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Home My WebLink About21097-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 8outhold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21187 Date DECEMBER 3, 1992 THIS CERTIFIES that 'the building REPAIRS Location of Property 90000 MAIN ROAD House No. County Tax Map No. 1000 Section 31 Block 8 Subdivision Filed Map No. EAST MARION~ NEW YORK Street Hamlet Lot 2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 17, 1992 pursuant to which Building Permit No. 21097-Z dated NOVEMBER 20~ 1992 was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ~PAIRS TO AN EXISTING TWO FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED SHERRY AMOTT (TIPPE¥) N-255794 - NOVEMBER 4, 1992 Rev. 1/81 TOWN OF SOUTI'fOLD 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°_N? 210g?Z Permission is hereby gr..ed/o: ~ ~ ..... ,~..~....,...~...~:.....~/~ d / .d/ . County Tox Map No. 1000 Section ......... ~../...... Block ........... ..~.... .... Lot No..~ .............. to application doted ..... ./.~.~.. ................................. , 19.~..~.., and approved by the pursuant Building Inspector. Fee s..~...~. Rev. 6130180 ~ 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 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 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 - $i00.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10o00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ./~ '~..~..'~ .~....~. ~ ..................... Location of Property .... .~....~..~.0..../~...~Z .~....~.~.~-..~...77....'.~. ~.~..~.. ~Z./~t/~.L~2.~...; ....... House No. Street ~amlet ~ Onwer or Owners of Propgrty.~..~.~.~~.~~. ,..~///;f~a?~... .... t lock ot -- .... County Tax Map No i000, Sec ion..%,~ .......... B .... ~. ...... ~ .............. Subdivision ................................... Filed Map ............ Lot ..................... Permit No..~./..~..~.7.]~' ,Date Of Permit.././/../~./~. ..... Applicant.~../3...~-~?./...i .... Health Dept Approval .. Underwriters Approval .................... Planning Board Approval ........................ ~ Request for: Temporary Certificate .......... .~ Final C~rticate..7...~7.~. Fee Submitted: $ ........ ~..~.: .C~.. .... OUNDATION ( ls t) OUNDATION (2nd) FRAME & .PLUMBING iNSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMME~;TS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ZND [ ] INSULATION ROUGH PLBG. [ ] FRAMING REMARKS: ~AL DATE /[/~q~/~ ~INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .... /./"~? ...... 19/?.~. Permit No.~./. ?..~..7..¢ Disapproved a/c ..................................... -- . i'~tlding/J~pect;r) .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL . . .'. HAIL TO: a. Tiffs 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- cati~on. c. The work covered by tiffs application may no.t be commenced before issuance of Building Permit. 11 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 wbrk. 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit author/zed inspectors on premises and in building for necessary inspections. ~ ~ / / .... ~i; ~' 't~r; g'r'h'~' '~''' ~ '~' ' '~-'~ ........ -- ( 'g at e bqafipplicant, or navfie, '~..~r,15oration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contragtor, electrician, plumber or builder. ;z: ........" .... ' .... .............. If applicant is a corporation, signature of duly auth~orized officer. .(Name and title of corporate officer) Builder's License. No ....... /fC/~: ...... Plumber's License No ........................ ~. Electrician's License No. ' - Other Trade's License No ...................... i. Locatio,n of land on which proposed work will 1)e'done ..... ~ ............... ,~r-~. .......... ~. .......... ..... .......... ... House Number . -Street . Hamlet County Tax Map No. 1000 Section . ...'.~... d ......... Block '. .... ~ .......... Lot ..... ~ .......... Subdivision ..................................... Filed Mhp No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy eproposed construction: a. Existing use and occupancy ............... ~~,;:, ..... b. Intended use and occupancy . /~ ~ ' ~ ~ ~"5~' '~".'~'f~;;:~"f~.~. .... 3. Nature of work (check which alSplicable): ~New Building .......... Addition .......... Alteration .......... Repair . ~ ........ RemOval ..... : ........ Demolition ............. Other Work ............... , . ~, (Description) 4. Estimated Cost . · ........ Fee .~.o...~ .............................. i (fo be paid on filing this application) 5. If dwelling, number of dwelling nnits ............... 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 typ~ of use ............. ..... ....... 7, ~mensmns et ex~snng structure, if any: Front ............... Rear ........... pth ......... Height ............... ~um:ber of Stories ..................... ~j~. ' .... D~ensions of same stmctur~ wi'th alterations or additions: Front ................. Rear.. ~. ~. 2j. j Depth .................... ].. HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new constmcfion: Front ............... Rear ............... Depth ............. Height Number of Stohes 9. Size of lot: Front ...........] ........... Rear ...................... Depth .................... I0 Date of Purchase ~ Name of Fo~er Owner 11. Zone or use district in 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. Nme of Owner of premises ... ~ ................ Address ........... Phone No N~e of Architect , Address Phone No Nme of Contractor ' Address Phone No 15. Is ~h~s property w~th5n 3~00 feet of a t~dal wetland? *Yes.' ....... No ......... · ~f yes, Souchold Town Trustees ~erm~C may be requSr~d. .'. PLOT DIAG~ Locate clearly and distinctly ~1 bmld~gs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block number or description accordhg to deed, and show street nines and indicate whethe~ ~te~or or comer lot. ~ ' APPenD AS NOTED 765-1802 ~ AM m 4 PM FOR THE FOLLOWING ~NSPECTtO~S, ~TATE OF N~pR~ /~' 1. ~OtJNDA-rK~N ~'O 20U~Y OF~'~D/.*~ .. S.S FO~ POURED (.ONEhE'H (Name of individual si~ning ~ntract) , ~bove named. . ,, . BE COMPLETE FOR C,O. ~ ~ ALL CONSTRUCTION SHALL MEET Ieisthe ................... ~ ' . :'. .THE REQUIREMENTS 9F ZHE .............................. 8T~IE 'CONS~RU~ON '~ ENERGY'' ~ (Contractor, agent, corporate officer, ~ES. N~ RESPONSIBLE FOR f said owner or owners, ~d is duly ~uthofized to perform or have perfo~ed pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ~ork wUl be perfomed in the m~ner s6t forth in the application filed therewith. .......... ........ ..... lot a~ Public, ~ .~~;:u nty C~IRE L GL~ ' ~ Publ~, 8t~e of New No, 487950~ ~ .~ ' ....... · ........ ~al~led In Suffdk, Cou~ ~ ~ --~ ~ ~ure of applicant) ~ml~lon E~es D~e~ber 8,19 ~