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Home My WebLink About20834-zFORM NO. 4 TOWN OF SOUTHOLD ~3ILDING DEPART14ENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20868 Date JULY 20, 1992 THIS CERTIFIES that the building ACCESSORY Location of Property 6065 INDIAN NECK LANE House No. Street County Tax Map No. 1000 Section 86 Block 6 Subdivision Filed Map No. PECONIC~ N.Y. Hamlet Lot 18 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 15~ 1992 pursuant to which Building Permit No. 20834-Z dated JULY 16~ 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 ACCESSORY BUILDING IN REAR YAP~ AS BUILT. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HFAtLTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED JOSEPH SHIPMAN & ORS N/A N/A "/ B~ain~ InSpector Rev. 1/81 · OB~ NO. 0 TOWN OF SOUTHOLD BUILDING DEI'ARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ..... 7..'./.~ ........................ N-ON? 2083tZ Date ~ ................, 19...~,,.~ Permission is hereby granted to: _ ........... ........ ' ' .... 7'-""'"-'" ..... 7 .... ~.,'~'"':'"*", , , County Tax Map No. I000 Section ...... ~,.,,~,, ........ Block ....... ~ ......... Lot No ....... Z~.,, ....... pursuont to oppllcation dated ...... ./~...~... ................................. , Building Inspector. Fee $,.~ 19.~...~-~--and approved by the Re~ 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION 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 Ppre-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 Date .... ... o . ~ ....................... .. .. New Construction ........... Old Or Pre-existing Building.} .~....~__~.U~ ?''~''' '~'' Location 6f Property ...... ~ ......................... House No. Street Hamlet Onwer or Owners of Property][.~. ~/~,k~.w~,Z ~,. ~:~.~2.q~ .~'~.~. 9.~.~ .f.~. ~ ~' ~C, C ~ ~ County Tax Map No 1000, Section..'...~.[ .... Block ..... ~ ......... Lot .................. Subdivision Filed Map Lot .... Permit No Date Of Permit . .. Applicant ........... Health Dept Approval Underwriters Approval .. Planning Board Approval ......... Request for: Temporary Certificate ........... Final Certicate ........... Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 BETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. CALL ....... MAIL TO: Date ............ , 19. ~. This application mff~t 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 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 buitdingfor necess.',~~inspections. ~..~..~.. ( [Signature of applicant, or name,/fa corporation) . .'7. . : . :r. c, ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, signatnr~ of. dfil~,'au'tl~drize'd officer. (Nam~ and title of co.orate officer) Builder s Lmense No ..................... Plumber's License No ......................... Electriqian's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work Will be'done ........ ~..0.~...ff~...~.~'%~....~)...~...,~../~.,.. }louse Number Street Hamlet County Tax Map No. 1000 Section....~.6 ........... 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 b. Intended use and occupancy . .~'..,~... ~Z~.~ ~,~ ~.'~ ~'~~,. ~i. ~;~; ~?,.,~ ~.,: ,~ ,~~[iiiii~i'?i!::iiii?/i:' ~ i"i: ................. ~.,, ,~!,,,~. .,? , ?'.~ ; '.~. . '( ~ .................. 3. Nature of work (check which a plicable): New Building .~."f.. ddition .......... Alteration .......... Repair Removal .............. Demolition .............. Other Work ............... ~ 6'O' ~ c.,.'O (De scr iptio n ) 4. Estimated Cost ...........'' :. .................. · .... · Fee ...~-..~..~ .... (to be paid on filing this application) 5. If dwelling, number of dwelling [~nits ............... 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 ..................... 7. Dimensions of existing structure~, if any: Front Rear ............................. Depth ............... Height Numiber of Stories Dimensions of same structure wi~h alterations or additions: Front ............... Rear .................. Denth ' · ' ............ Number of Stories,~!~ ;. ........... ~ ....... 8. Dimensions of entire new const~ction. Front .......... Rear ............... Depth .............. Height ............... Number of Stories ' 9. Size of lot: Front .......... . ............ Rear. Depth ...... 10. Date of Purchase ' - . ................... ' ......... ~ame or former owner ............................. 1 I. Zone or use district in which pre~nises are situated ......................... 12. Does proposed constructmn vml~te any zoning law, ordinance or regulatmn: .......................... i ..... 13. Will lot be regraded ......... i, .............. .... Will excess fill be removed from premises: Yes No 14 Name of Ownerofp cruises i Add Ph ' · r ................... ress ................... one No ................ Name of Architect .......... 4 ................ Address ................... Phone No .............. Name of Contractor ........ ~ Add Ph No '~' 15. Is this property within 300 feet of a tidal wetland*. *Yes ........ No ......... · If yes, Southold Town 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. Gwe street and block nlumber or description according to deed, and show street names and indicate whether interior or corner lot. ,~ OCCUPANCY OR ! USE-IS UNLAWFUL W]IHOUT cERlr FICATE OF OCCUPANCY APPROVED AS NOTED DATE: ..... B.R # -- FEE: ,.~ BY: ~ NOTIFY BUILDING DEPARTMENT '76§-t802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH o FRAMING & PLUMBING 3, INSULATION 4, FINAL CONSTRUCTION MUST SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENT~ OF THE N.y. STATE CONETRUCTiON & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS .I STATr Or NEW _ s.; cou~¥ OF ..... .~.~,~.~ ..... , · ..~..O.,5. ~.. ~¢.. ~. ~ ~'.~ ~ .~ .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing~ contract) above named· He is the ' 0.~~ i (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly a~thorized to perform or have perfo~ed the said work 'and to m~e and file this ~pplication; that all statements containe~d ~ this application are true to the best of his knowledge and belief; and that the ~ork will be perfo~ed in the m~e~ forth in the application flied therewith. ................... ~.~y of. ~..[J.. ~ . . .l ....... 19 ~ · ' / .... / [~,~~.a~ ~v - 'o ..... o- .... ~ . · ............. f ~&n~,~~ ~ (S~gnature of applicant)