The URL can be used to link to this page

Home My WebLink About19733-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19813 Date MARCH 26~ 1991 THIS CERTIFIES that the building Location of Property 38910 MAIN ROAD House No. Street County Tax Map No. 1000 Section 15 Block 8 Subdivision Filed Map No. ACCESSORY ORIENT, N.Y. Lot 30 Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 21, 1991 pursuant to which Building Permit No. 19733-Z dated MARCH 25~ 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 (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A MARTIN J. BANCROFT, JR. Rev. 1/81 ltrOuM NO. t TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (3'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*. 19733 Z Date ....;~ ............................................... , pursuant to applicotlon doted ...... ~?/~z:/. .................................... , 19...~.~..., ond opproved by the Building Inspector. Rev. 6/30/80 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: i. Final survey of property with accurate location of ali 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 architec~ 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. ,. 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 - $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~5'0i' ~(mmercialDate ~.../...~...l.~. 1 .................... $151® ;ew Construction ~.. - Old Or Pre exis~irlg Building,~ ...... · ocation of Property,~.~. 1.~. .......... ./Y.~.AI~.....~..; ................. }louse No. Street __~amlet ...... 'ounty Tax Map No i000, Section...l..~. ...... Block .... ..~. ........ ubdivision Filed Map . .. Lot ermi~ No. [ .~..~...~.....Date Of Permit.~.~.../..~. ]...Applican~.~S ]~...~--~O~.~.. ealth Dept Approval .... Underwriters Approval ................... lanning Board Approval ...................... · . . equest for: Temporary Certificate ........... Final Certicate ........... ~e Submitted: $ ....................' ' '''''°"~~/'~.i ! Co 'S 8 2~2.51 S~LE-4.O"I" E]: 1'4Of..~Lli'4 E NT G' P~?E AP. EA:67.655.5Q.~ AF ,~'v,/N OF ~OL.)THOLg, N:Y, ,IT S~JFA CO. TA~' ~-'1,',? L, ArA: O'~L>-,5-5-5:.3. 10o48-~. TOWr~! OF ~qOUTHOLD FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~,,./'/~.55 ~5 ........... '~ 19 ~/ ~ .~,~'7. ......... ^~ro~ .. ~¢ ......... ,~, ~ ~rm,~ No ~ .~.~. ~. Disapproved a/c ..................................... - J, guildi~:gn sp'e c t o r ) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. t~OT I ~Y ~ CALL ................... HAIL TO: 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. e. 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 necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) isG lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. State whether applicant If applicant is a corponttion, signature of duly authorized officer. " (Name and title of corporate officer) Builder's License No ..... . .~...~..-~. q ............ / Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Locatio3~of land on which proposed work will be done .................................................. · ~.~ .~.\ ~. ............. L~.~,.~.......~.., ............. ..~.~ .~.-c.. ~.w.. ............ House NumberStreet Hamlet County Tax Map No. lOOOSection .... 1..~... ......... Block ...~ ............. Lot 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 .... ~ ..................... t' ........... :.~ ........................... b. Intended use and occupancy .... ~..~..~.~..~ .~ G .... .x~...~. ~ ..... . .~...~..~... ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... AIteration~..._ .......... Repair .............. Removal .............. Demolition .............. O t h ~c~,ktl~ ,t~l~ 17-, -.-~. .... cription) 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 ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... 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 ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises 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 .................... 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, Southoid Town Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. FEE: ~ BY: ~ 765-~802 9 AM ~ 4 PM FOLLOWING INSPE~ONS: 1. FOUNDATION - ~ REQUIRED FOR POURED CONCR~E 2. ROUGH - FRAMING & PLUMBING 3. INSU~TION 4. FINAL CONSTRUCTION MUST 8E COMPL~E FOR C.O. ALL CONSTRU~ION S~ ME~ THE REQUIREME~ OF THE N.Y. STATE CONSTRU~ON & ENERGY CODES. N~ RES~NSlB~ FOR DESIGN OR C~STRU~ON ERRORS STATE OF NEW YORK, S.S COUNTY OF ................. (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized 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 set forth in the application filed therewith. Sworn to before me this ............. .~ .~ ....... day of ..... ..~~ .... , 19 .~.-~ '4otary Public. ..... ,Et~N~...~...~. ~_.~eg~..~'.K. DE rOE ' C°u n tY-/~.t~' Term [xldres Mm~h ~0, 1~-.--~-.'-/