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Home My WebLink About20129-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. CERTIFICATE OF OCCUPANCY No Z~20204 Date SEPTEMBER 10~ 1991 THIS CERTIFIES that the building. ADDITION Location of Property 2775 PINE NECK ROAD House No. Street County Tax Map No. 1000 Section 70 Block 6 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 17 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 9~ 1991 pursuant to which Building Permit No. 20129-Z dated SEPTEMBER 9, 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 ADDITION TO ATTACHED GARAGE OF EXISTING ONE FAMILY DWELLING The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED WILLIAM & AUDREY NORRIS //Bui~ing Inspector Rev. 1/81 I~ORM NO. 0 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No- 2012~ Z Permission is hereby granted to: .................. ...az.z~.....,~....~.......~.~ ....... ....... .~..~ .......... ~~~-~:.J ...................... ~, ................................ at premises located at ..... .~Z..../..../~,~ ....... ..~..~.**..~/.~**.,-Z'~.. ...................................... County Tax Map No. 1000 Section ......... .~..~.. ....... Block ......... ~ ........Lot No ....... ..//.Z ......... pursuant to application dated ......... ..~...~.~.. ................................... , )9 .~...., and approved by the Building Inspector. Fee O ~ $...~~ Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD 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: 1o 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 "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. 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 ::ew Construction ........... Old Or Pre-existing Building ................. Location of Property 2775 PINE NECK. ROAD. .. . $OUTHOLD, N.Y... House No. Street - Hamlet WILLIAM NORRIS & WIFE Onwer or Owners of Property ....................................... County Tax Map No 1000 Section 70 Block 6 Lot .17 ...... Subdivision .................................. . . Filed Map............Lot ................... ... 20129-Z 9/9/91 14R. NORRIS Permit No ................ Date Of Permit .......... Applicant ...................... Ilealth Dept. Approval ....................... . . . Underwriters Approval ....................... . . Planning Board Approval ........................ Request for: Eee Submitted: Temporary Certificate ........... Final Certicate ........... , .... ??. .....................· APPLICANT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ~ ........ 19 ?l Approved i~ii ....... , 19 .~. Permit No...,~..Z~,~. ?....~ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOAKD OF HEALTIt ......... 3 SETS OF PLANS ...... ~... SURVEY ................... CHECK .................... SEPTIC FORH .............. hO,~PY: CALL ................... HAIL TO: Date ......... ': ......... 19... -_ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 Dr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- zation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wi/1 issued a Building Permit to the applicant. Such permit ~hall 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 ,hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or · {egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. l'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to tdmit auth°r/zed inspect°rs °n premises and in building f°r neces .7~?"~/jff.~.' .~_:' ~ - · /' '5~,. ' ': ........... '. ....: .... : ...... - (S~gnature,,of apphcant, or nam~ ~f a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................ ~ . .. //~ , /f~Jg~ ,~-~ (as on the t,ax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~..'..~..'. ................ Plumber's License No. ~4,/./q, Electrician's License No. /~' ~)l~ Other Trade's License No ..... ' ....: ............ I. Location of land o~which pro, posed work)3vill be done ......................................... ' ......... llouse Nmnber Street Hamlet .......... Block ..... 6. ............ Lot .... /'2 ............ Coanty Tax Map No. 1000 Section Subdivision...~..,.,~..,. ........................... Filed Map No ............... Lot ............... -- (Name) '.. State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction: a. Existing use and occupancy . '~<b/?.~' ~../.._~.t ~.~...~...~...~,ff].~<. ~.~ ...... .' ';~3 .......... b. Intended use and occupancy .. . . ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... / (to be paid on filing this application) 5 If dwelling, number ofdwellin~ h~ts ~,~ ........ ' * --r:~ ....... : ....... ~um~er Ol swelling units on each floor ....... . If garage, number of c~s .... ~.~ ............. · ........ ~. [.busmyss, c~p~efyial or mixe4 occupancy, sp~y~a;ur~'and ex[e~}~f'ea~ t~e ofule' J ~ ~,j~;~ j ' j ' j~ .... t. ~mensmns ot ex,st~ng stmcture~, if any: Front.. n~:.6~~ ..... Rear . .~ ~ ..... Depth ~' ' . j j'' Height Num~ber of Stories ]. Dnnensmns of same structure wi:th alterations or additions: Front ................. Rear .................. Depth ............... i Hei ht . ~ g .................... Number of Sto~es ...................... 8. Dimensions of entire new construction: Front ............... Rear .............. Depth ............... Height ............... Number of Sto~es ...... . 1 1. Zone or use district in which pre,lies are situated ~l~[~f&~ .~ ................... 12. Does proposed constructio~ violate any zonin, law a~m.~oo'~ ~ ~' ~' ' ' '~, ............................ ,. ~ ..... 7:: ~,.-. · · .~* · ~'~ ~.. .... ~m excess m~ oe removea ~rom premises: ITe~ No Nme of Contractor ~ ~,,. .................... Address ................... Phone No ................ 15. Is this proparEy within 300 fae~ of a tidal wetland? *Yes ........ · If yes, SouCh61d Town Trustees Permit may be required. ,.. ~ PLOT DIAG~ Locate clearly ~d distinctly ~1 ~uild~gs, whether existing or proposed, ~d. indicate ~I set-back d~ensions from prope~y lines. Give street ~d block ~u~ber or descfipfioh accord~g to deed, and show street nines and indicate whether interior or comer lot. ;TATE OF NE~R~ ( b S.~ (Name of individual signi~'~idc}{ ......... being duly sworn, deposes and says that he is ~he applicant hove named. (Co~trador, agent cgrporat~ ~ice[, etc. f said. owner, or owners, ~d is duly. ~uthorized. to perform or have perfo~ed the said work and ~o m~e and file this ~phcat on, that all statements contained m this application are true to the best of his knowledge and belief; and that the :ork will be perfo~ed in the m~ner sdt. forth in the application filed therewith. worn to before me th~. _ ota~ Publi , . ounty~ ~ NO. 4879505 / ~UaI~L~ in Suffdk CouhW ~ ~ (Signature of applicant)