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Home My WebLink About20214-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20296 Date OCTOBER 22~ 1991 THIS CERTIFIES that the buildin~ Location of Property 430 SKUNK LANE House No. County Tax Map No. 1000 Section 97 Subdivision ACCESSORY CUTCHOGUE~ N.Y. Street Hamlet Block 3 Filed Map No. Lot 8 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 4, 1991 pursuant to which Building Permit No. 20214-Z dated OCTOBER 18~ 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 RELOCATE ACCESSORY SHED IN REAR YARD 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 Rev. 1/81 CRAIG & SUSAN LEHF~tNN /Bulldlng Inspector FOB, M NO. Il TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL. FULL COMPLETION OF THE WORK AUTHORIZED) No. 20214 Z Permission is hereby granted to: ....... ~,~..~..~....~. ................ ....... ~~.......</.:.~..../~.~ ........... . ........ ;~.: ...................... .~ ........................... ? ................. ~....;. ............. .;. ........... 2; ................ ,'"'; ..... at pr~mises located at .......... '~.,,L,..~....'~ ............ :.,.."~.'-.-..-.~'~,,*~;,,.¢...-'~6 ................... ' ~ .......................... "'--"~-~,. -~--~...: .... ~ ~ x ~,.,~-. 2'2..~ // ?~ ~- cou.~ Tax ~op No. ,000 ~.tion ..... Zg. ........... ,,oc~ ..... ~ ............ Lo, No. pursuant to application dated .......... ~ ....... .~.... ..................... , 19...~./.., end approved by the Building Inspector. Fee $...~ ............ 8uilding Inspector 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: 1. Final survey of property with accurate location of all buildings, p~Jperty 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: l. Accurate survey of property showing all property lines, streets, building and unusnal 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 v 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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $I5.00, Commercial $15.00 Date /O-- ~ew Construction .......... [ ~..~?.. Old Or Pre_existing Building...~'~--~ ~_~.~ .... ............. ''''~ [ ~ ~ ~'~' · I.ocation of Property ...... ..~..~.~. .... ~.~.~. ~ House No. Street ' ' ........ Oawer or Owners of Prome~tv Map No 000, S ctio= ....f2 ...... .... D .......... Subdivision ............................... Filed Map Lot ~ermit No Date Of Permit .............................· . · Applicant ............................. ~ealth Dept. Approval ....................... · · · Underwriters Approval .................. . . .... . '1 nning Board Approval ~equest for: Temporary Certificate ........... Final Certicate Fee Submitted: $. . ...... ~ . .... e 0 ~o~q 6' ~PLICANT N. $1' ~'I'CO"E. - 1SS.GO .f '' k ~c~Je: 40'= I" FORM NO, 1 TOWN OF SOUTHOLD ' EUILDING DEPARTMENT TQWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTIt ......... 3 SETS OF PLANS ......... SURVEY -. .................. CIICCK .................... SEPTIC FOR~I .............. HAIL TO: APPLICATION FOR BUILDING PERMIT .~, INSTRUCTIONS Sa. This application must be completely filled in by typewriter or'in ink and submitted to the Building Inspector, with 3 · cfi; of plans, accurate plot plan to scale. Fee according to schedflle. , b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets )r 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 application may not be c~mmenced 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 ~uilding 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. Fbe applicant agrees to comply with all applicable laws, ordinances building code housing code, and regulations, and to .... . ............ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... (as on the t,'~x roll or latest deed) ff applicant is a corporation, signature of duly authorized officer. (Name/md title of corporate officer) Builder's Licens~ No .......................... Plumber's License No ........ ' ............. Electrician's License No ....................... Other Trade's License No ...................... Location ofland on which proposed work w bedone ,d/.~"") ~'~/~.,~/.~. d/SZ~4j,~ · ............................ llouse Number Street Hamlet Cotmty Tax Map No. 1000 Section .............. Block ............... Lot ........... Subdivision ..................................... Filed Map No. Lot (Name) ............................. State existing Use and occu anc of ~remises and inte P Y t nded use and .~ccupancy of proposed construction: ~. ~ ............................... ~.: ................................. b. Intended use and occupancy .................................. 3. Nature of work (check)vhich ipplicable). New Build ng ,.../~... Addit' Repair Re-- · ' ....... on Alterat on ........... Demoht~on ....... ..... Other Work ........... 4. Estimated Cost ...... c. . ~ (Descrtion : ..... Fee ~ .~ (to be paid on filmg~s application) 5. If dwelling, number of dwellin units .......... Number of dwelling units on each floor ...... Ifg .... · arage, number of cars .... : .... . .... 6. If business, commercial or mix occupancy, specify nature and extent of eac e of use ....... 7. Dimensions of existing structurles, if any: Front h typ .............. Height hb fSt ............... Rear ......... Depth ............... Nut er o ories ......... ' ................... Dimensions of same structure, with alterations or additions: Front .......... Depth ' Rear Height ' ' ' ~q' .............................. · Dimensions of entire new construction: Front Umber of Stories ..................... Height Number of Stories ................ Rear ............... Depth ............... 9. Size of lot Front , ......... ? .......... near.. . Date of Purchase . .~ · ~ 1 ~! ~O ~ ..... k,' ........... Dep.t,h .... Zone or use district:'' ;; ,~' ~.~ ~t~ ~.or vormer Owner .... ~?/~ '~'~ ............... 12. m xvt ....~-r ....... are mmated ..... ' ..... Does proposed construction vio ate an,, z^-: ..... ' ' ' .............. -'~ ........... 13. ' ? , ~-,-s law, ordinance or regulation: .../~..O. ...,;... Will lot be regraded ......... : ................... Will excess fill be removed from premises. 14. Name of Owner of premises ...! ................ Address xes Name of Architect ................... Phone No .......... ........................... Address ..... ................... Phone No ................ Name of Contractor ......... i... 15. Is this property within ~00 .............. Address ................. Phone No ......... . ...... feet of a tidal wetland? *Yes ..... '... No..~ · If yes, Southoid Town Trustees Permit may be required. ' .... : PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give Street and block number or description according to deed, and show street names and indicate whether interior or coruer lot. APPROVED AS NOTED ' DA~:., ~ B.p.# F:EE: ',Z''~ ' BY: ~.~z,~ ~OTIFY BUILDING DEPAR"r~/IENT AT 765-'1802 g AM TO 4. PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ROUGH -, FRAMING & PLUMBING INSULATION FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ,,LL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ,ERRS% .................... ' ....... duly sworn, deposes and says that he is the applicant ...................... being (Name of individual signingI contract) )ore named, iS the (~ [(..Z~ ./~fr~. ......... . ......... (Contractor agent corporate ...................................... , , officer, etc.) said OWner or owners, and is duly afitborized to perform or have perfo~ed the said work and to m~e and file this plication; that all statements containe'd ~ this application are true to the best of his knowledge and belief; and that the ;rk will be perfo~ed in the m~ner se~ forth in the application filed therewith. 'om to before me tl~ ~~.1~ .~.'. ...................... ..... l' ................ ............. .' m~l~ ~p~te, I~Y~ (Signature of applicant)