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Home My WebLink About19905-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of %he Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19968 Date JUNE 1~ 1991 THIS CERTIFIES that the building. Location of Propert~ .1295 SIGSBEE ROAD House No. County Tax Map No. 1000 Section 144 Subdivision ACCESSORY MATTITUCK, N.Y.. Street Hamlet Block 2 Lot 5 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 24~ 1991 pursuant to which Building Permit No. 19905-Z dated MAY 31, 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 IN REAR YARD AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FELIX & DIANA MULE' Rev. 1/81 B~ilding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~. 1990~ Z Permission is hereby granted to: ~..a~.~..~~......~....:. ....... ;. ............ ~ ......... ............ ~. ...... t....~ ............. ,o o~ premi,~ Ioco~ed ot ..,......,...... ........ : ........... County Tox Mop No. 1000 Section ................ Block ......0......~... ...... Lot No ..... ............ ~ "~ .."~" ~... '9..(~..(., ond approved by the pursuant to application dated ............ , Building Inspector. '-'""'~ ...... Fee Building Inspector Rev. 6/30/80 ,Form No. 6 TOWN OF SOUTUOLD 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, property lines, streets, and unuaual natural er 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 archiuect or engineer responsible for the building. 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. 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 - Residential $15.00, Commercial $15,00 Iew Construction. Old Or Pre-exzstmng Buzld ,ocation of Prope . ... ~-. , House No. Street Hamlet ~nwer or Owners of Property .... ..~. . ...................................... .. . . ~ounty Tax Map No 1000, Section...l..~..~.. .... Block.. ~ .~. Lot ...(~. 'ubdivision Filed Map Lot ermit No.. i. -~...~ ..... O~..~..Date Of Permit. ].~.O'..~..~./. ~ .~. l, .Applicant.. ~ .~.~.~ .~.'./i .'.~.....~..~7~ .~..~./. ealth Dept. Approval .......................... Underwriters Approval ......................... lanning Board Approval ............... equest for: Temporary Certificate .......... . Final Certicate ........... ~.~0 ~ I~(~(~' .........................APPLICANT ' ' ' ' ' ' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~,~ATION FRAMING [//~FINAL REMARKS: //~.._~_~~~----~ DATE / INSPECTOR FOUNDATION ( ls t) FOUNDATION 2. (2nd) ROUGH FRAME & .?LUMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. t TOWN OF SOUTHOLD BUILD/NC DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197'1 TEL.: 765-1802 <amfi .,19... .sapproved a/c ............................. ~ ................ ' ............... APPLIGATION FOR BUILDING PEEMIT BOARD OF HEALTII 3 SETS OF PLA~.IS .......... SURVEY ................... CIIcc~ .................... SEPTIC [' 0 R,'l .............. CALL Date ...... ' ....;..., 19... STATE CONSTRUCTION & ENERGY )cation ofland on which proposed work will be done ......... ' CODES. NOT RESRDNSIBLE FOR / g ~. ~ ........ '/ ..... DESIGN OR CONS'TRO~T4ON.E, RRORS ~usc Num her Street ' ' · · Hamlet bdivision ................................... Filed Map No ~ Lot (Name) ............................. te existing u~e and occupancy of premises and intended use and occupancy of proposed constrnction: :xisting use and [ ~;J occupancy .tended "Se and occupancy J (.~ ~O J. k & Builder's License No ...... .~. [.r'} ................ Plumber's License No ........... ~././I ............ Electrician's License No fl/.~.. 3thor Trade's License No ~ / ~ FOR POURED CONCRETE ,. F,A",,,NG · 85,.~x!~... F,NAL CONST.~'OT,O" :~.~ T.E RE~OIRE. ENTS O~ (Name and title of corporate officer) 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS. INSTRUCTIONS a. Tlds application must be completely filled in by typewriter erin ink and submitted to the Building Inspector, with ; of plans, accurate plot plan to scale. Fee according to schedule. L. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubtic streets trees, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl/- on. 