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Home My WebLink About21127-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTPIENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22010 Date DECEMBER 8~ 1992 THIS CERTIFIES that the building Location of Property 800 OAK DRIVE House No. County Tax Map No. Subdivision ADDITION SOUTHOLD~ NEW YORK Street Hamlet 1000 Section 80 Block 2 Lot 10 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECF2~BER 4~ 1992 pursuant to which Building Permit No. 21127-Z dated DECEMBER 7, 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 BATHROOM ADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" The certificate is issued to KATHERINE L. KLAUM (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 /~ Building Inspector FI)NM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, Ho Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*_N? 21127Z Permission Js hereby granted.to: // / ..................... .... Z~.....~....~.. z/.~. ..................... ~~.._~;......~.. ....... ~../..,..,... ................................................................................. at premises located at ......~....~..~.. ....... ~.....~...~.4. ................................................................. County Tox Map No. 1000 Section ........ ~..~... ....... Block ......... ~ ....... Lot No ........ /..4~.. ........ pursuant to application dated ......... ./.~./.~.. .............................. , 19.~....~., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN MALL 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 Complianee from architect or engineer responsible for the building. 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 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 ..... ?..~.~:..~.l.I ~ ~..~. New Construction ........... Old Or Pre-existing Building....~.. ........... Location of Property ..... ~?..~ ....... $~J~ ................. ........ ~.~.?.~q~.~ ............. House No. Street Hamlet Onwer or Owners of Propgrty..~<~..T~.~.q~.j ~g.4 ~.~ rr~..~ ................................ County Tax Map No 1000, Section...~.9 ........ Block..?%. ............ Lot./.~ .................. Subdivision .................................... Filed Map ............ Lot~ ..................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept Approval . Underwriters Approval . Planning Board Approval ........................ Request for: Temporary Certificate ......... ~ Final Certicate ..... APPLICANT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Disapproved a/c ..................................... BOARD OF HEALTH ......... ~.-~3 SETS OF PLAN.~ ....... ~ . . .../SURVEY ................... ./ClIF-CK .................... SEPTIC FOR.q .............. NO?I FY: CALL ................... FLAIL TO: .-:~ ~_~ ~:, ~-~.' ~ (Building ~i)~ectbr) ' ..... ", ' APPLICATI UILDIN-G PERMIT a. T~g'~'lication must be completely filled in by ~pewdter or in ink and submitted to the Bulldog Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of bulldogs on premises, relationship to adjoining premises or pubic streets or areas, and giv~g a det~led description of layout of property must be. drawn on the diagram which is pa~ of this appli- cation. c. The Work covered by t~s application may not be commenced before issuance of Building Permit. d. gpon approval of this application, the Building Inspector will issued a Burring Pemit to the appEcant. Such pemit sh~l be kept on the premises available for ~spection throughout the w~rk. e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bulldog Dep~ment for the issuance of a Building Pemit pumuant to the Building Zone Ordnance of the Town of Southold, Suffolk County, New York, ~d other app~cable ~ws, Ord~ces or Regulations, for the construction of bufld~gs, additions or alterations, or for removal or demolition, as here~ described. The app~cant agrees to comply wit~ a~ apphcable laws, ordinances, bufld~g code, housing code, and regulations, and to admit authohzed ~spectomon premises and ~ bulldog fo rnecessa~j~~ .............. -- (Signature of applicant, or name, if a corporation) ..... f q. Rr. t (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... .......................................................... N~e of owner of premises ./(A rCg~,.~( ~Og~Tt~. ]f~ e~. .... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ? Builder's License No .......................... Plumber's License No ......................... ; Electrician's License No ................ ' -' .. Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...... House Number Street Hamlet County Tax Map No. 1000 Section ~ t~ Block .................................... Lot.lo ................ Subdivision ..................................... Filed Mhp No ............... Lot ............... (Name) L State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing usc and occupancy ..... ~ ( Or~ .'. b. Intended use and occupancy ~ ~ 3. Nature of work (check which applicable): New Building ....... Addition . f .&Iteration .......... Repair .............. Removal ., ........ Demolition .............. Other Work ............... ' ~1 '~oo (Description) 4. Estimated Cost ....................................... Fee ...................................... i (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 ' lmenmons of existing stmcture~ if any: Front ' Rear ' ' Depth · Height ' ............................................ ........... Numlber o f Stories . ] ...................................................... Dimensions of same structure w(th alterations or additions: Front ................. Rear ................. 8 Depth .................... i' ' Height ...................... Number of Stories .............. ;: ...... · Dimensions of entire new constrcction: Front Rear Height Number of Stories ............................. Depth ............... 9 Size of lot: Front ................................................. ' ...... · ' Rear Depth 10 Date of Purchase ~ .................................. ' Name of Former Owner 11' Zone or ........ ................ ' ............................ · use district in which premises are situated lat g 1 12. Does proposed construction viD e any zonin aw, ordinance.or re,~ ation' 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 39o feet of a tidal wetland? *Yes.' ....... No... ...... *If yes, Southold Town Trustees Permit may be required· ... i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. PLUMBER CERTIFICATION .ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED fig WATER SUPPLY SYSTEM CANNOT ' EXCEED 2/ 0 of 1% LEA& RPi~O~EO AS NOTED . 5..-, ---- BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEW YORK. .. o ,~ - 'OUNTy OF ~.~./~- _ o.~ .............................. , ................. being duly sworn, deposes and says that he is t~¢ applicant (Name o¢ individual signing ~contract) hove named· 'e is the ' ~ (Contractor, agent, corporate officer, etc.) ~ said owner or owners, ~d is duly authorized to perform or have.perfomed the said work and to m~e and file this >plication; that all statements containe~ ~ this application are true to the best of his knowledge and belief; and that the ork will be perfomed in the m~ner se} forth in the application filed therewith. aom to before me this ............... a{y ot .... ,.. .................. 1~ . ' otaw Pu lic., . ~ ...... County ~ov~v ~u~, ~t~ o~ .*~ ~ ,* , (Signature of applicant) No. 52-~23~, Sulto)k Co~t,jJ