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Home My WebLink About19968-zFORM NO. 4 TO~N OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20027 Date JUNE 25~ 1991 THIS CERTIFIES that the buildin~ Location of Property 895 DEI~4AR DRIVE House No. County Tax Map No. 1000 Section I27 Subdivision ACCESSORY LAUREL~ N.Y. Street Hamlet Block 4 Lot 15 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 24, 1991 pursuant to which Building Permit No. 19968-Z dated JUNE 24~ 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 DECK ADDITION TO ACCESSORY INGROUND SWIMMING POOL AS BUILT. 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 JAMES &CAROLE MORINI Bui%dlng ~nspector Rev. 1/81 TOWN OF SOUTHOLD Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN I~LL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY i. 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/i0 of 1% lead. 5. Coramercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code C~pliance from archiuect or engineer responsible for the building. , 6. Submi~ Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and xzstzng" 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 I. Certificate of Occupancy - New dwelling $25.O0, 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 - $I00.00 3.Copy of Certificate of Occupancy - $5.00 OVer 5 years - $10.00 Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ew Construction....~.. .... Old Or Pre-existing Building ............... oration of Property...~%~' ....... D~z~/~~z ~ House No. Street Hamlet ~wer or Owners of Property..~ ~ ~o~ ~nnty Ta~ Map No I000, Section. /~l~ ..... Block .... .~. ......... Lot ~hdivision .................................. Filed Map .............................. '' Lot ...... Date Of PermJt.~ ........ Applicant ......................... .alth Dept Approval · ' ......................... Underwriters Approval .................... arming Board Approval .......... . ...... quest for: Temporary Certificate ........... Final Certicate ........... e Submitted: $.~ ............ , ............... ?)~ c ,," (516! 754-o?~3 SURVEY OF I..Ol(s) 6 MAP OF I.AIJREI_ COUNI'RY ESl'AlES LOCATION LAUREl_, IOWN OF SOUI'ItOI.D, DATE 6/13/91 · £ERTIFIEI) ONLY lO CLARE BARBAI)ILt_O I]LOCK SUFFOLK CO. N,Y. FIRS[ AMERICAN TI'II_E INS. CO. OF NY, ALL STATE ABSTRACT NOW Oil FORMERLY OF ROMANOWSI<I 18°36'20'' E 100.33 ,125.33 CD DELMAR DRIVE Disapproved a/c ..................................... ................................ . ()~iildi~y~pector) APPliCATION FOR BUILDING P£RMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH 3 SETS OF PL,,~NS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .......... .,... Date 6- ~-,~,, 19q/ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 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 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 shall 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 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 of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessaw inspections. -- (Signature of applicant, or name, if a corporation) . . .;. . . , ?. . . , , . . < < q. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , ~, ~, ~ ,,: :.. .~ (asonthetw3rollorlatestdeed) I£ applicant-is,a ¢orp~ra~orh~ signature o~ duiy authorized 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 .................................................. House Number Street Hamlet County Tax Map No. 1000 Section / .~..~. Block .~. Lot /3'~ 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 ................................................... . .. ................ b. Intended use and occupancy.. ....................... .. . , ........... . . .. ' ............... Locate clearly and distinctly all property lines. Give street and block interior or comer lot. 3. Nature of work (check which applicable): New Building ...... Addition..~....O?~. '~[eYhti~n":?,;?~(~i ~ .~... Repair .............. RemOval .............. Demolition .............. O/herE .............. i ' ~-0.~'~,~.~,,._.~:~ ~ ~ ~I~ription) 4. EstimatedCost./.~.O.O. ..... ~ i ............ Fee. ~..~.- 'f ;'~ (to be n 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7 Dimensions of existing structureg if any' Front Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure wrth alterations or additions: Front ................. Rear .................. Depth .................... I.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ....... Depth ........... Height ............... Numper of Stories ........................................................ 9. Size of lot: Front ........... ~ .......... Rear ...................... Depth 10 fP ' fF · Date o urchase ........... ! ...... Nemco ormerOwner ............................. 11. Zone or use district in whichpremises' ' are situated ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ..~ ........................... 13. Will lot be regraded ..................., ......... Will excess fill be removed from premises:' Yes No 14. Name of Owner of premises ... i ................ Address ................... Phone No ......... Name of Architect .......... ~ ................ Address ................... Phone No ................ Name of Contractor ~ ......... ~ ................ Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRA~ buildings, whether e. xisting or proposed, and, indicate all s~t-back dimensions from umber or description according to deed, and show street nantes and indicate whether STATE OF NEW YORK, COUNTY OF S.S FOLLOWING ~NSP~C~IONS. 1. FOUNDATION ~O REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL CONSTRUCTION MUST BE COMPL~E FOR C.O. ALL CONSTRUCTION 8HA~ ME~ THE flEQUIREMEN~ OF ~E N.Y. STATE CONBTRU~ON & ENERGY COOES. N~ flES~NBIB~ FOR DESIGN OR C~~N ERRORS .................................................. being duly sworn, deposes and says that he is the applicant '(Name of individual signin contract) above named. He is the ....................... (Contractor, agent, corporate officer, etc.) of said owner or. owners, and is duly ~uthorized to perform or have performed the said work and to make and file this application; that all.statements contained in thi~ application are true to the best of his knowledge and belief; and that the work will be performed in the manner s~ Sworn to before me this ........... ¢~ .~. ......... day of.. Notaryrublic, .~ ..~...~ HELEN lC DE VOE NOTARY PUBLIC, State of New Y~I ~ No, 4707878, Suffolk County~ I~rm Expires March 30, ~$ :t forth in the application filed therewith. . .~-g-, .' .......... , 19.?./. M..~.~ .... ' · ~ · County (Signature of applicant)