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Home My WebLink About20507-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20612 Date MARCH 27~ 1992 THIS CERTIFIES that the buildin~ Location of Property 350 House No. County Tax Map No. 1000 Section Subdivision ACCESSORY TRACK AVENUE Street 103 Block 12 Filed Map No. CUTCHOGUE~ NY Hamlet Lot 3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~%RCH 27~ 1992 pursuant to which Building Permit No. 20507-Z dated MJkRCH 27~ 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 CONSTRUCT ACCESSORY BUILDING AS BUILT The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A DAVID BLADOS & WIFE Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT O'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NgN? 2050'/Z Permission is hereby granted to: ..... o.~_~....~~.~...~< .. ..... at premises located at ........ ~,.. ~.,..~.'.......~~..~ ......................................... ................ '~'~/. ~='i .............................. County Tax Mop No. 1000 Section .... ./.....~.~.. ....... Block ..... /....~ ......... Lot No ...... 3. ............. pursuant to application dated ,,.,~.,~'~o ........... ~,~,-- ...... , 19,~.....~'~, and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTI~LD BUILDING DEPARTMENT TOWN HALL 765-1802 A~PLICATION FOR CERTIFICATE OF OCCUP 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. 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 Plauning 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../.~/~..f ..... Block.../~. ......... Lot... ~ .... Subdivision .............................. · · · .. . Filed Map ........... · Lot ...................... Permit No.~.~,~.TZ.Date Of PermiJl~..~/~..Applicant. ~. ~.~..~.,. Health De t. rov '--'--- ~--'~%~~'" .. ' Planning Board Approval Request for: Fee Submitted: $ .... ~..~ ....... Temporary Certificate .... ~ ..... Final Certicate..~ .... APPLICANT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 Examined ............... Approved ~.'.~..~..~.., 19~-~Permit No.. ~...~..~..~. 57~ BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... ClIECK ...... NOTIPY: CALL ................... MAIL TO: .............................. APPLICATION FOR BUILDING PERMIT Date ............ 7;.- 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 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 6f 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinancez%,building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa~ns. ~ -- (Sig~a%ur~b~'~pplican;t, or name, if a corporation) ,.. · [ (Mailing'atldress of applicant) State whether applicant is owner, lessee, agent, architect, en=~nee,q.~ene[aJ,contrac~or, electrician, plumber or builder. Name of owner of premises .3~.//0..4.,/d0~2~15.~' .... .~.'~.././'7..g~.:. ~.~.~'A0..~f. i ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth,?rized officer. (Name and title of corporate officer) Builder's License No .... ,d~...{ ............ V Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will bd done .................................................. .... ..................... ................... 7. ............. House Number Street Hamlet County Tax Map No. 1000 Section ..../.0.3 ........... 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 ............. W ........... ¥ ¢-~'. .. .. ,o :,Bsq? ................... b. Intended use and occupancy . . . 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rembval .............. Demolition .............. Other Work.. ~Jl~.,/~ ....... 4. Estimated Cost - Fee r' '~ .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling.'units ........ . ....... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and.extent of each type of use .................... 7 Dimensions of existing structurds if any: Front Rear Depth Height Number of Stories ' ' ' Dim nsions of sam ct e with It ti dditi F Rear ' ' ' e estru ur a era onsor a ons: runt ................. . ............ Depth ' Height Number of Stories 8 Dim io ofentir tx' ' F t R D pth "' · end ns e. new cons uctlon: run ............... . ear ............... e ............. Height Number of Stories" 9 Size of lot: Front ' Rear ' Depth ' ' 10 Date of Purchase i Name of Former Owner ' ' 11 Z ..... ' ..................... · one or use dastnct ~n which premises are situated ................................................. 12. Does proposed construction violhte any zoning law, ordinance or regulation: 13. Will lot be regraded ............................ 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 ' Address Phone No 15. Is this property within 300 feet of a tidai wetland? *Yes ........ No ......... · If yes, Southold ~own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block 9umber or description according to deed, and show street names and indicate whether interior or corner lot. : OCCUPANCy OR USE IS UNtAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF N~J~'Y~ t [./ S S COUNTY OF .... ..... ~..~[. V.(..~-~...~. '~~.~ ............. being duly sworn, deposes ~a says that he is the applicant (Name of individual signing contract) above named. , (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly[ authorized to perform or have perfumed 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 will be perfumed ~n the manner ~et forth in the application filed therewith. Swum to before me this Nota~ Public, .~. ~ ~~'. County .(/f) No. 487950~ [ (Signature of applicant) Oualffi~ ' . ~ >~/ CHIN~GO TITLE INSURANCE CO~P~N~ '~' ' ~ ~ v. (516) 727-4455 ' ' D~ID A.BL~DOS ~ SALL~ M. BL~DOS ' OCT, ~O~ SUFFO~ COUN~Y~ N~W ~K NO. ~-I1~ H ~U~IZ[O ALTERATION OR AODITION ~ ~1S GU~ANTEEDTO: su~vtY ~ · V~T~O. ~ StCT~O~ ~2~ ~ T,E SOUTHOLD 8A~~ I '''YOUNG , RIVER~AD, NEW YORK NOT~m" MONUMeNt: ' ~-~TA~ ALDEN W. YOUNG, PROFE~IONAL ENGINEER AND ~ND SURVEYOR N.Y.S. UCENSE NO. 12845 HOWARD W. YOUNG~ LAND SURVEYOR M ~ L~ ~ ~L{W), ~IC TAHKIS~I C[~S(~) ~W ~E~ N.Y.S. LICENSE NO. 45893 BRANDIS & SONS INC~ 1046