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Home My WebLink About19723-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19811 Date MARCH 23r 1991 THIS CERTIFIES that the building Location of Property 970 VILLAGE LANE House No. County Tax Map No. 1000 Section 114 Subdivision ACCESSORY Street Block 6 Lot 15 Filed Map No. Lot No. MATTITUCK r N.Y. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 18r 1991 pursuant to which Building Permit No. 19723-Z dated MARCH 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 SHED AS BUILT The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED HENRY B. & JOANNE KUHN N/A Rev. 1/81 FORM NO. 0 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-~ 19723 Z Permission is hereby granted to: -- . .; ~~.~..~~;~....~.~... .... ~...~z¢.....~~.......~ ...... ,o .~~...~....~~........~..~.~....~......~... at premises located at ..... ~...~.. ....... .~'.~~.....~...~-~ZF~ ..................................................... County Tax ~op No. I000 Section ....... .~./~'...~.. ....... Block ........... ~... ...... Lot No ....... .~'..~ ....... ~u~uo~, ,o o~,,~o,,o~ ~o,~ .... ~ ................................... . ,,.~o~ o~.o~ ~ ~ Building Inspector. Rev. 6/30/80 TOWN OF SOUTHOLD 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. 5. 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. 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. 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 Date .~..~...~... ~.. ~f/ ................ New Construction ......... Old Or Pre-existing Building ........ L°cati°n °f Pr°perty'i]'?'~'~ ................ '~J['~.~'~¢'~'~''C/''~''I[~ ''~~~[~'1''' House No. Street Hamlet Onwer or Owners of Property..]~...~....~..5~..~ ............ subdivision .................................... Filed Map ............ Lot ...................... Permit No../F. ................................................ Date Of Permit Applicant . Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ .... £~ I¢¢'11 . FOU~;DATION ( 1 st) FOUNDATIOn; [ 2nd ) ROUGH FRAI,IE & PLUMBING INSULATION PER N. STATE ENERGY CODE FI~AL ADDITIONAL COMMEr;TS: 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION :)ND [ ] INS.~LATION FRAMING [ ~]"FINAL 0 i,T~. '< ---- i~ ~ ' ~ Z :I ~ . ~ ' ~ "V- ":' ' ~ FORM NO. 1 · ' ~ [" TOWN OF SOUTHOLD 'L ~ ' 8'"u~ [~:: BUILDING DEPARTMENT .......... ~ ~ SOUTHOLD, N.Y. 11971 · ,,:_,,.. ~ ~;~- ~;~,'~:- .m~ ...... j TEL.: 765-1802 Approv .............. ~ Disapproved a/c ..................................... as ........ ...... :~' ~- BY ' .~'~ :8~)2 ~ AM ~ 4 PM FOR TH~ppLICATiON FOR BUILDING PERMIT ::':'.)L L:;W~NG ~NSPECTIONS: ~.. FO[ mlDATION ~O REQUIRED FL,~: POIJRED CONCRETE 2 ~QUGH - FRAMING & PLUMBING [NST~UCT[ONS 3 i~J~ULATION BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL .............. FLAIL TO: 2/ Date .................. 19 a!~ ~h~2':apptict~[b~h-qffd!.!~t~g:l~M~Tely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of ~[n~lt~ ~ ~iOst to scale. Fee according to schedule. I~. L~I~'~J~I~I~I~ 1~ ~ and of buildings on premises, relationship to adjoining premises or public streets or ar~_~.-~_a~(~il~g~JJ~ailll~: d'[[~'il~iY~n of layout of property must be drawn on the diagram which is part of this appli- catio~TATE CON~rS~C~ON & ENERGY ~O~l~'w - ' ~ ' ~ion may not be commenced before issuance of Building Permit ~ YJ~°~l~?~-~-J~(, the Budding Inspector will msued a Building Permit to the applicant. Such permit shall be kept on flSe' p-£e'Eais~ ava~spection throughout the work. e. Bio' b, uildin~ ~hall~b~oe. cm~i~a~e, ed in whole or in part for any purpose whatever until a Certificate of Occupancy shall ha~e' Be~h · :. ~::, ~. z r;: ,,.~ '! ;~M FOR APP~i~K?A.~CrIO'N' II~:'I'YERiR~r'fS'MADE to the Building Department for the issuance of a Building Permit pursuant to the Building~ Z6~,m~tJfi,tJee of ~l~EBouthold, Suffolk County, New York, and other applicable Laws. Ordinances or Regulation~i;fbPrflJOroii~Jt~g~ffiS'f~of buildings, additions or alterations, or for removal or demolition, as herein described. The app~ic~fi:tiJ~l~ee~C~8~l~J~lt~l~ t;~llMilll~lliSplicable laws, ordinances, building code, housing.code, and regulations, and to admit au~h~U~0l:.b'lJctors on premises and in building for necessary ifi~ections. ~E COMPLETE FOR C.O. ''' '.~//-' ,:-: '.~' · --,z'rY:.''' ....................... A~ CONSTRUCTION SHALL MEET (S~n_ature of a~ppti, cant, or name, if a corporation) THE REQUIREMENTS OF THE NY ~/~/~?~ S¥~TE CONSTRUCTION & ENERGY; ...... /..../!.../i./.././.4~..~..~....~,~2././..~.~././././~.f..C.,.4.~.~.c/~. CODES. NOT RESPONSIBLE FOR (Mailing ad'dress of applicant) DESIGN OR CONSTRUCTION ERRORS State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If 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 ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ......... House Number Street-' ..................... Hamlet County Tax Map No. I000 Section ..... ].[/ ......... Block .... ~. ........... Lot.../..~.'~. ............ Subdivision ..................................... Filed Map No ............... Lot .. ,. ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b.a. Existing use and occupancy Intended ....... use and occupancy ...... . .: .. ~-............: .-....~. '.'.. 3. Nature ofwork(checkwhichapplica,ble): New Building .......... Addition .......... Alteration .......... Repair.............. Removal .I ............. Demolition .............. Other Work ............... E ti ted C ' 4. s ma oat ............ .... ..................... Fee .... i (to be phid on filing this application) 5. If dwelling, number of dwelling unitsl .............. Number of dwelling units on each floor ................ · If garage, number of cars ........ il ............................................................... 6. If business, commercial or mixed occ.Upaney, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if ,any: Front ............... Rear .............. Depth ............... Height ............... Number 6f Stories ........................................................ Dime sions of sam struct e with al~e ation r add'tions: Front n e ur r s o 1 ............ Rear . Depth Xeight Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ........... Depth ........... Height ............... Number df. Stories ........................................................ 9 Size of lot: Front ' Rear ............... i ............................. Depth ...................... 10. Date of Purchase .............. i ..... ' ......... Name of Former Owner ......................... 11 Z edisti i whi h i~ it t d ' ~'' · one or us rct n c prems sares uae ............................................... 12. Does proposed construction wolate ~ny 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 i Address Phone No Name of Contractor ' Address Phone No 15. Is this property within 300 ifeet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Tows 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 numlber or description according to deed, and show street names and indicate whether interior or corner lot. 2OUNTY OF ................. ............................... i ................ being duly sworn, deposes and says that he is tl~e ap~i~a-~ '~' (Name of individual signing contract) bore named. , [e is the i (Contractor, agent, corporate officer, etc.) f said owner or owners, ~d is duly a~tho~zed to perfo~ or have perfo~ed the said work and to m~e ~d file this pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and ~at the ~ork w~l be perfo~ed in the m~ner se't forth ~ the application filed therewith. worn to before me this ......... day of. J ............... ....... ,19 total'Public, ..... ~ ~ . ., County