......... ~.' ' .' ' 'dtJt'.~ t ........... D .... ' '4-~u:a"~ ......... '~ ..... t[~. ~ ............ qepm . . llT:~'.j ............. ate oi i-urcnase ....~ . .l.'71 .a" ......... . ......... Name of Former Owner ~.. ~l~.(.~-. ................. Zone or use district in which premises are situated . Do s proposed construction Bql&te any zoning law, ordinance or regulation: .... ~..0 ...................... Will lot be regraded ....... ~.O, .................. Will excess fill be removed from premises: Yes Name of Owner of premises ./~.~6gi~,r~.~.e..~.F.o.~. Address ............. Phone No... Name of Architect ' .......... , ................. Address ................... Phone No ................ Name of Contractor ......... 1 ................. Address ...~ ................ Pho~¢ No ................ Is this property within 300 feet of a tidal wetland. *Yes ........ No.~ ...... ~ *If yes, Southold ~own Trustees Permit may be required. .... : PLOT DIAGRAM Locate clearly and distinctly ' ' all I buildings, whether existing or proposed, and. indicate all set-back dimensions from according to deed, and show street names and indicate whether 10. 11. 12. 13. 14. 15. property lines. Give street and block fiumber or descri tion P interior or corner lot. STATE OF NE'W~RKu',['" :OUNTY O~~ .~, ....... ;....~..~.~f...~-. ~ .~. I~. .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing cdntract) tbove named. ' te is the ' · .'. ~ ~ (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this pplication; 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 sit forth in the application filed therewith. worn to before me this ' ,rotary Public c~[,.) Notary Publlo, Stat~ No. 4879~ Qualified In Suffo Commission Expires ~n~voa~ "- ---" ........ V' ..... ,,,,,;~__.: .7..;.... ..... )5 - ~mgaaxa're ot appdcant) k County ember 8, 1912- / 055~0 .MAP OF DES CRIBED PR TOWN OF S~.ITHOLD