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Home My WebLink About21154-zFORM NO. 4 TOWN O¥ SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22259 Date APRIL 16~ 1993 THIS CERTIFIES that the building. Location of Property 450 BIRCH ~ House No. County Tax Map No. 1000 Section 83 Subdivision ADDITION CUTCHOGUE~ N.Y. Street Hamlet Block 1 Lot 23 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 17~ 1992 pursuant to which Building Permit No. 21154-Z dated DECEMBER 17~ 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 ADDITION TO AN EXISTING ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to PATRICIALARK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A ~Building Inspector Rev. 1/81 TOWN OF ~SOUTJ'!~LD TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~N? 2115~Z County Tox Mop No. 1000 Section ....... .~....~...~. ...... Block ..... ..c~.l. .......... Lot No ...... ..~....~, ........... pu,~-ont to opp,~o.o. ~o~ ~.... ......,.l~. ..... . .......... ~9.~ ond o~p,~ b~ ~, Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOU~HOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be fi21ed 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 ~opographic 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 2½10 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 App=oval of completed site plan requirements. B. ~- 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, Swinnning pool $25.00, Accessory building $25.00, Additions t9 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 ................. ocation of Sroperty ........ ..... House No. Street Hamlet 0nwer or Owners of Property...~.~ .~.~/~ .... '~.~...~..~ ...................................... County Tax Map No I000, Section ..... .~).~...Block ...... .C~.I ..... Lot. P-- ~ ~ubdivision....~. ~.~Io~.. ~..~//~ .............. Filed Map ........ ~...Lot....~.? ............... 'ermit No .......... .~..Date Of ~ ~..a_ .... Applicant .~..~.~i~....~.~..~.~..~. ...... lealth Dept Approval '" - Underwriters Approval ~ ~lanning Board royal ..................... equest for: Temporary Certificate ........... Final Certicate...~ ...... S bmitted: .................. OUNDA~ION OUNDATIO~4 OUGM FRAME & (1st) (2nd) -PLUMBING .~;SULATIO~! FER N. STATE ENERGY CODE Fi:;AL ADDITIONAL COMMENTS FORM NO~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~" TEL.: 765-1802 Examin~d'~.x."l,' 19 .~.."~.~ Approved 19~1..}-'. Permit No ............ Disapproved a/c ....... (g'ffllding Inspector) APPLICATION FOR BUILDING PER,MIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS SURVEY CIIECK .................... SEPTIC FORH C^LL ;j: ................ MA I L . /)£c.-,37v/t, rz/e /' Date ..........: .... ~.., 197J. a. Tlfis application must be completely filled in by typewriter orin 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, relatior~ship 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 tlfis application may not be commenced before issuance of Building Permit. d. Upon approval of this application, tlie Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the w6rk. 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 rem6vai'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 instils. ,., _ ,) -- (Signature of applicant, or name, if a corporation) " . ..$V.~. ~(~.~(Z...~-,-'~.<~, .4'.-r¢. ,~:'.V:'.<..~.Z.' (Mailing address of applicant) State whether applicant is~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises .................................................... (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) Builder's License No Plumber's License No ......................... ; Electri,cian's License No ...... - ... Other Trade's License No ...................... Location of land on which proposed work will be'done ................................................... House Num bet Street Hamlet County Tax Map No. I000 Section ......... ~..3 ...... Block '....lt. ............ ~ Lot .'?. ?. .............. Subdivision./..~/.//.,ff'....~..~.. ?,~././~.¢./g'... ~.//(.~.fi- ...... Filed Mhp No .... j~.. '/?,$' ..... Lot . .~,' ............ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .b'.,/)~.~47-. .... .~?/V..~?P./..,q~.. ~.'.~.~.,x'.~F.-.z-;. ~.,~.~./] ..... .~.Q..~.?. ?. '.Z.2.~ ......... b. Intended use and occupancy ,. [.o...C.C.,c:5../-.,y?5.C../] W.3,7./.,r/.vp...2'~..~.~./.$ .-'5./.>(a...3~'.n ................. 3. Nature ofwork (check which a~plicable): New Building ...... Additon., .L~.... Atera ' . .... Repair ....... Rem--" ' . ' · ' · .... t on ..... ....... ~val .............. Demolition ..., ........... Other Work ....... 1 ..... ~. ~..c.o ,~,~../-~?//d~.~ (Des riptio ) 4.' Estimated Cost .... c n eil'ygiu t '' ....... .mber of 6. If bus~ness, commercml or m~xcd occun v ~w,, -~+ ..... ~ . . ~ _ ' ......... ,' '~ ............... 7. Dunensmns ot existingstmcturd ..... ~ ~ / each type of use . .~. . , ...... [ ,%Hazy: Pro~[.. ~;..(.. . Re~ ~. ~ .,7 ......... ~e~ght . . .~ ........... Number of Sto~e~ ~ · · · ar . .n ~ .......... Depth . .~ .......... Dimensions of same structure whh ,), .... :~_~ ' ' ' ~LL' ' ' ' ~' .................................. ..... ' ....... l.. He~t .... ~ .... ,, ..... / ............ ~' ~menstonspfenttre newconstfi~ction Front ZT~ ...... 2" t~um~ot~tones ... ~. ......... ~. ~ ..... Height ...( ........... Num'ber of Stories · ~ 5 ......... t(ear .... ~ f; ........ Depth . fi ............ 9. Size of lot Front /Zo 10. ' '~ .... ~ .......... DateofPurchase ~.{6~f.~.~.. . . Rear .... ~KO .............. Depth ..Z~' .......... 11. Zone or use distri~ti~which pre~nis~s'ar~ 2. Does proposed constructton violate any ~'~,i, ~ -, ' ..... ................................. 3. Will lot be re~raded . ~/~ ...... , ......g .aw, oramance or regulahon ~4 .... ' /~ ................ Wdl excess fill be removed from premises: Yes 4. N~e of Owner of premises .~nc~/>. ~d~ .... Address ~ ~.e~e~./~.., Phone No. ZX ~;~ ~?f ...... or ..... ........... :.. Aa& s .... .......... N~e of Contractor ..... , ........... Address . ..~. . . Phone No. ~(~ . ' . ~. 15. Is ~h~a property wxcnxn 300 [ee~ of a C~dal wetland? ~Yes'."..'.'.'.'.'.' No. ~ ...... ' .... ~[~ yes, Sou~ho~d T~n Trustees Perra~ may be required. .... PLOT DIAG~ Locate clearly ~d distinctly fi[ ~ufld~gs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from properW lines. Give street ~d block ~ umber or description accord~g to deed, and show street n~es and indicate whether ~tefior or corner lot. 2. RO~JGH - FILe~MING & PLUM~IN{ 3, ]NSLILATIf)N ~ BE COMPLETE FOR C.O, ~ "ALL (,ON;~FRUCTION $HALL! MEE1 '?~E REOUIREMENTS OF THE N2 ~i~TATE CONSTRUCTION & ENEEG CO~ES, NOT RESPONSIBL~ FO~ OE~IGN OR CONSTRUCTION ERROR= TATE OF NEW YORK,... . ' OUNTy OF....5.q ~A~ %z.,;,( .... S.SI (Name of individual signing ~ontract) being duly sworn, deposes and says that he is the applicant rove named. (Contractor agent corporate office~ otc ) ........... md owner or owners and is du y an~horized to perform or have performed the said Work and to make and file this P cation; that all statements contained in this application are true to the best of his knowledge and belief; and that the )rk will be performed in tile manner set ;forth in the application filed therewith. tom to before me this ............ ff ......... day of .......... 19 ~.' {~- ' ............... , ............ County (Signature of applicant)