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Home My WebLink About20153-zFORM HO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20237 Date SEPTEMBER 25~ 1991 THIS CERTIFIES that the building. Location of Property 330 DOGWOOD LANE House No. County Tax Map No. 1000 Section 54 Subdivision ACCESSORY SOUTHOLD~ N.Y. Street ~amlet Block 8 Lot 3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 10, 1991 pursuant to which Building Permit No. 20153-Z dated SEPTF24BER 20~ 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 ACCESSORY STORAGE SHED 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 SUSAN CANEJA & ORS. Rev. 1/81 ~ // ~uilding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No' ?01 53 Z Dot° ...~.../.?.~ ........................................ , ~9.~./ / Permission i~ereby g/co, ted to: at premises located at .....~....~..~.. ........ ~.~-.~.....~ ...................................................... ........................................................... ~~~ ...,...~ .~ ........................... .......... : .................. pursuant to application dated .... . .~././.:.~.. ...................................... , 19...~./..~ and approved by the Building Inspector. Fee / ~J~Cuildlng In.~ector Rev. 6/30/80 BLDG. DEP'L TOWM OF SOUTHOLD Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 7 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 "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 - $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 - Residentia]~ $15.00, Commercial $15.00 Date..?/!.~. ,1. fi J ........................... .... Old ....: · ,ew Construction ........... r -existin uilding ............ Location roperty ............................. House No. Street Hamlet Onwer or Owners of Property.,..~..~.~...~..t~,.~.~.,~..~,..0~.~.~ .............. County Tax Map No 1000, Section .... ~..? ....... Block . . ~ .... Lot ...... ~. .... Subdivision Filed Map Lot Permit No ........... I ..... Date Of Permit ......... Applican~ .............. tlealth Dept. Approval ........................ Underwriters Approval PI tuning Board Approval APPLICANT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 · (Budding I~ect6r) ' APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEFTIC FORH .............. CALL .......... HAIL TO: Date .... ......... 1991 . -- INSTRUCTIONS a. This application must be completely filled in by typewriter orin 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 Jr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this applica[~on 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 ;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 apvlicable Laws, Ordinances or ?,egulations, for the construction of buildings, additions or alterations, or[flor removal or demolition, i~s herein described. Fhe applicant agrees to comply with ali applicable laws, ordinances, buil~'~ code, housifig/~od¢~ regulations, and to ~dmit authorized inspectors on premises and in building for necessary-q'fi~,~ons. / / C - ............ tmgnature ~ app$icant, or name, if a'%orporation) (Mailing add~'ess of applicant) ] / ~ 0~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . . .~3,~./~t~{ ..........~____j~ lQ ~ '.~. ............. -~'C~" ' '(~'~ . (as on the t.ax roll 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 ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................ · .&: ............................. f lou Street Hamlet County Tax Map No. 1000 Section ..... ~'~. · .4 ....... Block ....~. ............. Lot 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~. ~ .....~ b Intended and · use occupancy .................. ~ , 3. ~Natur. e of work (check whi_ch applicable): New Building .......... Addition .......... Alteration..., .......... ~epair .......... .~.. l<.emoyal .............. Demolition .............. Other Worl~.... ~,~.~ ~ .~. .... '^ -- i " ~ (Description) 4. Estimated Cost .... ?J'F0' '0'~' . I ........................ Fee ................ . ~ (to be paid on filing this application) $. If dwelling, number of dwelling tlnits ............... Number of dwelling units on each floor ................ · If garage, hum bet of cars ..... i .................................................................. 6. If business, commercial or mlxedi occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wit. h alterations or additions: Front ................. Rear .................. Depth ~ Height .................... i ....................... Number of Stories ...................... 8. Dimensions of entire new constr~ction: Front ............... Rear ............... Depth ............... Height , · ............... Number of Stones ........................................................ 9 Size of lot: Front J Rear · ' .......................................... Depth ...................... I0. Date of Purchase ........... , · ....... ' ......... Name of Form r Owner ..................... 1 I. Zo.n.e or use district in which premises are situated ............ ' ....... 1 2. Docs proposed construction violate any zoning law, ordinance or regulation: ..., ............. ,.. .............. 13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. I Add · '1 ................ tess ................... Phone No ................ Name of Architect .......... , . ................. Address ................... Phone No ................ Name of Contractor ........................... Address ................... Phone No ............... 15. Is this property within 3~0 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southdld Tpwn 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. Give street and block nhn:lber or descriptioh according to deed, and show street names and indicate whether interior or comer lot. ~E~: .~,B: ~ 7(~B-1802 9 AM TO 4 pM FOR THE FOLLOWING tNSP~CTIONS: 1. FOUNDATiON TWO REQUIRED FOR POURED CONCRETE 2, ROUGH "FRAMING & PLUMBING 3, ~NSU[~TION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL ME~ TNE REQUIREMEN~ OF THE N.Y, STATE CONSTRU~ION & ENERGY CODES, N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ;TATE OF NEW YORK, :O u,xq'Y OF .............................. ~ .............. being duly sworn, deposes and says that he is the applicant (Name of individual sJgnmg contract) bore named. is the ........................................................................................ (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly: uthorized to perform or have performed the said work and to make and file this pplication; that all statements contalz ;d in this application are true to the best of his knowledge and belief; and that the .'ork will be performed in the manner s~t forth in the application filed therewith. worn to before me this l NOTARY PUBLIC, State of flew ~ · . ..... Tern [xpims l~ch ~0, tg--~' (S'gnature of applicant)