HomeMy WebLinkAbout21133-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22017 Date DECEMBER 10~ 1992
THIS CERTIFIES that the building
Location of Property 5635 WESTPHALIA ROAD
House No. Street
County Tax Map No. 1000 Section II3 Block 12
Subdivision Filed Map No.
~CCESSORY
~u~TTITUCK, N~Y.
Hamlet
Lot 4
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 8, 1992 pursuant to which
Building Permit No. 21133-Z dated DECEMBER 10~ 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 ACCESSORY STORAGE SHED AS APPLIED FOR.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
ROBERT & DONNA NED-DECK
Rev. 1/81
IPO~M' NO. 0
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NoNe.
County Tox Map No. I00~ ..... Block ....... ) .............. Lot No .....,,C~., ..............
pursuant to application doted ~,.~. ........................ , 19.~......-~:~-a, nd approved by the
Building Inspector.
Fee
Re~ 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
~JPPLICATION 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 - $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
1992
Date .... ........................
New Construction ........... 01d Or Pre-existing Building .................
. A TTI CR,
Location of ~roper~y ...........................................................
House No. Street Hamlet
ROBERT & DONIqANEUDECK
Onwer or Owners of Property
113 12
County Tax Map No i000, Section .............. Block ...... Lot.
Subdivision ................................. · . . Filed Map ............ Lot ......................
Permit No ........... Date Of t~e ...................... Applicant.. RBT N~UDECK
Health Dept. Approval ........................ · . Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate .......... ~ Final Certicate ...........
Fee Submitted: $ .... ~...0.0 ................. ~'
~ ~ '~'~ ~ '7 ' -- ' ROBERT I~UDECK
]'7 ,. APPLICANT
OUNDA'TION --- _ (~l~t)
OUNDATION (2nd)
OUGH FRAME &
.PLUMBING
NSULATION PER N.
STATE E~;ERGY
CODE
Fi;;AL
COMMENTS
ADDITIONAL
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
,, SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examine~t~. }. 9., 19~..Jr'---
Approved..~..~. !.~., 19~ .'%-. Permit No. · .'~. ()..~..~..~.
Disapproved a/c .... ................. 39,9 ....... ./.../~
/
................................. ........... .....
'('Building Inspector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH
3 SETS OF PLANS
SURVEY ...................
ClIECK ....................
SEPTIC FORH ..............
CALL ...................
HAIL TO:
Date ~..~~ .... , 19~.~.
INSTRUCTIQNS
a. Tkis 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 coverOd 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 Buitding 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 authorized inspectors on premises and in building for necessary irp~ections.
.... (Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . .~'~....~. ~07zO-,...~P-,~¢0.~9~, .........................................
(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 License No .........................
Electncmn s Lmense 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 . .1.1~.-.],,:,9 :'.z-;Z ...... Block .................. Lot ...................
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ../9./Z~ . ,f~/z~.. ~.. da/
b Intended use and occupancy
9.
10.
11.
12.
1.3.
14.
15.
property lines. Give street and block number or description according to
interior or corner lot.
Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Remdval .............. Demolition .............. Other Work ...............
(Description)
Estimated Cost .~. ~0.O ............................... Fee .~.~. ........................
(to be paid on filing this application)
If dwelling, number o f dwelling ~nits ............... Number of dwelling units on each floor ................
If garage number of cars ~'
· If busine'ss .... ~ ...................................................................
, commercial or mixer occupancy, specify nature and extent of each type of use .....................
Dimensions of existing structureg, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure wiih alterations or additions: Front ................. Rear ..................
Depth .................... :.. Height ...................... Number of Stories ............... ~ ........
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 premises are situated ...........
DoesX'prol~osed con ction violate any zoning law, ordinance or regulation: .................
Will lot be regraded '< ' ! ' . ..............
........ : ............ 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 ......... i ................ Address ................... Phone No ................
Is this property within 3100 feet of a tidal wetland? *Yes'. ....... No .........
*If yes, Southold T?wn Trustees Permit may be required,
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
deed, and show street names and indicate whether
STATE OF NEW YORK, SiS
COUNTY OF .................
.....~.q .A{..~..4...~...~..C)..O..~.c..~'. i ................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ....................... i ..................................................................
~ (Contractor, agent, corporate office~r, etc.)
of said owner or owners, and is duly iauthorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner get forth in the application flied therewith.
Sworn to before me this
......~......./.t~ ....... day of...~..~ .' ..... 19 .~-.
Notary Public, Sta't~ of ~ York
No. 495224.6, SUffolk Coun_ty (Signature of applicant)
Term Expires J~ne 12, 19-~