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Home My WebLink About20763-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20853 Date JULY 13~ 1992 THIS CERTIFIES that the building. ADDITION Location of Property 1755 SIGBBEE ROAD House No. County Tax Map No. 1000 Section 144 Block 2 Subdivision Filed Map No. LAUREL~ NEW YORK Street Hsmlet Lot Lot No. 13 conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 25~ 1992 .pursuant to which Building Permit No. 20763-Z dated JUNE 2~ 19B2 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 DECK ADDITION AS BUILT TO AN EXISTING ONE FAMILY DWELLING The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIPICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A JOHN J. & BARBARA A. CONDON ' Buildinq Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NgN9 2076}Z Permission is hereby granted to: .... ~z~...r~ ...... ~......~ ........ .~.: ..... ~ .......... ...... ........................... at premises located at .............................. .~.. ........ ~ ........... : ........................................................ ............................. ..Z...~ ~Z ...... County Tax Map No. 1000 Section ..../.. ,~..~.. ......... Block ...... ,,~27?. ......... Lot No....~/,.~....~..Z?.. ..... pursuant to c~ppltcation dated ................. .~.../.~....~... ..................... , 19..~...~.., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 Compliance from architect or engineer responsible for the building. 6., Submit Planning Board Approval of completed site plan requirements. 3. 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. '. 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 $15o00 Constructaon ...........Old Or Pre-existing B~lding)ca . tlouse No. Street Hamlet lwer or Owners of Property...~...Q~.% ~ _~_~/~ ~, .~.~/.~..~. unty Tax Map No 1000, Section...4~Z ........ Block.....'-~. .......... Lot,. g.~.~.-~ L.~. bdivision .............................. Filed Map ............ Lot ...................... . . rmit ~"P.~.~ ........ Date Of Permzt. ' alth Dept. Approval ...... /~/~. ....... ' ............. Applmcant .................. ....... arming Board Approval ................ quest for: Temporary Certificate ........... Final Certicate ........... - itt · Subm ed: ..................... qqs15 - · ........... ~0 ~-,~0 ~,-'~--~ APPLICanT FOU~Dn~IO~ ¢lstl _FOUNDATION ( 2nd ) ROUGH FRAME & -PLUMBING INSULATION PER N. STATE ENERGY CODE Yo FI~IAL ADDITIONA~L COMMENTS JUN 2 § 1992 ]'./OTe~$: -¥~o° C~A B~AtU~ 1 JUN 2 5 1992 Examined ......... 1~ Approved 19 Disapproved a/c ..................................... FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~ui~ Inspector) APPLICATION FOR BUILDING PERMIT SEPTIC FORH .............. INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 appl/- caUon. 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 ispued 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 necesec,.ry inspe~s. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~..~...~... zl~qz.~,>.. ~-,~/r~...~..~.~..~. ~'~ .X~.Jpd? .~...~gP.~ ~P ...... If applicant is a corporation, signature of duly authorized officer. FEE: '~ ~ BY: ~'/~ ' ~ N~I~ SUILDING DEPARTMENT AT ............ USE UN W[UL Plumber's License No ........... WIT~0~ C[~Tg [~C~T[ Electrkian's License N° ......... ~F' 0~PANGY Other Trade's License No ...................... STATE CONSTRUCTION ~ ENERGY CODES, NOT RESPONSIBLE FOR ]. location of land o~ which p~oposed wor~ will be' done ..................... DFS~GN OR C~9~UCTIO~ ERRORS' .. Y .... ff i. .............................. ..................... House Number Street. Hamlet County Tax Map No. 1000 Section /~ Block ~. Lot .~.. Subdivision ~4T~.~ ~ Filed Map No. ~O~ ........ Lot ~ X 7~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy ......... ~.i.~.~ .................... '¢~-. :; .... ~t.'. ............. a. Existing b. Intended use and occupancy ........ ... :' " ~ ' ' 765-1802 9 AM TO 4. PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION 4. FINA~~- ~-'~ON,e4rTRUCTION MUST SE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. 3. Nature of work (check which at plicable): New Building .......... Addition ... ~...., Alteration .......... Repair .............. Rem, wal .............. Demolition .............. Other Work ' ' (D ripti ) .'~/.:~c' '~' est on 4. Estimated Cost . ~ ~ (to be paid on filing ti{is 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 ,"g/,,~ ............. 7. Dimensions of existing structure~, if any Front ........ Rear ............. Depth ............... Height ............... Number of Stories . · ' ...... i .......... Dimensions of same structure w(th alterations'or additions: Front .............. Rear Depth .................... ].. Height ...................... Number of Stories ............... ~,. ...... 8. Dimensions of entire new constr~ction: Front ............... Rear i .... .......... Depth .... H lg'lt .... of St ' '- .......... e ~ ............... l~qum Ocr ones ..... : .......................... 9. Slzeoflot: Front ..... I. . R~ar ...................... Depth ...................... 10. Date of Purchase ~,.~4/¢~'/. ~.~'/.. .... ........' .... " .. .. .. Name of Former Owner ... ~.~,~../,.~q.~. ............. 1 1 Zone or use district in which premises are situated , , 12. Does proposed construction viol~te any zoning law, ordinance or regulation: ..,44J? .......................... 13. Will lot be regraded ......... ? .et~! ........... ,,.. ~ill excess fill be removed from premises: Yes No 14. Name of Owner. of premises .~,,~.~.--T~t~A~ .d~.~d~ress, ,(. ?.,x~'..~f~../f~.. Phone No..~e}~..= .~?/.~.. Name of Architect ....... ~{.)~.. ........... Address ........... Phone No ................ Name of Contractor ..... ,,f/~,~. ........... Address . ' ....... . ..... I0 this property within 3:00 feet of a tid'~l wetlah'd'9' ' '*~'e's ..... .......Phone No~ ......... · If yes, Southold Tiown Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from" interiorPr°pertYorlineS'cornerGiVelot.Street and bock ~umber or descnphon according to deed, and show street names and indicate whether STATE OF NEW YORK, S S ' C O.U..NT. Y OF .</-)o'-~,,~..~o,¢/~,,....'~..-r..] ' ' ..... .~7~._~,,~.XO....~OA~.~-,'O~. ............. 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 officer, etc.) of said owner or owners, and is duly ~uthorized 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 s~t forth in the application flied therewith. Sworn to before me this .................. u y oi. otary Public,.. ~.~..~...~'.~ ...... County ~o.~015a ~ ~ '(Signature of applicant) Qual~f~:l In We~tche~ter County, Corn ffllsslo~ Explrt)i