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Home My WebLink About20290-zFORM NO. 4 TOWN OF BOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE O~ OCCUPANCY No Z-22263 Date APRIL 16~ 1993 THIS CERTIFIES that the building ADDITION Location of Property WEST END NEAR FOX LANE, FISHERS ISLAND, NY House No. Street Hamlet County Tax Map No. 1000 Section 12 Block 1 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 4~ 1991 pursuant to which Building Permit No. 20290-Z dated NOVEMBER 22~ 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 OFFICE ON SECOND FLOOR ~ APPLIED FOR TJS ENTERPRISES, INC. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N 236668 MAY 28~ 1992. PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERJ~IT Ct'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) coun, Tox Mop No. ,000,.c,ion ....... /..~ ....... B,~k ......... /. .......... Lot No...~ ............... Building inspector. Building Inspector Rev. 6/30/80 FOnM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 1 lg71 765 -' 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY~ Instructions A. This application must be filled in typewriter OR ink, and submitted ,a lm,,,m,mm to the Building Inspec* tor with the following; for new buildings or new use: ' " 1. Final survev of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features.' r : ' 2. Final approval of Health Dept. of water supply and sewerape disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tlons, a certificate of Code compliance from tl~e Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requi.reme0ts where applicable. B. For existing buildings (prior to April 195~), Non*conforming uses', or buildings and "pre-axis'ring". land uses: ' 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings, 3. Date of any housing code or safety, i~spectibn of buildings or pre. ,raises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00' POOLS ,$25.00 ALTERATION $25,00 1. Certificete of occupancy New Dwelling $25.00, Accessory ,$10.00 Busin~es9 $50.00 2. Certificate of occupancy on pre-existiog dwelling . '$ 5 0.0 0 3. Copy of certificate of occupancy $'5.00, over 5 years $10.00 4.Vacant La~d C.O. $ 20 O0 ./~/~ ~ . .............. 5.Updated C.O. $ 50,00 Date ... NewCons truc Lion Old or Pre existing Building Vacant Land Location of Property I~j ?_ ~:~ T f.:!? ' -, ;, . House No. Street fram/et Ownar or Owners of Property ~A C7~ ? ~ ~.~ _L,(Lg, c nty M 1000 S ti ', ' ' Subdivision ................................. Filed Map No ........... Lot No ............. . Permit No. ?~ 3.~.~ Date of Permit ~ .Applicant ~- ~ ~ .(~-:L Health Dept Approval Labor Dept Approval Underwriters Approval .~. ~. ' Planning Board Approva ...... Rdq y C ' uest for Temporar ertificate ........ , ............ Final Certificate ...................... Fee Submitted $ ,°. ?. ,. "'.* ............... .Construction on above described budding and per_Lo~it meets albapphcable codes and regulatmns, , -P · ~' ............ v ........... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~.~0(~{~[~({ BUREAU OF ELECTRICITY 85 JOHN ~TREET. NEW YORK. NEW YORK 10038 Date ~ ~$~[~ ApplicationNo. o~f~le '~{~[~/~. ~ ~3~ CE~IFIES THAT Lot FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS: HO'i~OR~: 3~'i? 71. P~ P~{~,[,8OAROH~ 1~,'i2 CIR, 3}.00 E R V I MULTI-OUTLET SYSTEMS NO. OF FEET CO~TR$, I~C, 202 GENERAL MANAGER ~v '[his certificate must not be ohered in any manner; return to the office of the So~rd if incorrect, inspectors may be identified by the{r credentials. FOUNDATION {1st) FOU~DATIO~4 (2nd) 2. ROUGH FRAME & .PLUMBING 3. INSULATION FERN. STATE E~ERGY CODE FI~;AL ADDITIONA'L COMME~ITS: Exanlincd ................. 19... Disapproved a/c .. . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL TEL.: 755-1802 BOARD OF HEAL'TH 3 SETS OF PLANS SURVEY CHECK SEPTIC ...................... FORH CALL (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .. :1¢/~.../. ..... , I9... INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink/znd submitted to the Building IhspeCtor, with 3 sets of plans,accurate plot plan to scaIe. ]E:e¢ 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. c. The work covered by this application may not be commenced before issuance of Building Permit. g. 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 for inspection throughout the work. ¢. 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 or the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Tile applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to · admit authorized inspector~ on premises and in building for necessary inspections. · '(§,g~it[~ ot al~pticant} K ~ade', if a coi'~o'rlrldn')' ' ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of ~remises .-~ ¢-5 dcm grscg (as on the tax roll or latest deed) If aP~y is a CToration, signature of duly a. uthorized officer' (NaOmi and title of corpora~/;~c;r') ' ' ' ' Plumber's License No. '-5~6-~ Electrician's License No....~..~. 7~'. ........... let c cerise No. ....... Location of land on which proposed work will be done: House Number Street, Hamlet County Tax Map No. lO00 Section ..... / -~']x ...... BlOck. / Subdivision ..................................... Eiled Map No. (Nmne) .............. Lot ........... State existing nsc and occupancy of premises and in tended sse and occupancy of proposed constrnction: A. Existing use and occupancy .... B. Intended use and ocgupancy ................ . . 3. Nature of work (check which applicable): New Building .......... Addition · · eration ......... '. Repmr. .............. Rpmo.val .............. Demohtmn ............ ..~ o P · Tennzs Court ......... /~ccessory Building .......... Fence ..... ~l~OtherWork; ........... 4. Estimated Cost ..o?.O/..b~..-,...4 ........................ Fee ..i~.Z~..~./~. ,~. ......... '' i 0a:~lae. paid on filing this apl~ticat on}. Ifd ' ' ' $, welling, number of dwclhng Un,ts ............... Number o f dwelling units on each floor .............. If garage number of cars ~· · · · · ................. 6. If business, commercial or mixed[ 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 structurc with alterations or additions: Front................. Rear.......... ...... Depth .................... !. Height ...................... Number of Stories .................... 8 Dimensions of entire new constrqction: Front Rear . . Depth Height ,Number of Stories ' 9 Size of lot: Front ' Rear'. , Depth ............... Date of Purchase : Name of Former Owner 11. Zone or use district in which pre[nises are situated . ' r'e~,',/a't;' ~'~1'11~1~ ............ ~' 12. Does proposed construction violate any zoning law, ;'r~tin'a'n'c~ o'r' on':' · .......... - t3. Wilt lot be regraded ~ , ......... ; ................... Will excess fill be removed from premixe,~ . Yes .... 14. Name of Owner of prerahes .. 'i ................. Addrea~ ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Narae of Contractor ......... i ........ ~ ........ Address ................... Phone No .......... t~.I.a ~k~ laropert~ located w~thx ~{l feet of a tidal ~etland? *YES .... NO .... · If yes, Southold Tow~ Trustees Permit may be required. i PLOT DIAGRAM Locate clearly and distinctly all[ buildings, whether existing or proposed, and. indicate all set-bask dimensions from property lines. Give street and block humber or description according to deed, and show streei names and indicate whether interior or comer lot. STATE OF NEW~.YO RK,,~. S.S COUNTY OF~./?.~. ....... ............ 2~o~q~...~.,...~).//o. .................. being duly sworn, deposes and says that he is the applicant (Name of individual s'goiug contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe,rform or have performed the said work and to make and file this application; that all statements conltained in this application are true to the best of his knowledge and belief; and that the Work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day · . . Notary Public ........ .., ....... ~., .t~-?, · ·, ......... County ,~:I'ARY PUBU~, ~ATE ~ NEW C' ::~;~S~Ofl EXPIRES q/3o/9 ~ (Signature of applicant. T