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Home My WebLink About20450-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA!{Tt4ENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20550 Date FEBRUARY 27, 1992 THIS CERTIFIES that the buildin~ Location of Property 4100 YOUNGS A~NUE House No. County Tax Map No. 1000 Section 55 Subdivision ACCESSORY Street Block 2 Filed Map No. BOUT~OLD, N.Y. Hamlet Lot 14 Lot No. conforms substantially to the Application for Buildin9 Permit heretofore filed in this office dated FEBRUARY 25, 1992 pursuant to which Building Permit No. 20450-Z dated FEBRUARY 25~ 1992 was issued, and conforms to all of the requirerAents of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY UTILITY BUILDING AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A HOWARD P. DICKERSON Rev. 1/81 ]roils[ NO. S TOW~ OF SOU'I'HOLD 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~_ 20450 Z Permission Is hereby granted to: ' ..~../.~~.....~...c ~~.,,..~..~...xx..~/,~,m, ,., , ,o ......... ~....~ ........ ~3,.~._:;~...~, .......... 7Z:ZTi' . ::::::::::::::::::::::: ............. .............. pursuant to application dated ............... ,.~,...~...,~,...~, 19..~..~.~, c~nd approved by the Building Inspector. r~e $...~.. ................ Re~ 6/30/80 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, 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 bu%lding, 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 Vpre-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 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 $15.00, Commercial $15.00 Date ~~. ~..~,../~. New Construction ........... Old Or Pre-existing Building .............. Location of Property....~./~. ................ ~ ~--~ ........... ~ / .......... House No. ~ ~,treet ~ Hamlet Onwer or Owners of Property ..... ~..~..../.~.....~.~ ............. County Tax Map No 1000, Section .... .O.~.~.'. .... Block ...... ~ ....... Lot./.~.. ................ Subdivision .................................... Filed Map ............ Lot ..................... . Permit No... A ~..~..~.~.~te Of Permit ~..~..~/.~pplicant.. ~.~.~. ~~...~~ Health Dept. Approval ............... ~ ....... Underwriters Approval .... ~ ................. Planning Board Approval . Request for: Temporary Certificate ........... Final Certicate ..... ~ Fen Subm±tted: $ ................ q . . .... .... C 0 ~ ~ ~ APPLICANT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ................. lP ... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. ,,O~ LFY: CALL ................... HAIL 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 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 cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hail 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 BuiIding 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 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 ail applicable laws, ordinances, building code, hcm'sing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspecti~~y~ -- (Signature of applicant, or name, if a corporation) ...... (Mailing'hddress of applicant) ;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qame of owner of premises .... f./..~.. ~... L.d..../?.~ ....................... (as on the ts roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~.r. ......... '.' Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ....................... ' ... ........... ........... ............ ........................ House Number Hamlet Map No. 1000 Section ..... ~..~.. ...... Block ....... c~ ........ Lot .... /..~/ .......... County Tax 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 '''~~'~3 ~. ~ '': ::~ ....... . Intended use and occupancy .~//v~. .. ~--4c,~/~ .~v-t-. ~. ~.~'. 27 ',;/d .......... 3. Nature of work (check which applicable): New Building ... Add tion .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost "' ' (to be paid on filing this application) 5. If dwelling, number of dwelling hnits .............. Number of dwelling units on each floor. If garage number of cars . 6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctur6s, if any: Front ............ Rear .... .... Depth Height ............... Numlber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ~ Height Number of Stories 8. Dimensions of entire new const~ction: Front ............... Rear ............... Depth ............... Height Number of Stories - 9. Size oflot: Front ........... I........... Rear ...................... Depth ...................... 10. Date of Purchase ........ i N of Former Ow 11 Zo Si i ti hihp''"i'i ...... sit~"'J .... amc ncr ......... . ................... . · ne or use strc nw c rensesare ate .................................................... 12 Do prop d tio viol{~te ny i gl di l rio ' 13. Will lot beregraded...........................,I . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ... ! ................. Address ................... Phone No ................ Name of Architect .......... ; ................ Address ................... Phone No ................ Name of Contractor ......... I ................ Addres~ ................... Phone No ................ 15. Is this property within 3100 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold TDwn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all property lines. Give street and block: interior or coruer lot. buildings, whether existing or proposed, and, indicate all set-back dimensions from umber or descriptioh according to deed, and show street names and indicate whether ,TATE OF NE~-'"'~R~/ (Name of individual signing contract) bore named. is the.... .......... ... . ' ................. ~ (C ntractor, agent, corporate officer, etc.) said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this '*plication; that all statements contained h~ this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set fort ~ in the application filed therewith. worn to before me this ~ . ............. day of. .'.., 19~ otaw Public,' · ~..f~~ ~~~County ' - ~allfledl. Surfak Cou~ ~ ~ ~ (Signature of applicant)