The URL can be used to link to this page

Home My WebLink About20830-zFORM NO. 4 TOWN OF BOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20940 Date AUGUST 12¢ 1992 THIS CERTIFIES that the buildin~ Location of Property 155 GLOVER STREET House No. County Tax Map No. 1000 Section 59 Subdivision ADDITION SOUTHOLD~ N.Y. Street Block 1I Lot 2 Filed Map No. Lot No. Hamlet conforms substantiaIl¥ to the Application for Building Permit heretofore filed in this office dated JULY 9, 1992 pursuant to which Building Permit No. 20830-Z dated JULY 14~ 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ROBERT J. & BETTY DEROSKI Rev. 1/81 IFOuM' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLDo N. Y. BUILDING PERMIT ~'HIS PEPJ~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N N? 20890Z Permission is hereby granted to: .......... at prem,sesrllocated at ...t.C-~..~......~~...~.. · ..~.~-~t~u~~'~'.~ ~,-~ ,._~U ~ -,e~ . ~. ~ ................................. County Tax Mop No. 1000 Section ..... ..C~...~..~., ....... Block. ....... ),.! ........... Lot No......C~......~., .......... pursuant to application dated ....... .,~...,d~...,,.~ ....................... , 19.~....~., and approved by the Building Inspector. Fee $.~..,......,~... ...... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 i ~" AU6 1~ 0 %2 ,, ' i,I APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2.Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" lend uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusum natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling. S25.00, Accessory.,.$t0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 ~. 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 ~. /..C7,/~.,~.t'/ /'~': 5.Updated C.O. $ 50.00 Date ............ NewC°nstructi°n Old or Pre-existing Building Vacant Land Locaton ofProperty /~.~,~ ~'. ~.~/~. ~'~ ~ C~O~/~ ~ ,/~z/ ou8o No. Street / ~qa~let / Owner or Owners of Property .(~.~.//.k~.~...~.~.t°.~..~.~.~..c.t..-~..~..~.t~.~..~....~...~ .~P.~-PF' . County Tax Map ~o. ~000 Section . P. ~'-~. ....... Block ../ /. Cot...q..Z-.. Subdivision .............. ~. .................. Filed Map No. ~ ...... lot No. .. Permit No 2o~q~3.0.~. ....... Date of Permit ~l~g.~. .Applicant :~.~ ,'~-~-/~. -- ~z,~. ~.. ~-~'~ Health Oept Approval '-- Labor Dept Approval Underwriters Approval ......... '---.-. ............. Planning Board Approval ..... ~ .............. Request for Temporary Certificate ........ ~.'. ........... Final Certificate .. ~ Fee Submitted $~ ......................... Construction on above described building and jpGmit meets all applicable codes and regulations. Applicant ..... , ...................... Rev. 10-10-78 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL ?OU~;DA'TION '*OUNDATIO:! IOUGH FRAME & (2nd) .PLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FI;IAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .............................. i:i~ ' ................. ' ............... iZ3.'.L.' i (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTIt ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: Date .7/..~. ........... , 199Z'... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 gets 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 bg 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 pursuan~ 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... ~.insp'~cti°ns' .~...~].e,4.~.w,~ ................... ' --' ' (Signature of applicant, or ddme, if a corporation) (Mgiling address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... "i'" .................................... Name of owner of premises .... j... .......................... ,-~..~ ...................... ' (as on the ta~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 LicenseNo ......................... Electridan's License 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 .... ff..?. ......... Block 1/ Lot Subdivision -"~ Filed Map No ............... Lot (Name) State existing use and occupancy of~remises and intended Use and occupancy of proposed construction: a. Existing use and occupancy . .~. g .... b Intended use and occupancy ~ ~ .~ .- :' 3. Nature of work (check which ap'plicable): New Building Addition .......... teration .......... Repair .............. Rem6val .............. Demo/it/on .............. Other Work 4 Estimated Cost 7~..~ ~.~. (Description) ] , (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ,f. ......... Number of dwelling units on each floor... Z ........... . if garage, number of cars .... ~ .............................................. ..~o. · ,.. ¢ ............ 6. If business, commercial or mixed occupancy, specifyjl.at.u~./e/and extent of each. type of use /~--l~,r ,~ ~ ~-,a~ ,.-, ' Dirnensionsgsame structure w!th alterations or,.ad, ditions Front . L~. ~.'... Rea~2 ~"~' .... 8. Dimensions of entire new construction'~ Front ~.'-~. · . Rear ~'. ~'~' n~-,~- '~' ~:k'! ' ' ' Height .......... Num~ber of Stories . ..... · .......... Rear ...... Depth .7-~.~.. . ....... I0. Date of Purchase .--7 ." · · · · Name -f Fo er 0 Zone or use district in which pr mises are ituated': 12. Does proposed construction viol~te.i/ny zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .."M'.a,~..,i .................... Will excess fill be removed from premises:t.t-- ''"'tY~s~.~ Name of Architect .-'~..._:_~. · . Address . Phone N 15. IS this property within 300 feet of a tidal wetland? ~Yes ~ll~ . · If yes, Southold ~own Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all Ibuildings, whether existing or and_.~icate ali set-back dimensions from property lines. Give street and block humber or description according to and show"~re,~s and indicate whether interior or corner lot. STATE OF NEW YORK, ............ (Name of individual signihg c~-ttract) above named. O .... being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyl authorized to perform or have performed the said work and to make and file this application; that all statements contailned in this application are true to the best of his knowledge and belief; and that the work will be performe~l in the manner Sworn to before me this ................. ~ay of .: . JOYCE M. WI Notary Publlo, Stere No. 4952246, 8ur1 Term Expires Jura forth in the application filed therewith. ~lk CounW_ ?2, ~s.z~ AREA -' sq. ft, :....,,, A T SUFFOLK' 1000',-'59'--i~ 11 ' 02 Scale Nov. 27, 1989 ,:~ . EURO~AN AM~mCAN.,BANK · ':=' AOUEBOGUE ABSTRACT '.:~ ' ' '~ WLADYSLA WA SABALJA Prel~ared in accordanoe With thw m/n/mum $tanif$rdm for title ~turvftym mm ~wt~bllwhwd by the L,~A,L.S. and ~provwd ~ adepted Title Aawo~latlon. K.S. LIG. NO. 49668 trAIN ROAD.,,