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Home My WebLink About19991-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. No Z-20266 CERTIFICATE OF OCCUPANCY Date OCTOBER 7~ 1991 THIS CERTIFIES that the building ACCESSORY Location of Property 1630 TOWN HARBOR ROAD House No. Street County Tax Map No. 1000 Section 65 Block l Subdivision Filed Map No. SOUTHOLD~ N.Y. Hamlet Lot 2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated J~NE 26, 1991 pursuant to which Building Permit No. 19991-Z dated JUNE 28~ 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 BUILDING AS APPLIED FOR. The certificate is issued to PAUL L. MITCHELL (owner) 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 /Budding Inspector FORM NO. it TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING P E~v~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to:~.~ ...... ....... . ....... ../..~.~ .... ~...~.~..~ .......... ~ .......... ~ ........ ~ ........ ~ ................. :.~.~.~..~.~ ........................................... ~, ~,~,,e, r~**~ ,~ ....~.....~......~...~../~ ................................. County Tox Map No. 1000 Section .......... ~...~..... Block ............. ~.. ..... Lot No ....... ~ ......... pursuant to application dated .......... ~....~....~ .......................... , 19..~../.., and approved by the Building Inspector. Fee $..~...~ uildi~lnSl~Ctor ~' Re~ 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 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. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect 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. C. 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. Businesse~ $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 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00~ Commercial $15.00 Date ......... .~/.~.~./..~../ ...................... :,ew Constructmon ...... Old 0 re-existing Building ............... Location of Property... j../.~..~.~...7..~.. ................................................. House No. Street Hamlet 0,,wet or Owners of Property... '.~..../?~ ............ ..~../7~g~'~°~// County Tax Map No 1000, Section .............. Block .............. Lo ................. Permit No...~.f.f.7. f.~..~..Date Of Permit ....... Applicant .................. !{ealth Dept. Approval ....................... · . · Underwriters Approval ..................... ... . 21arming Board Approval ........................ '~,eqt~est for: Temporgry Certificate ........... Final Certicate..: .~.."[... Submitted: $ ~--~ ............................. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: INSPECTION DATE ~/,.2~/~ ./ L ~ INSPECTOR (1~//)~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOAgD OF HEALTH ..., ..... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEFTIC FORH .............. MAIL TO: Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT Date .................... 19... INSTRUCTIONS a. Tiffs 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 pr 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, ¢uil~i~g code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary/ins~[ ~1:~./peck°ns' ~, Nm /' ~ ............. -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant j~ o~w~e~/~essee,~ agent, a[chitect, engineer, general contractor, electrician, plumber o~ ....................... d? 'n :.. ..... ............... : ........................ Name of owner of premises..(:~v,~(.~<(7. ?.'...~.. ?(~c~...~.. ............................................ (as on the t,ax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License NO....~.?..)3. ·~. ~ ............ Plumber's License No...~... '.~...v.~ ./3../?.~'.~ . . . Electrician's License No ..... q4¥'.a:z.? ..... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... ....................... }louse NumBer Street Hamlet County Tax Map No. 1000 Section /.-.a<~q>7..~.',~-~'"J~.. Block ..... /. ........... Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy...~/l ..C:.. ~.~..~.P/)~.7...~ .... './.~..~..)~..~'..'~. .............................. b. Intended use and occupancy ............................... ,, ............................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration f .......... Repair .............. Removal .............. Demolition .............. Other Work..',~./~?/q. ....... g~7(9~.-~)- .... . '~ .~.t. ~..._ (Description) 4. Estimated Cost . Fee - . .... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ]. ·. Number of dwelling units on each floor. /. · If garage, number of cars .... ~O~.~. ............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ 7. Dimensions of existing structure~ ifanv' Front ~5:[ / ~o~ .o'~! ' pth .~a~' . . . · ,- .. ...... ........................ De ............ Height .............. Number of Stories ..................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front -tl ~,~ .... ~...-/.,5..~....,- ...... Rear ... 2 .................. , Depth '~-),./, -- 10. Date of Purchase ... ~o.q../.~. :\/?..'?.~'.... ......... Name of Former Owner '.~.e.~.'r/.[: i .~.'o'r~i~s.".~.' i .,~.~i 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ~ ................ Will excess fill be removed fzom premises: Yes No 14. Name of Owner of premises .~..~f/i ~.....QTi.:7..ci~.'~../f. Address/.~(go ~F6o~,,,(f~i~ Name of Architect .......... i ................. 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 Tbwn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block umber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. (Name ..... of ~nd~v~dual s~gmng contract) above named. being duly sworn, deposes and says that he is the applicant He is the . i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly iauthorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner get forth in the application filed therewith. Sworn to before me this .................... day of ............ ,19 Notar Public, ..... County I' NOTAIW PtJBtl(~, Stal~ of New ~ (Signature of applicant) No. 4707878, Safolk County T~m [xpkes MarCh