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Home My WebLink About19738-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19900 Date MAY 8~ 1991 THIS CERTIFIES that the building. ALTERATION Location of Property 855 BRIGANTINE DRIVE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 79 Block 4 Lot 50 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Per~it heretofore filed in this office dated MARCH 25, 1991 pursuant to which Building Permit No. 19738-Z dated MARCH 26, 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 ALTERATION TO EXISTING ATTACHED GARAGE 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 SCOTT J. & ELISA L. THOMAS PENDING - MAY 8~ 1991 Rev. 1/81 I~OBM NO. ~J 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~- 19738 Z Permission is hereby granted to: ..... ~.L~..~......~b_~~ ................. · ...9. ~..~ ~.-~....~. ~.~, ..... located ,~C',9,'-' ' ~ ' ~ ,-?_. . at premises at ...~. ............. ~.~.....~ ...................... .~~.~.. County Tax Map No, 1000 Section ..... ..~..]...9 ........ Block ...... ..(~.....~.. ....... Lot No..~.'~... ............... pursuant to application dated ........ Y,~.~ ....... .~.....~... .......... , 19~..~..., and approved by the Building Inspector. Rev.' 6/30/80 SOUTHO D BUILDING DEPARTMENT TOWN HALL 765-1802 8hOG. DE~. ~ TOWN OF ~OUTHOLD ' .... 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 o? 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 i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alter~ons to~ng $25.00, Swimming pool $25.00, Accessory building $25.00, Addztzons 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 $i5.00, Commercial $15.00 Date .~./$ ~/..~..~ . New Construction ........... Old Or Pre-existing Building..~. .............. Location of Property ............................... House No. ~ Street Hamlet Onwer or Owners of Property.~....q~....~.~.~lf~.~....~.:..~.~..~ ................. County Tax Map No 1000, Section.~.~.~l. Block.~,..~ .... Lot...~.~ ............ Subdivision.~~ ~. Filed Map.9.~.~.~ Lot .~ ~ Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ ...~.. Request for: Temporary Certificate ........... Final Certicate ...... .o..0. FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & -PLUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL ADDI g~L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSUI..~TION FRAMING [ L DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FI~NAL REMARKS: _~ ~ //// INSPECTOR ~/~~~ DATE Examined Approved'~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 il, ( uihiing nspector> L Illl BLDG. DEPT, TOWN OF SOUTHOLD , ',"--~-- INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CtlECK .... Date .................. 19 a. Tkis application must bt 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 commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shalFbe 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 sha~l 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 tee construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ,o/~ --- (Signature of applicant, or name, if a corporation) P State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' ,S -tt ' Z. /-7% Name of owner of premises ............. ~t-- ~.._~ ~ ~k : O ~ ~ (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 ................................................. .... .ck4 House Number Hamlet County Tax Map No. 1000 Section ...... .t-i .~. ........Block ..... .~. ........... Lot..~5.O. ............ Subdivision...~.(~tq'l_~ .............. FiledMapNo..'.~... Lot.:~ ........ State ex~sting use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~se~ c~nstruct~n:~ ~ ., a. Exmtmg use and occupancy ~,.. ~VD tl.H.. · mtended use and occu~anc~ ~.~..~ J ~,.. " tidn~ ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Altera..... Repair .............. Remoial Demolition Othe We k ~; ~} ~D~dription) ' 4. Estimated Cost ..... . F ~.~..'. , , (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ............... Number of dwelling units on each floor ................ If garage number of cars 6. it business, commercial or mixed ,occupancy, specffy~ure and extent of ea~ type of use ! ........ lf.'¢" .......... 7.Dimensions of existing structures if any: Front .......... Rear ............ Depth ............ 'ght D el ............... Num er of Stones ............................... o~f. s a~.~ tm, ~ct.u it~ ' · -~'~ i ............ ~;~[~ " Dimensions s re w alterations or additions: Front .... Rear ..... ............. Depth .... l[[~l~F.... IlS' i Height ................. '*. ~'u'n~;; of Stories... ~ .................. 8. Dimensions of entire new construction: Front Rear .............................. Depth ............... eight ............... Number of Stones ... . ........... 9. Sizeoflot: Front .... .]~...~.~i .......... Rear ~O,~..~l ........... ~)eni~ ~)ki. li~.' ......... 10. Date of Purchase .c~Jlq~,.~. xr ....;~.' ..... .2." ',-..~Z~ _'""',~;;.e'_'t':~ .......... Zoneorus " . ': t' '.' · .?. ............... /.,,,umemrormer~wner t.&xt~q~4..~~... ' 11. e restrict ,n which premises are situated.. ~ .................... ~]~.~..~.. ~l~.. 12. Does proposed construction violaie any zoning law, ordinance or regulation: .~q~ ........ ............... 13. Will lot be regraded ........ ~ ............... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .... i ................ Address ................... Phone No ............... Name of Architect ........... [ ........... Address ................... Phone No ................ Name of Contractor ........... l ................ Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No4~, ...... · If yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all huddmgs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block m mber or description according to deed, and show street names and indicate whether interior or coruer lot. 3TATE OF NEW YORK, S.S 2OUNTY OF ................. ............................... ~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signinglcontract) ~bove named. te is the ....................... (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly ahthorized to perform or have performed the said work and to make and file this pplication; that all statements containdd in this application are true to the best of his knowledge and belief; and that the ~ork will be perfor~ned in the manner sci forth in the application filed therewith. ;worn to beforeaff~ this ....... . ................ day of..~. 7~ .~.~.'.. ' ........ ,19 ... [otary Public, .................... :. · ·Countv 0 u~ o