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Y
FORM NO. 4
TOWN OF SOUTHOLD
BIJILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20354 Date NOVEMBER 19, 1991
THIS CERTIFIES that. the building ACCESSORY
Location of Property 1750 SMITH ROAD PECONIC, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 98 Block 3 Lot 20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVENBER 12, 1991 pursuant to which
Building Permit No. Z-20354 dated NOVEMBER 19, 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 GREENHOUSE AS APPLIED FOR.
The certificate is issued to DONALD RAYNIS E KATHY GRAHAM
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
1t18M NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENY
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZEDI
N 2 0 2 7 4 Z Date 19.~~
Permission is hereby granted to:
~
ro .~.'~G.GIs'j~'~'~f••••••Q-r.~.....~r~P..~.~~:~a. :?~:......®t~~
of premises located at ......~.~~......`:E'~....~~/
~..~.~`.rP--i ~
.
County Tox Map No. 1000 Section Bloek .......'°'~............ppL/ot No...............
' pursuant to application dated ..1~~.~ 19..T../.., and approved by the
' Building Inspector.
Fee S.••,r~:.dr.
. . ~c
Buil for
Rev. 6/30/80
s~4:'r~(;g~?~,~~~+vf 1=:,~. ~."'~~e Form No. 6
Y+
~ ~ ~ e TOWN OF SOUTI[OLD
NOV ) 2 I e ~ ~ BUILDING DEPARTMENT
i~ i
TORN HALL
:,-~~~i6~r 765-1802
.t.r. 14.:' ~ f 6 `.~i 74'5! ~l
N,,~.,..w ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OP, 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 Iines,
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 17 lead.
S. 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.
S, 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 525,00, Additions to dwelling $25.00,
AlteraCions 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 Euilding - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
S. Temporary Certificate of Occupancy - Residentia~,l~7/$1n5~00,/ Commercial $15.00
Date ...ll.kV.':...f .°1 ~G./.~~,~. f
::ew Construction....... „ Old Or yre~-e~xi~sting Building. ?
Location of Property...~,~5.~,,,~~~~,'•'•°: :"=i...,~j~.-....~..re~....N. f~~ U O
House No(~n ' I ~J/~ Street Ham
Unwer or Owners of Property..?%y~~~~. /l~lp..
County Tax Map o 1000, Secti n.... .~~lock......~~ ~,....Lot.......~, J
Subdivision. ~?~~~ti~;Gaf;!zwo.;~<ve-k ...............Piled Map..~.J.-:~ I ....Lot....
permit No ................Date Of PermiC................Applicant.............................
!iealtli Dept. Approval ..........................Underwriters Approval.........................
:Tanning Board Approval
~~oquest for: Temporary Certificate........... Final Certicate...........
:'ee Submitted: $
X02 X635 „~~~t~
(„2 ~ i.+'oj~(~ APPLICANT
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STATE EIJERGY II
CODE II
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N = FILED JUNE 20, 1983
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1 BOrARO OF HEALTH
t: ~ , .
f~l J(; FORMNO.1 3 SETS OF PLdt1S
~j ~ ~ t+~V 1 ~2l99I I f ' ~Y TOWN OF SOUTHOLD SURVEY .
i BUILDING DEPARTMENT CIICC>;
~tvicea..vvm-xm ~LI.FF~ '
Ea_II~+r°r.7.:,......_. S TOWN HALL SEPTIC I'ORr!
7(3t~U;'°S f~~~rC<<;-~~;1•;p ra SOUTHOLD, N.Y. 11971
,
C~ TEL.: 765-1802 t:orlFY;
Examined ~I/~:3....... 19./~ CALL
/ ~~y rInIL ro..
Approved /~~•~ti~...... 19 ~/Permit Nos!:". ~.~7 . .
Disapproved a/c • - .
(B ding Spector) ^ ~
APPLICATION FOR BUILDING PERMIT (~--,t~(~i'--~
Date G~L~. 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
~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
:atL~n.
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
.hall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whale or in part for any purpose whatever until a Certificate of Occupancy
hall ]rave 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
Zegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
flee applicant agrees to comply with all applicable laws, ordinances, buildin'g~ c~odQe,~housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspection~r'(?/`!~
(Signature of plicant, or na rf a cor o atron)
(Mailing address of applicant) ,l~c~/
Stale whe applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or b/udder.
\ame of owner of premises . ~t~~ °~.`.~.'e:~ . ,n'w;-!....'.'- .
( on the tax roll or latest deed)
:f 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 .
Otl~cr Trade's License No . .
Location of land on wh' h proposed work will be done. .
