The URL can be used to link to this page

Home My WebLink About20068-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20135 Date AUGUST 8, 1991 THIS CERTIFIES that the buildin~ Location of Property 1620 GRAND AVENUE House No. County Tax Map No. 1000 Section 107 Subdivision ADDITION TO ACCESSORY MATTITUCK,. ~.Y... . Street Hamlet Block 3 Lot 9.2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated__~A_UGUST 5, 1991 pursuant to which Building Permit No. 20068-Z__dated AUGUST 8¢ 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 ADDITIONS TO EXISTING ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to (owners) 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 GEORGE & ADRIANA ROHRBACH / ~Building Inspector FOB~ NO. O 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) 20068 Z Date ~' ........ ~Z. .................................... , ,,.~/ Permission is hereby granted to: ...... ~.~...~_~.....~... ...... ..... ~~,-.~:..: ....... -/ ~' / .; / , __../--- '~"_Z- ....... ,o.~,¢, :....,~r..,,~.....~...;. ,~. ...... ~ ........ at premise, located at ..... .~.~.. ....... ~.;~..~......v~_~.. ..................................................... County Tax Map No. 1000 Section .... .~...~....?. ....... Block ........ ~ .........Lot No......~.c.....~... ........ / pursuant to app,Jcat,on doted ........... ~./.~..... ............................ . 19....~..X and approved by the Building Inspector. Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN I~LL 765-1802 L 8~DG. DEiST' _~TOWNOFSOUTMO~ APPLICATION FOR CERTIFICATE OF OCCUPANCY \. This application must be filled in by typewriter OK ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of prqperty 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 sewernge-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 archiuect or engineer responsible for the bu:'.lding. 6. Submif 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, Swi~ing 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 C~rtificate 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 Construction ........... Old Or Pre-existing Building .......... ili.~.'i~i' ~''~ ...... i'' ocation of Propert ~ /~ ~2~ ~ ~ ~ y .................. ......... ltouse No. -- Street ........................... Hamlet '~wer or Owners of Property ......... .~.~ ..i. ~.~-. ~'~a~-/~l )unty TaR Map No 1000, Section... Block .......... L~ ~ !bdivision ............. .... · .................. Filed Map ............ Lot ................... :rmit No ........... Date Of Permit ..... · ............... Applicant ........................... .alth Dept Approval · ' ....................... Underwriters Approval ....................... arming Board Approval ...................... quest for: Temporary Certificate ........... Final Ccrticate ........... ~0~20 )~-~ APPLICANT · ~ BLDQ. DEPT. ~ OF $OU'II40~J~ , ;.-d:i~ .'*dockOWS~ ~4,0~,OSTRANDER AV£NU£, RIVE:RHEAD, NEW YORK ~"'i '- · ~ HOWARD W. YOUNG 7 Ig~ BUILDING DEPARTMENT ' TOWN HALL · '- 8LDG. DEP~. SOUTHOLD, N.Y. 11971 ~' T0WNOF$OUTHOLD . TEL.: 765-180:3 Exam,ned' ~/~.' 9.?/ APPROVED AS ~OTED ~_.,~ ~ ~ 76B-'1802 9 AM TO 4. PM FOR TN~ppLiCATiL)N~ ~J'L/'/~'F; BUiLDffqG PERMIT FOLLOWING iNSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE $. ROUGH - FRAMING & PLUMBING INSTRUCTIONS 5. INSULATION BOARD OF HEALTH ;3 SETS OF PLANS .......... SURVEY ................... gllECK .................... SEPTIC FORH .............. CALL ................... MAIL TO: Date r~/~.-· 197./- ,'4 NT T T sets*ofA~_ ~v~p~[~l~ci~:lFee according to schedule. b~'~O~l~-{.and of build~gs on premises, relationship to adjoining premises or public streets or.ar~~~r~e~' of layout of property must be drawn on the diagram which is pa~ of this appH- catl~~~,~on may not be cbmmenced before issu~ce of Building Permit. d.-~Sffff3~ffqfi[d~h]s'~pplt6ation, the Building Inspector will issued a Bufld~g Pemit to the app~cant. Such pe~it shill be ke~t on the premises available for inspection throughout the work. e. No building shall be occupied 6~ fi~6~'in whole or in p~t for any purpose whatever until a Ce~ificate of Occup~cy shall have bee~ gran~ed~by' th~"~u~din~ I-nspector Building Depmment for the ~ssuance of a Bml~m~ ~e~zt p~rs~ant to the Buildin~ gog~Or~naa ~T't~e,'~$wn of Southold, Suffolk County, New York, ~d other app~came Laws, uro~ces or additions or alterations, or for removal or demolition, as here~ described. The app~a~!