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 I 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 I have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issu · ' - ding Zone Ordinance of the Town of Southold, Suffolk County N-'~, v,..[- an_c~e o.f,a Bmld,!ng, .Permit pursu.ant to the ., ....... , anu omer appncaele Laws, Ordinances or ulations, for the construction of bu¢Idings, additions or alterations, or for removal or demolition, as herein closer/bed. applicant agrees, to comply with a~l app icable laws, ordinances, building cod housing code, r gulations, and to it authorized inspectors on premises and in building for necessary inspections. ~ (Signature of applicant, or name,]f ~. c~orporarion) ......... )..~s~ ~ ~. (Mailing address of applicant) -: w~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .. . ' . ' ............. (~ 'o'.';~;e'&L'o'~i 'o; id?~;t'Z~'d.'~l[il'~'i pncant is a corporation, signature o£ duly authorized o£ficer. · ' -'"-'~_,~ ^11 ~ . FEE .,--. · -_ ..... ~.v./.~l ....... " NOTIFY BUILDING DEPARTMENT AT 3. Nature et work (check which app)icable). New Building ........... Addition ,\Iteratmn .. ~ ' ' ......... .~r.e ....... Repair .............. Remo 'al .... Demolition .i. .......... · ........... Other Work . c~- .r'kcd 4. Estimated Cost ,;-o' o , ,, *' senptmn) ".: ................... .... Fee; ........... ' ~ I . (to be paid on filing this application) $. If dwelling, number of dwelling u its Number or,welling umts on each floor... · If garage, number of cars .............. 6. lf. busin.ess, co.mm, eryial or mixed Occupancy, specify nature: id ex ten't of e' ' · ' 7. Dimensions et exLstmg structures lifanv ~ .... ach type o! use . . N.[~... ..... Haig ~t .~./ ./ /.~.. Num"i .... ~. ~'~' '~ ........ ·. Rear ..... Depth .. . Dunens'on~/Xdf~a~ne~ structure witll alterations or additions: Front ' ' ...... Q ~D.epth .. .... .. ................ i Height .,. · ........ Rear .um~ens~ons o~ entire new constmcltion: Front ................... ! Nnmber el Stories ..... '~ ' tO'' ....... -,uero,~tones ,. ..',.. Rea!r ...... ......... Depth . He ~ht · · Nu .... ', ........ ~/' ' ' 9. Sizcof et Front Oo "~ .... ' 'r ....... · ' .7~ .............. ,,ear ,o~, ~ o' .............. ). Date of Purchase Rt4 ............. ..... Devth ./.St ....... · . . ':-.t~. ....... , ....... . ........ Name off .nb Zone or usc d~stnct m Whtch premises are situated. R~ ~ ~ r Owner . ~'-gh,~ d'o, rao .......... I. de ,,-t- I ............................ 2. Does re osedc ' ............. ~... P P onstructlonvlolatean z ' , · . " .......................... o Y .orang law, ordrnance or regulgtmn ~..9 3. Wfl et be regraded ~. t 'i ,'...' ' '7~' '~; ...... Wall excess till be removed ~'rom premises· ' Yes lq,, ~..Name of Owner of,,rem s~ F~ . ' .q ......... Address . 1.a.~?.,.5'~'$¢~ Al... Phone No. Name of Architect ' ~/'l'~' i - .... ' '. ............... Address ...... ......... .... Phone No ........ Name of Contractor ........... ~ .............. Address ................... Phone No .......... Is this property within 3001 feet of a tidal wetland? *;Yes ........ No.~/ ...... · If yes, Southold Tow? Trustees Permit may be reqluirod. ' ....... .... PLOT DIAGRAM Locate clearly and distinctly all bu!ldings, whether existing or proposed, and. indicate all set-back dimensions from operty lines. Give street and block number or descriptioh according to ,trier or comer lot. deed, and show street names and indicate whether ............ '~'F' ........ [ ............. u s rn, deposes anti says that he is the a t (Name of individual signing contract pplican ~ named... ~': ,,. ·' "' ........ "'[(6 '";'g,;; ; 'rfl; .............. · .... :'" ~ ' ~¢ on,rector a nt co rat o c r,e . ' ....... '4 OWner or ow,ers, and is duly authgrized to perform or have perfonne'd the saM work and to make and flit this :alien; that all statements contained in this application are true to the best of his knowledge and belief; and that tho will be performed in thc manner set forth in the application filed therewith. ~ to before me this ! ..-... da or '% , · ,, ..... y .... ......... , .... ~'t~ ............ ~1'"\ ...... County ~t~ ,. ,fid i, ~.:,. :..,.ns Coun~ [ ...... i ' ! ' C,~754r.,/tr,;~?:', '~- A~- 3! !gqt. i (S gna,ute ofapphcant)