. ~ SOU.. J~C~~coJu.:~
Ifouse Number Street ~ ~ ~ ~ ~ ~ ~ ~
Haml
County Tax Map No. 1000 Section Block .....1,. ~ , , , , , , , , , Lot U
Subdivision . <~i~/, Filed Map No. . J~s"~, , , , , , Lot ..~`1~...... .
....(Name)
State existing use and occupancy of prem~ises~and intended us and occupancy of proposed construction: ,
a. Existing use and occupancy ..,,A~~~t ;v`~•`,~....5~'~>~ - ~ , . c : .
,t._:=..:-~: _
b. Intended use and occupancy " ` ' ;
~.w t~ ; _r , . _ .
3. A'ature of work (check which applicable): New Building
Re air , , , , , , Demo • ~ • • • ' Addition Alteration, ,
P • • • • • • Rertyaval
_ lition ,
,t .Other SVork :
4. Estimated Cost . , ~~v ~ (Description)
~ . Fee
5. If dwelling Nu ' (to be paid on filing this application)
o, num er of dwelling
g g d units , ber of dwelling units on each floor . . . . • , ,
If era e number of cars , .
6, If business, commercial or mixgd occupancy, specify nature ar~d extent of each type of use ~ •
7, Dimensions of ~e~isting structures, if any; Front ,(o ~ ' ' ' ' ' ' ' ' ' ' '
Height ...~r.Y.7...FT ; T` ' • ....Rear Depth ,
Nurjtber of Stories : .
imensions of same structure ~gith alterations or additions: I'rpnt ,
Depth........... Rear..................
, Hei tt ......................Number of Stories .
8. Dimensions of entire new coast rction: front .
Height ~ I.. Rear Depth
Nurt'~ber of Stories ~ ,
9, Size of lot: Front , . v , • • , , , Rear . , , , ' ' ' '
10. Date of Purchase ~ Depth,~,',,,,,,,,,,•,,,,•••.
] 1. Zone or use district in w~icl ~prG • ~ ~ • ' ' ' ' ' ' • • Name f Former Owner .
misesaresituated.........~,,,,,,,••••..•
12. Does proposed construction violate any zoning law, ordinance {tr regulation: ~ • • •
13. Hill lot be regraded ,v, . , spill excess Gil be re ved from premises: Yes
14, Name of Owner of remises , .
Name of Architect P ~ ~ ~ ~ S • ' ' ' ' ' • • Address ~7. ~,s/Yl,~;?7•v., R~ , ,Phone No. ~~.rl, :moo
Name of Contractor . ' ' ' ' ' ' ' • • • Address . .................Phone No........... .
p P y • • • .Address ' ' ~ '
Phone o.
15. Is this ro ert within 3
* y 00 feet of a tidal wet] nd? ~ " " " " "
Yes........ No..
If es Southold Town Trustees Permit may be required.
PLOT DIAL
Locate clearly and distinctly al]'buildings, whether existing orj proposed, and. indicate all set-back dimensions from
property lines. Give street and black number or description accordin~ to deed, and show street names and indicate whether
interior or corner lot.
~~1~ ~ 2
AP AV D AS NOl'ED
NaTIFY BtJIL.LtNG DEPART
?fi5-9$0"l AM Ta A PM FOR THE
6=aLLf7t/t11NG INSP7rCTIaNS:
Fai.DNDAT1aN TWa REQUIRED
FaR PafJRED CaNCRETE
2. f•3al1CiH - FRAIVI9RJC; Z+a PLUMBING
S. IlusLiL.ATIC)N
« r"";i"!r-0d- - CaNSTRUCT4aN MUST
BE CpMPt..ETk' FaR C.a.
AAt~t. CDNSTRUCTIaN SH4lLL MEET
mhF_ REQUIREMENTS aF THE N.Y.
STATE CONSTRL1CTIaN 1~ ENERGY
t:C~DFS. NaT RESPONSIBLE FpR
DE4iGN aR CaNSTRUCTIUN ERRORS
TATE OF N O S.S,
O NTY OF~ K
• ' ' ~ '~•i•~• • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual si nin contract)
rove named.
4~~~_
rsthe
(Contractor, agent, corporate officer, etc.) ~ ~ ~ • ' • ' ' ' ' ' ' ' ' '
sa~downcrorowners and isdul a,.....•......•..•.•.•.••.••.••......•.••••••
phcation; that all statements containe(itlin this application are true toot]
embesdt of hisaknowledge and belief; and t
let the
rrk will be performed in the manner set forth in the application filed therewith.
~orn to before me this n ,
day of N C'~ I
19~
tary Public, , , • , , . , County
~c~ .
Notary PubIIcR State a
New
Qualified in Suffdk
County ~ ~ ~ / C~~
(Signature of applicant)
Commlaebn E><plras December 8,' 18v!~•