The URL can be used to link to this page

Home My WebLink About21116-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21194 Date DECEMBER 3, 1992 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 870 SCHOOLHOUSE ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 102 Block 5 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 2, 1992 ~ursuant to which Building Permit No. 2111g-z dated DECEMBER 3, 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 BUILDING "AS BUILT" The 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 BRUCE & PATRICIA STEWART Building 'I~'sp6ct~r' ' i Rev. 1/81 IVOnM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21118 Z Permission is hereby gronted to: ...~..~.~...~~~....~ ....~..~..~~...~ / .J.~~..~.,...~./.....~.~ . , ,o ......................... ........ ................. ~ ...... ~ .......................... ~_~ ......................................... ~, ~,.m,~, ,~,~ ~, ....~./~..~ ...................................... ...................................... ~.~/.~..~...~..~= .................... co,,~ T.~ ~p No. ~0o0 Se~,o, ...~=~...~. .... m~k ...~.~... Lo, No....~.~..~ ...... Building Inspector. Rev. 6/30/80 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ~ALL' 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 mew 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 '¥re-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 House No. Street Onwer or Owners of Propgrty...~.~<7~.a~../?~. .... ~~ ..... County Tax Map No 1000, Section. Z~..~. .... Block...~ .~.. ...... Lot...~../...~-/ ........... Subdivision .................................... Filed Map ............ Lot .................... .. Permit No.~J.~L~...~..Date Of Permit~..~/f .~...Applica'nt./~...~....~....~....~...... Health Dept Approval Underwriters Approval ...... Planning Board Approval ........... Request for: Temporary Certificate ........... Final Certicate ......... ..~.... Fee Submitted: $.. ~.~.~. ~.. ~. .............. R~S$£LAER Il. TERRY, Jr. A'ITORI'IEY - AT - LAW. :_. ' := ........ ~OUTHOLD, ~ V_ ' &Lo T-oVlqT~ / / Examine, Approved Fon 'kib Y' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Disapproved a/c ..................................... BOARD OF HE&LTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: (Building Inspector) APPLICATION FOR BUILDII';~3 PERMIT INSTRUCTIONS a. This application must be completely filled in by ty!bewriter 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 p em~ses, 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 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i~. ~.~ (Signature of app~ca'n~', ~r" n~e' ', ~ ~ corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ~.~../4-.. (~.~.. ~..,...~..~.t.~..,~../~...77....~.../-~../..,~.~. ............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth~orized officer· (Name and title of corporate officer) Builder's License No ............ Plumber s L cerise No ..... Electncmn s License No.. ............... Other Trade's License No ...................... Location of land on which proposed work will be'done ................ House Number Street Hamlet County Tax Map No. 1000 Section /F_.) e~ Block ' ~ ~-~ Lot ~/.~. Subdivision ..................................... Filed Map No. · · .~.- ...... Lot . . .t~. ...... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~r~./~ I0. 11. 12. 13. 14. 15. property lines. Give street and block ~3umber or description interior or comer lot. 3. Nature of work (check Which applicable): New Building'.. Addition .......... Alteration .......... Repair .............. Removal ...... Demolition ............Other Work ............... ' .......... esc on 4. Estimated Cost ................. Fee .................... ! (to be pa/d On filing ~his application) 5. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ................ · If garage, number of cars ... L ......... 6 If business commercial0rmixe[d occupancyl};~ci~ ' ' · ' nature and extent of each type of use 7 Dimensions of existing structures if any: Front Rear .......... Height Numl~er of Stories ............................. Depth ............... Dimensions of same structure with alterations or additions: Front Rear Depth Height ................................. .................... ' · Number of Stories 8 Dimensions of entire new construction: ..................................... : ...... · Front Rear Depth Height ............... Number of Stories'. ....... Size of lot: Front ................................................ .......... ' ........... Rear : Depth Date of Purchase ~ ......................................... Name of Former Owner Zone or use district in which pr6mises are situated ............................. Does proposed construction violate any zoning law ..................................................... Will lot be regraded ' , ordinances,or regulation: ............................. Will excess fill be removed from premises: Yes No Name of Owner of premises ................. Address Phone No Name of Architect i .... AddreSs ................................... .............................................. Phone No ................ Name of Contractor. ........ 1 ................ ~. Address ................... Phone No ................ Is this property within 300 feet of a tidal wetland? *Yes.' ....... No ......... · If yes, Southold Town Trustees Permit may be required· PLOT DIAGRAM Locate clearly and distinctly all 'buildings, whether existing or proposed, and, indicate all set-back dimensions from according to deed, and show street names and indicate wheti~er CRATE OF NEW Y,O,, P~, , . 20UNTY OF .... -%.. '.'~..'X~. ~.~ ...... S.~ ....... ~t&c.~'...~. ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) .bore named. I [e is the ~"~° k~'f I (Contractor, agent, corporate officer etc.) f said owner or owners, and'is duly ~uthorized to perform or have erformed t ~e sai . · pphcatzon; that all statements contained in this annlicatinn are tm~ tP2 the h~* ~r~-:~ !_d_ wo,rk, and t,o.m..ak~e and. file tins 'o-'- :,. ..... ~ . - ................... ~t ,..umu Knowleage ana OelleI; and that the · ,~ wm oe penormea ~n the manner set forth ~n the application filed therewith. worn to before me this g, ., 19 'otary Public, .. County (Signature of applicant)