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Home My WebLink About20445-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20662 Date APRIL 21~ 1992 THIS CERTIFIES that the buildin~ Location of Property 730 ROBINSON LANE House No. County Tax Map No. 1000 Section 98 Subdivision ACCESSORY PECONIC, N.Y. Street Hamlet Block 4 Lot 34 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 19, 1992 pursuant to which Building Permit No. 20445-Z dated FEBRUARY 24{ 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 AS APPLIED FOR. ~le 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 CRAIG & PENNYANN VON BARGEN Rev. 1/81 Building Inspector fro~e NO. I~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 20445 Z Permission is hereby granted to: ........... ~ ............ ..~.:~. ....... ,../../.....~...~ ,o ~ at premises located at ....,~,~.~......~...~~......~.....~.... ........................................................... County Tax Mop No. 1000 Section .....~...~... .......... Block ....... :...~...~ ...... Lot No...~.....~... ........ pursuant to application dated ............... ~ ............................. , 19...~;r.....Z~, and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF S0OT[[OLD BUILDING DEPARTMENT TOWN tDILL 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: 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 buiIdings , , 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) eon-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 ~roperly 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 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 - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.0~, Co~ercial $15.00 · / Date ~/~A. D /?'~__ ~ - v/ ......... ~ .... ~ .................... noeatio~of Propertv..7~o ...~.hCqi~v ~. f~cc~ _ - ......................... ~.% .... ~ .-%- ........ .. House No.' S~t '' '''' , Hamlet 0nwer or Owoers of Fro err C~f & ~ f~j,J~/ ~//v/ .~.9~ ~/__~/t.7 Oounty ax ap o O00, Section ...... .... Bloe ....... ........ ..... Subdivision. . · ................... Filed Map .......... Lot ...................... Permit No .... ~. ~/...~.~ ~r~ ~Z~ ~ ........ Date Of Permit ................ Applicant ..................... Health Dept. Approval ............... Underwriters Approval ...................... Planning Board Approval ................... Request for: Temporary Certificate ....... Fiua~ te ........... Fee Submitted: $ .J~.. ............. i.ii...i ~ e ~0 ~ ~ ~ ~E,~'' v- :OUND^TION (1st) 'OUNDATION (2nd) ~,OUGH FRAME & -PLUMBING :NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION XST [ ] ROUGH PLBG. [ ] FOUNDATION ;ZND [ ] I~JLATION [ ] FRAMING [,~NAL REMARKS: ~'//~ DAT"= (~/'/~/~'~'/ INSPECTOR FEB 2 01992 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Disapproved a/c ..................................... . (Buil/dingz~pector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. HAIL TO: Date.. ~'( { ?, 19~2~ INSTRUCTIONS a. Tkis 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 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 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 a Certificate of Occupancy shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for rem.,t~,l or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building/%ode~}~ousing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r neces:~?.i~:~ti?~,//....~...~.~. ..................... - (Signaturi.~f.~t,. ~i ~:me, if a corporation) (Ma~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises C2A( - cO . t/a~J [3 4AC., _2J (as on the t.~r/< roll or latest deed) If applicant is a corporation, ~ignature of duly authorized officer. (Name and title of corporate officer) Builder's License No. (~oJ ,AJ'~/~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ... 7. ?. .................. ................. .................... House Numlder Street Hamlet County Tax Map No. 1000 Section f g Block .~. Lot 3 ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,~ tL~, b I d d d pan y ~ " '" nten e usean occu c ........ ~ ........................ :~.., ..... ~ ................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work .... .~.'f'~.~..--~. .... ~ io P. (Desc~ption~ 4. Estimated Cost O ~ ~ ~ Fee .~.,. ~ L~ . ~;,. . (to be paid on hung tins appncation) ~. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ . If garage, number of c~s ..... ~ .................................................................. 6. If business, commercial or mixed~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmcture~,ifany: Front ............... Rear ............. Depth ............... Height ............... Number of Stories ............................... ~ .................... D~ensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... ~. HeiSt ....... 8. Dimensions of entire new const~ction: Front .... ? .......... Number of Sto~es .......... -.(~ ....... Rear .... I~.'. ...... :~'~ t ......... .... . Depth .. [ ............ Height ............... Numl ~er of Sto~es ........................................................ 9. Size of lot: Front ..................... Rear ...................... Depth ...................... 10. Date of Purchase ................... . ......... Name of Fomer Owner ............................. 1 1. Zone or use district in which pre~aises are situated ..................................................... 12. Does proposed construction viola' te any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed' from premises:' Yes No 14. Nme of Owner of premises ... ~ ................ Address ................... Phone No ................. Nme of Architect ........................... Address ................... Phone No ................ Nme of Contractor ........ ~ .. 15. Is this property within ~Ob] ~ael .......... Address ..... ; ............. Phoqe~o ................ of a tidal wetland? Yes ........ No.. ~ ...... *If yes, Southold Town Trustees Permit may be required. PLOT DIAG~ Locate clearly and dmt~nctly ~1 ~uild~gs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give streeL~d block ~umber or descfiptioh accord~g to deed, and show street nines and indicate whether inte~or or comer lot. USE uN W ' CUPAN ,, (Name o¢ i~dMdual si~ni~ con[ract) above named. He is the .................. ?.~. ~ ......................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly Jau~orized to perform or have perfo~ed the said work and to m~e ~d file this ,application; that all statements contaihed ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~ner $et forth in the application filed therewith. Sworn to before me thi~..~ ~ , ...... ¢.~ ..... o~.~.~.q~%~ ....... ~¢a ~?¢ N~ 4725~ S~ ~W~ /