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Home My WebLink About20753-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Eouthol~, N.Y. CERTIFICATE OF OCCUPANCY No Z-20824 Date JUNE 24~ 1992 THIS CERTIFIES that the building. Location of Property 195 OAKWOOD DRIVE House No. County Tax Map No. 1000 Section 70 Subdivision ALTERATION SOUTHOLD ~ N. Y. Street Hamlet Block 13 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 1992 pursuant to which Building Permit No. 20753-Z dated JUNE 22~ 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 ENCLOSE AN EXISTING SCREEN POECHAS APPLIED FOR. The certificate is issued to STEVEN CISEK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_N? 2075~Z Permission is hereby granted to: ..... ~...~,,~:.:...~::./..~....~, ..~ ................. e ............ ~ ............. ~ .................................... ~..~. ................... . . ~.~ ........ d ................................... ........... ~ ................. ~ o~i~e~ ~*~ed m ................... / ~ .............................. ~'~a~ ..... ... ~l~ ................... ..................... .................................. ~; ...... ~~ ....... ¥ ....................................................... L~.ZZ.~ ....... ~L..~ ............ ~ ........ ~..~'~2.~:~:~.~..7. ....................................................... co~ ,~ uop ~o. ~ooo s~.o~ ...... ~ ........... m~k ....... ~ ......... lot uo ..... ~ ............ Building Inspector. Fee $ ........................ / Building Inspector Rev, 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN I~LL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY i. .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: i. 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 C~pliance from archiuect or engineer ~ responsible for the building. 6. Submi~ Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and pre-exzstmng 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. ~. 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 - $I0.00 4.Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~----I~ ~ ew Construction..~j: ...... Old Or Pre-existing Building .... .~. ...... .... ~ ~.~ ~ ~.q...~. .... Nouse No. Street Hamlet '' )unty Tax Map No 1000, Section ........... Block ............... Lot .............. ~bdivision ..... . .............................. Filed Map .......... Lot .................. ,trait No ................ Date Of Permit..i.~.{J>~.~. ....... Applicant .... 'alth Dept. Approval ...... ' Underwriters Approval... ~. arming Board Approval ........ quest for: Temporary Certificate. . . Final Certicate ...... ~ Submitted: qO~_.O~Og~V APPLICANT ............. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~NAL REMARKS: DATE TOWN O:; ~ tOT ~e~ c Examined ~./f..). )~ 19 .~..,~ Approved ...... .~.~..fiT. .....19P.,~. Permit No...'"~..~.2~.4.~.. Disapproved a/c .................... ' ................. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ~uilfling Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORM .............. NOTI P¥ | CALL ................... MAIL TO: INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 set~ 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 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 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 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 authorized inspectors on premises and in building for necessary i~nspections. ... ,g3.t/ c ......... -- (S~re of applicant, or name, ifa corporation) If applicant is a corporation, signature of duly authorized officer. Builder's License No .... ~,.%-~O~7~..~ ~[!~J'~ Electrician's License No. ,~ ~'~aa a~a l~,~ Other Trade s License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. fi ~!t:..~.'v370¢~..9'o. G ............... APPROVED'AS ti0TI~D ...... Name of owner ofpremises ~J)°C'o ¢ (.\ .... .~.l.~ .~.~.--:/ ................... on roll or FOR POURED CONCRETE 2, ROUGH * FRAMING & PLUMBING 3. INSUL.ATION 4. FINAL CONSTRUCTION MUST ~E COMPLETE FOR ALL CONSTRUCTION SHALL MEET THE R~QUIREMENTS OF THE N.Y. STATE CONSTRUCTION, ~ ENERGY CODES, NOT RESPONSIBLE FOR O[$!GN OR CONSTRUCTION ERRORS I. Location of land on which proposed work will be'done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... c .'. ........... Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy I t.;LCD ~ ~ .,.Fl ', ......... .,' ..,.... :' ............. W d. t l \..:! ,.,...]: : : i:.,. .......... b. Intended use and occupancy ....... I.. [2B 1 [ .... bqr~C. .... t 0,. ,,. ,.,,~ ~ ~.... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ....2~. ..... Repair .............. Remo?al .............. Demolition .............. Other Work ............... ! . D sc ption) 4. Estimated Cost .............................. Fee ...................................... : (to be paid on filing this application) 5. If dwelling, number of dwelling Units ....... I ........ Number of dwelling units on each floor ...... 1 .......... If garage number of cars ' 6. If business, commercial or mixed.' occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ......... Dimensions of same structure with. alterations or additions: Front ............ .. ... Rear . . pth ' ight f De .................... ~.He .............. .... .. . .Numbero Stories ..... 8 Di f tra ................. · mensions o entire new cons.ction: Front ............... Rear ............... Depth ............... Height Number of Stories 9 Size of lot: Front ' Rear ............................................. Depth ...................... 10 Date of Purchase ~' Name of Former Owner 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. FI9 ........................... 13. Will Iot be regraded ..... ~. 'o ·.. O.. ................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises ·..~?Bq-....04 ....... Address ................... Phone No.g.I):.7..~?.': :,p.-/ Name of Architect ......... '.:i ................ Address ................... Phone No ................ Name of Contractor .To~x~. ~_cb~,r~'~ .~[ ~, .r ?-~...~.:. .... Address 1''~.,¢tA' .O..~:q.~? ~/./;.C.. Phone No. 7/,~,.'."'7t. ?.t/7.'~ ..... 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No..~. ...... · If yes, Southold T6wn Trustees Permit may be required. 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 nhmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEgt YORK, : ..... .~ ('5~.c,~ ..... e.q /D .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements containbd in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~t forth in the application filed therewith. Sworn to before me this Notary Public, State of N.ew Yo~ No. 4952246, Suffolk Courav (Signature of applicant) Term Expires June 12,