HomeMy WebLinkAbout20069-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCf
No Z20177 Date
AUGUST 28, 1991
THIS CERTIFIES that the building.
Location of PropertL 455 KOUROS ROAD
House No.
County Tax Map No. 1000 Section 117
Subdivision
ACCESSORY SHED
NEW SUFFOLK
Street Hamlet
Block 6 Lot 11.2
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 30~ 1991 . . pursuant to which
Building Permit No. 20069Z dated AUG. 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 CONSTRUCT~NACCESSORY SHED AS BUILT
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
STANLEY J. & PATRICIA A. IS/LKSEN~ JR.
Rev. 1/81
/ Building Inspector
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)
20069 Z
Permission is hereby gra~ted to: /7 /
~...~../...... ~.. ~
~. .................... ~..,...~....~ ...... ~
~..~~. ,..~ ./~ ~,/~
~J~'7%]~ ................
....
.~ p~m,.~ ~at.~ .~ ...... ~....~~ ........................................................
................................................... ~~...~~ .......................................................
Coun~ Tax Map No. 1000 Section .... .~.~ ........ Bl~k .......~ ..........Lot No ...... ~..~
Building Inspector.
Fee $~.
Rev. 6/30/80
Form No. 6
TOWN OF SOUTllOLD
BUILDING DEPARTMENT
TOWN I~LL
765-1802
APPLICATION FOR CERTIFICATE OF,IOCCUPANCY
\. 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 instal~lation 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 C~pliance from archiuect or engineer
rssponsible 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
i. 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 - $I0.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
' · Date
ew Constructi~, ~ ~ , . [/ --'r .~.~.~.~.w~ ....................
........... ,.. u~o Or Pre-existmng Building./.
House No. Street ' ~. Y.~.~.~./o
~wer or Owners of Property . ..-~.
,unty 1000, Sectio ......
bdiviszon .................................. Filed Map ............ Lot ...... . ...........
.rmit No .
................ Date Of Permft
................ Applicant .............................
'alth Dept Approval
· ' ............. ...Underwriters Approval
arming Board Approval
quest f?r: Temporary~_~Ce~ificate .......... Final Corticate.
Sob itted: ...............
1.
FOUNDATION
FOUNDATION
2.
(1st)
(2nd)
ROUGH
FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
REMARKS:
[]FOUNDATIONIST ,[ ]"ROUGH PLBG.
[]FOUNDATION 2ND[ ] 'iN~SULATION
[]FI~MING NAL
DATE ')-// ~ ~ ~i~$pECTo
Exaxnined..
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.' 765-1802
Approved
., 19v ermit .........
Disapproved a/c .....................................
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ...................
CIIECK ....................
SEPTIC FORH ..............
1195
INSTRUCTIONS
· a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule, l~
b. Plot plan showing location of lot and o~' buildings on premises, relationship to adjoining premises or public streets
o'r 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 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 ~hole 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 nec,ossa-~ inspections.
-- c~ (Signature of applicant, or name, if a corporation)
(Mailing address of applicant) fid ~/l
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises %.T.~..'~.....~....~..~% .-4~...(7~....~.g;~]b. ....... (as on the t.ax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
OCCU?A C¥ 0B
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
..... .......... ................... ..................
House Number Street Hamlet
County Tax Map No. 1000 Section ....... [ t..r-2. ......Block ..... .(~3..~. ....... Lot. ti. ')xo
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 .................................. ' ' 'F~ ' ~ · ·: ".: ..... ..............
. b. Intended use and occupancy .... ,../1~ ~~ !' '..' ...... ..
3. Nature of work (check which applicable): New Building .....~..... Addition .......... Alteration ...............
Repair .............. Removal .............. Demolition .: .... Other w~)i-k J:"~ ':: .
4. Estimated Cost ~.F_D~ ~ ' (Description)
..................................... Fee ................. ~:~: .:_, .~ ~! ...........
(to be paid on filing this ~]ication) ·:
5. If dwelling, number of dwelling units .~.;w77:...: 7:.. Number of dwelling units on each floor '
· Ifgarage, number of cars ~ '..
6. If business, coxnmercial or mixed occupancy specify nature and extent of each type of use....~'.~: i~.~., iiii
7. Dimensions el existing structures, if any: Front...'.~../J~7 ...... R~ar .............. Depth ...............
Height ............... ~umber of Stories .. ~ .....................................................
Dimensions of same structur,, with alterations or additions: Front . · ·: .-.~x..~-. :-x-:vx.x Rear ........ 7'...-7777.....
Depth ...~'~ ~ ........... Height . .'~-.~ ~':7¥ ....... Number of Stories . .~ l .~.'~C~
8. Dimensions of entire new construction: Front
Height ............... Number of Stories '~-' ........ Rear ............... Depth
................... - ........... & ~.:'[,~ 11%1 ~:ii'
9. Size of lot: Front .............. : ....... Rear
...................... Depth
10. Date of Purchase ......................
............................. Name of Former Owner
l 1. Zone or use district in which premises are situated..--~.. .......... ' ............................
12. D°es pr°posed construction violate any zoning law, ordinance or regulation : ~
13. Will lot be regraded W ....... ' ' ' '::5' ...........? ............ ~
...... ,--,-, .................. A. ddm excess ru, ce removea~,xrom premises." Ye_.s (No]
I4. NN%: oO~ ~;~:;~ premises .-4-..% ~.e~..ir0 ...... Address ~..u~.j~E~'. Phone No. ~. ~.~.'...~'".~:~ .J~..
........................... tess ........ ~%. Phone No ..............
Name of Contractor .......................... Address ................... Phone No ................
15. Is this property within 300 feet of a tidal wetland? *Yes ........ No .........
· If yes, Southold Town True, tees Permit may be required.
... PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from
property Lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether
interior or comer lot.
GABLE
Shown here are one of the roomiest buildings.
The Gable is as versatile as your needs.
Maximum head room. The wide double doors
can be placed on the front or side of the building.
Fr :~ ~ OV;qh~G
2, ROUGH ,, FRAMING & PLUMBING
3. ~NSULATfOr~
4. FINAL CONSTRUCTION MUST
BE COMPLETE FOR
AIL CONSTRUCTION SHALL
TH~ RBOUIREMENTS OF THE
STATE CONSTRU~IO~ & ENERGY
CODES. NOT BESPONSIBLE FOR
DESIGN OR CONSTRU~ION ERRORS
s','o.v o,:-r.,. ..W
AND UNTREATED FLOOR
;rATE OF NEW Y~RKz/ . /~ o o
:OUNTY OF..~..~
· Pc.+. ~' ~ ~... ~,..-L~.-:4 '~-~.~. ~/.v...." being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
bore named·
O ~N~W-
is the .................................... . ..........
(Contractor, agent, corporate officer, etc.)
said owner or- owners, and is duly authorized to 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
'ork will be performed in the manner set forth in the application filed therewith.
,worn to before me this
......... ~ .... dayor .~~ ,19¢/
7/ ............
.
Qualified in Suffolk County /~ (Signature of applicant)
Commission Expires May 29__, ~ 9 ......