~?~ih an applicable laws, ordinances, bufld~g~e, housing codf, and regulations, and to admit ~F~&~*~¢~~ bulldog for necessa, inspecti~ ~. ~. / ~ / TN~H~ E~I~EflTS) ~H~HEi.,N.~ ........................... ~ .................... $~f~T~(~a~U~ ~NE~Gy (Mailing address of applicant) State %~~~~gent, architect, engineer, general contractor, electrician, plumber or builder. .. a ........................................................... : ........................ Name of owner of premises ~ ~ ~5' ~ ~ ~ (as on the ~ roll or latest deed) If applican~ is a corporation, ~ignature 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. 1000 Section .... ?..O.T ......... Block ..... ~ ........... Lot ?' ~ .. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use arid occupancy of proposed construction: '-. ...... ................. a. Existing Use and occupancy .................................... t.. .~.L.a b. Intended use and occupancy...,~.,..~....~...P---~..~..~-~. ....................... ~~ ....... 3. Nature of work (check which apPlicable): New Building .......... Addition .. . '... Alteratioii Repair .............. Removal .............. Demolition .............. 0~her Work ...... E ' oeoo. --~ l 4. st~mated Cost F~,. ~[ ~ 5. u awemng, number oi awenlng ulnits ............... Number of dwelling units on'6abh flOfr... ~. ~"¢'2 ~'. ~'=:'~ . . If garage, number of c~s ...... ~ .................................................................. 6. If business, commercial or mixed Ioccupancy, specify nature and extent of each ty.ve.af use ...................... 7. Dimensions of existing structures if anv' Front /8.8 ~r ~,~ n~,h /~' / Height ............... Number of Stones ................................. ; ...., .......... D~ensions of same structure with alterations or additions' Front / ~' 7 ~anr ~ ~' Depth.. ~ .~ ............. i" HeiSt ...................... Number of Sto~es..~ ..; .... ..:... ......... 8. Dimensions of entire new construction' Front Rear e~ght ............... NumBer of Stones ..................................... 9. Size oflot' Front ................ /~q' G~ Rear' ..~'.~.~ .......... ~e;[~.?[~;~;~ ........ I0. Date of Purchase.....~.........~&~/~l ................NameofFomerOwner..,.~Q~{~.~.~f&, ....... 11. Zone or use district in which pre$ises are situated 4 ~ ~ 12. Does proposed onstructlon wolate any zoning law, ordinance or regulation: .'~.Q ......................... 13. Willlot be regraded ~6 . I ' ' · ' .... ~. .. ................. Will excess fill b~ removed from. premmes: Yes No 14. Nme of Owner of premises ~ff~[~ ~o3~b~Address/6 ~o %~a~ ~ ph~n~U~ Nme of Architect ........... ~ ................ Address ................... Phone No...; ,....' ........ Nme of Contractor .......... '. ............... Address ............ ;: .~.. :. Ph~ae N~~: ......... ~... ~.. 15. Is this property within 3~0 feet of a ~idal wetland? *Yes ........ ~;~.~;...;....~ ,.~ · If yes, Southold Tpwn Trustees Permit may be required.:~..~.~ ,~,~<~ ~ ...... PLOTDIAG~ ~ ;~' :~O ~:'~ ~ Locate clearly and distinctly ~1 build~gs, wnetner cresting or proposed, and, indic~t0-~1 ,s0t-ba~k ~ensions. from prope,y Hnes. Give street ~d block nhmber or descfiptioh accord~g to deed, and sfi~;~$~6~s and ~diCate whe.ther interior or corner lot. STATEOF NE qYO [K,.~ ~ OF ......... ~ ........ above named. .. - He is the (Contractor, agent, corporate officer, etc:) of said owner or. owners, ~d is duly ~uthorized to perfom or have perfo~ed the said work and to m~e and file this application; that all statements contai~ ed ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner ~et forth in the application filed therewith. Sworn to before me this .......... I ....... dayof. .Q~..... .... Nota, Public,~../.~Q.~.[.~[. ~~'~ ~~ ............. ' County ~ - ....... ......... (Signature of applicant)