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Home My WebLink About20016-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20175 Date AUGUST 27~ 1991 THIS CERTIFIES that the building. ADDITION Location of Property~ 17950 MAIN ROAD (RTE #25) House No. Street County Tax Map No. 1000 Section 115 Block 4 Subdivision Filed Map No. NATTITUCK~ N.Y. Hamlet Lot 15 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 11, 1991 pursuant to which Building Permit No. 20016-Z dated JULY 15, 1991 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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A CHARLES & ELIZABETH GERBER' // Building Inspector Rev. 1/81 1~0~ NO. ~ TOWN OP 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-o 200!~ Z Building Inspector. tot Rev. 6/30/80 : BLDG. DEPT. TOWN OF,SOUTHOLD , 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 acchrate 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 "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, 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 - $i00.00 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 ....~/..~./. ........................... New Construction ~ Old Or Pre-existing Building Location of Property..Z.f.~.~.~.... ~.~/~..~...~a .'~. ............. ~.~.~..~. ~...~/. · .~. ...... House No. Street Hamlet Onwer or Owners of Property.d.~.~.Z~.~...~.. ~-.~ZZ ~. ~.~. ~-~...~.~. -~- .~.Z..~. ...... County Tax Map No 1000, Section ..... Block ............ Lot ................... Subdivision .................................... Filed Map ............ Lot ..................... . Date Of Permit ..~/.~./~../.Applicant ........ Permit No Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate Fee Submitted: $ ~ ~... ~. .................. [(J'~ ~)\q5 ....... APPLICANT ''' /1ELD FOU~DATION FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Q ~ /SKA 0£: I 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [ F/~INAL ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BLDG. DEPT. SOUTHOLD, N.Y. 11971 TOWN OF SOUTHOLD TEL.: 765-1803 Disapproved a/c ..................................... (Buildin~ In~ctor) APPLICATIO~ FO~ BOILDI~G PERMIT BOARD OF HEALTH . SURVEY .hr ...... ~. - c,,Ec~: .~..scy.'t ::. SEPT'lC FORH .............. HAIL TO: .~¢:0...'7~ ~ ............ INSTRUCTIONS a. Tkis application must 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. ~. The work covered by this application may not be cbmmenced 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 fo[ 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 [~egulations, and to admit authorized inspectors on premises and in building for necessary insp, eq~ions, fi /~ .... (Signature of applicant, or name, if a corporation) ~. ~.x.. ~ .t~.q,., .~.. a.r Y.. T. ~..~-~....~..'/ ......... " (Mailing address of applicant) State wheth~3 applicant' iS owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ,., ,.;, ,' (as on the t,ajx roll or latest deed) If applicant s a'lSoviS~a~tari, s~gna~t,~r~, of duly authorized officer: (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .............. ~ ................................... 1.'/. ~.~.0. ...... ,q.-r;.... Z.~ ................................. m. ~ r .'r.; .-r. ~ .~:' ............. House Number Street Hamlet County Tax Map No. lb00 Section ..... ].[5 ......... Block ....~. ............. Lot..l~. ........... :.. Subdivision ..................................... Filed Map No ............... Lot ............ ,..-~ · (Name) ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: : a. Existing use and occupancy ...... ...... 0..¢'~ ,~_:;.._~ I ./~..~. t~TJ ~J-~- ~ · .......... . ....................... ~ ~;.5,'J~ ~,;:;k~% ~¢! '" ' b. Intended use and occupancy ....................... ,. ,...~-...~, ........... property lines. Give street and block humber or deseriptioh according to deed, and show interior or corner lot. 3. Nature of work (check which ap:plicable): New Building .......... Addition ..... ^' ..... ' Repair .............. Removal ............. Demolition .............. Other Worl~.¢.~,~...' .... ~ l~ ' ' ~('~e~cfl~tion,). 4. Estimated Cost ...... ].~q.~[ ............... Fee ......................... . ....... (to be paid on fi ' fling this application) 5. If dwelling, number of dwelling hnits ............. Number of dwelling units on each floor ................ If garage numberofc~s . ~ . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctum~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Sto~es ........................................................ D~ensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... i.. HeiSt ...................... Number of Stories ...................... 8. Dimensions of entire new const~ction: Front ............... Rear ............... Depth ............... Height ............... Number of Sto~es ........................................................ 9. Size of lot: Front ........... ~ ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... .................. Name of Foyer Owner ............................. 1 I. Zone or use district in which premises are situated ..... 12., Does proposed construction wolate any zoning law, ordinance or regulation: .... 13. Will lot be regraded ......... ~ .................. Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises ... ~ ................ Address ................... Phone No ................. Nme of Architect .......... ~ ................ Address ................... Phone No ................ Nme of Contractor .......................... Address .................. Phone No 15. Is thS~.¢ropart~ ~i~h~n 3p0 feet of a t~dal ~etland? PYes ........ ~o.~0..J.'.' ............. ~&r yos, ~outaold T,own Trustees Permit may be requSred. PLOT DIAG~ Locate clearly ~d distinctly ~1 bulldogs, whether existing or proposed, ~d. indicate ~1 set-back d~ensions street nines and indicate whether N ~)-~:IF¥ ~ D ~ P~'~I~A~ 765-1802 9'AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ~0 REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSU~ON 4. FINAL CONSTRUCTION MU~T BE COMPL~E FOR C,O, ALL CONSTRU~ON 8HA~ ME~ THE REQ~IREME~ OF THE N.Z STATE CON~U~ & ENERGY CODES. N~ RESffiN$18~ FOR DESIGN OR ~8~ON ERRORS STATE OF NEW YOI~Ko,/_ COUNTY OF .~.c,t..~.... (Name of individual signin above named. .................. being duly sworn, deposes and says that he is the applicant contract) the (A.) tt~' ....... .els ...........,%.. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly iuthorized to perform or have performed the said work and to make and file this applicati6hi that all statements contain'ed 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 . ....... /J... ~f~ ..... ~...day, o~. ~ .......... , 19 ~../ ..... ~~ ~ ~ ' (Signature of applicant)