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Home My WebLink About20152-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20236 Date SEPTEMBER 20, 1991 THIS CERTIFIES that the buildin~ ALTERATION Location of Property 2125 HYATT ROAD (PRIVATE RD. #18) SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 1 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 19, 1991 pursuant to which Building Permit No. 20152-Z dated SEPTEMBER 20~ 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 ENCLOSE SCREENED PORCH ADDITION OF AN EXISTING ONE FAMILY DWELLING AS BUILT. The certificate is issued to ANTOINETTE HEILSHORN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ' / ~ildlng Inspector Rev. 1/81 i~OB,~ NO. $ 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~- 20152 Z County Tox Map No. I000 Section ...... ~..~... .... Block ......... ../. ......... Lot No ....... ~ ............. pursuant to application dated ......'~' ~./....~.~ ....................................... .., 19.Z./., and approved by the Building Inspector. ee ~, ........... ..~..,...., Rev. 6/30/80 Form No. 6 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 i% 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 unssual 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, Comlnercial $15.00 'Date .......... .~-~ J..~ .~ .k ........... House No.^ ~t~.~--~ .... Street~'~ Hamlet ' ,h~wur or Owners of Pro ert~ ....~.~~_ ~ ~ ~;ounty Tax Map No 1000, Section ....... ~..Block ...... .~ ....... Lot .... .~ ...... {ubdivision .................................... Filed Map ............ Lot ...................... .~ermlc No ................ Date Of Permit ................ Applicant ............................. {ealtb Dept. Approval .......................... Underwriters Approval ......................... 'lanning Board Approval ........................ '~ ~Temp°rar~t ificate~/ ..... ....... ...... al~~~.~ ~ ~ ~D~ . .... . ..... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORtl .............. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS CALL ................... HAIL TO: a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 hall 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 hall liave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of~ding Permit pursuant to the ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and..,ather ap~pticable Laws, Ordinances or '~egulations, for the construction of buildings, additions or alterations, or for rem/o~ai or 9k(molitj, on, as herein described. ]~e applicant agrees to comply with all applicable laws, ordinances, building cgff~e, houfffig co.,df.~ regulations, and to dmit authorized inspectors on premises and in building for necessary {nspectio~ J ~"'J ~ - ' (Signature 9f-aAfplCant, 9r name, if a corpo~tion) / ..... ..... (Mailing address of applicant) / ;rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the t~x roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's Licens~ No. ' Electr'c'an s License No ....................... Other Trade's License No ...................... Location ofland on which proposed work will be done .... :-..?-~.~.%. ~.~-..~...~..~ .~..(~.' .~.~....t')~...~ llouse Number Street Hamlet County Tax Map No. 1000 Section ....... .~.. .. Block ....~. ........... ' Lot ................ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. E×isti use and occupancy ...... ½ :,' ....................... ..... b. Intended use and occupancy .......................... 3. Nature of work (check which apphcable): New Building ......... Addition .......... Alteration ...... Repair .............. RemOval .............. Demolition .............. Other Work ............... 4 Estimated Cost ~..~. g~ "' (Description) · · · Fee i (to be paid on filing this application) 5 If dwelling number of dwelling knits Number of dwelling units on each · ' .............. floor If garage number of cars I ................ 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 ........................... 8 ........................................... Number of Stories ..................... · Dimensions of entire new construction. Front Rear Height . .... Number of'Stories .............................. Depth .............. 9 Size ..... ' .... ' ...................................................... of lot: Front J Rear · ' ..... ; .......... Depth 10 DateofPurchase ~ .......................................... ' N fF O 11 Zone editri ~i"v~t ...... i ........ ' ......... ameo ormer wner ............................. · or us s c n rich premises are situated 12. D°es proposed construction viola!re any zoning law, ordinance or regulation: 13. Willlot be regraded ..... I ....... .. ..... : .................. Will excess fill be removed from premises: Ye~ No 14. Name of Owner of premises .... i ................ Address Name of Architect ~ ................... Phone No ................. ........... i ................ Address ................... Phone No ............. Name of Contractor .......... i ................ 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 DIAGRAM Locate clearly and distinctly all l~uildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nCmber or descriptioh according to deed, and show street names and indicate whether interior or coruer lot. .~PPgO,V'ED 'L FOUNDATK)~'~t TWO REQUIRED FOR POURED CONCRETE 2~ ROUGH - FP, AMING & PLUMBING 3, NSU,{ ATIO~ 4. FINAL CONSTRUCTION MUST BE COMPLETE F OR C.O. ,¢ At& CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. ST, ATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATEOFNEW¥OI~/~ ~ ~ i · ~ .~'g)..V~. ~ axmvx//~, ~( ).~.O.,~4%x ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing, :ontract) )ove named· e is the . . . a;tor, agent, co;~ora'te o'fficer,'e'tc.) ........................... said owner or owners, and is duly aqthorized t~o perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the )rk will be performed in the manner setl forth in the application filed therewith· /om to before me this I ........... NOTARY PUBLI~ Stale d fLY. No. 4725089,Sdfolk County Term Ex~ir~ May 31, \ //