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Home My WebLink About19671-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19843 Date APRIL 9¢ 1.99$ THIS CERTIFIES that the building Location of Property 20999 MAIN ROAD House No. County Tax Map No. 1000 Section 17 ACCESSORY Street Block 4 ORIENT~ N.Y. Hamlet Lot 7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 15, 1991 pursuant to which Building Permit No. 19671-Z dated FEBRUARY 15, 1991 was issued, and conforms to all of the ~equiraments of the applicable previsions of the law. The occupancy for which this certificate is issued is ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to ESTELLE & EDWARD ADAMS (owners} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROV~J~ N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED //uilding Inspector Rev. 1/Sl 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 WOP, K AUTHOP, IZED) No- 1 9671 Z Permission is hereby granted to: .~.~..<.....~.~..~L...~..~ .... ..........2o ~ .......... .~.~ ~.~' .............. ~. ........................ .C~..~ 1...~..~...7. ...... , .......................... ~ at premises located at .,~.. .~. ~ ~..~....~. ~ ........................... ...~ .... ~ ...... . ............... .~. County Tox Map No. I000 Section .....~.../....~ .......... Block ........ .~...~. ..... Lot No .......... O .:7. ........... pursuant to application dated ...~..~.....~. ........ .)...S:.. ........... , 19.~./..., and approved by the Building Inspector. Fee $ ...... ..~.~ ............ 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 1% 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 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 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinging 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, Cormnercial $15.OO Date .~.~ New Construction ..... .~. .... Old Or Pre-existing Building ................. Location of Property .... ~ .~.~. f[-- ........... ~ - ~LL~...~.~. ........... ~.~ ~0~. ....... House N~o,~! Street Hamlet Onwer or Owners of Property .......... ~ ~Z'~c~ AC~aO]5 ..................................................... County Tax Map No 1000, Section...¢A7 ....... .......... not..rT. . ................. Subdivision .................................... Filed Map ............ Lot ...................... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ . .... Request for: Temporary Certificate ........... Final Certicate.....~.. Fee Submitted: FOUNDATION ( ls t ) FOUNDATION 2. ROUGH FRAME & -PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY CODE FINAL COMMEN7~ ADDITIONA'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~FINAL DATE FORM NO. 'l TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTH QL.D.. iNLY. ttq7t TEL.: 765-1802 Dlsapprovcd a/c . ...... (Buildin§ Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY .................. CHECK .............. NOT I PY ~ CALL ate .... I9 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to thc Building IrmpeCtar, wit/ sets of plnus, m-curate plot plan to scale. [:ce =Ccordring to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre or areas, and giving a detailed · cation· description of layout of property must be drawn on the diagram which is pan of th. is apt o. The work cOvered by tiffs application may not be commenced before issuance of Building Permit. zt. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throu~out the work. e. No building shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occupan shall have been granted by the BuildLng Inspector.· APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances Regulations, for the Construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein desczSbe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and · admit authorizec~ inspectors on premises and in building for necessary inspections. (Si=nature et apphcant, or name. if a corporJtlon') ' · dress of a State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder (as on the tax roll or latest deed) ' ' If applicant is a corporation, signature o£duly authorized officer. (Name -~d ........ ....... '' '' title ofcorp;rat; offic;r') ' ' Builder's License No .......... Plumber's License No ......................... EJcctriciarl's License No ....................... Other Tradc's License No ...................... Location of land on which proposed work will be done: ,ouscN,, , er/ ............. .' County Tax Map No. 1000 Section .. /. 7 ...... ' ....... Block .... ................................... Eilcd Map No (Name) .............. Lot " existing usc '~ q ............... " State and occupuhcy of premises and intended use uud occupancy of proposed constrnction: 3. Nature of work (cheek which applicable): Nexv Building .......... Addition .......... Mtcration Repair.............. Rbmoalv --.--,........ Demolition ~ Swi.'~c~o~.~'.':~'~' enn s Court ......... AcceSsory Buildlng...l~.. .... Fence ....... Other i4ork; ......... 4. Estimated Cost 2t /_ ~.~..~ Fee ~t.a be paid on filing this aoplication} 5. If dwelling, numbero£dwellingunits............... Numberofdwellingun on each floor . . If guru-e,_ number of cars ............................................................ . 6. If business. Commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions ofexisting structures, ifany: Front .... /..~./. Rear ' / ........... [3 ......... Depth ..,~.../ ......... Height .5-' ~' a Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear ............. ·. . ................. tleight .................. Number of Stories ................. Depth .. 8. Dimensions of entire new construction: Front ....... /.~L ./ .... Rear ..... ./q~.../ ......Depth . 4./. .... Height ..... 7.~.b.'. ..... Number of Stories .... ' .... · ' · ....... Rea ..... [.~.~;. .............. Depth .... ;:.~e ........ 9..Size of lot: F~ont ...... ./.~.4... ,~ ..... : ...... 10. Date of Purch~se ....... J.~ 7~:{ ................ Name of Former Owner ./?'~: ...... .q. ~..4.-t ......... 1 I. Zone or use district in which premises are situated ': .0 12 D sp d tic i I i gl di '-52 · de ropose Construc n v o ate any. zon n aw, or nance or regulation .... .. ~. .. ................. . · .. 13. Will lot be regraded ........................ Will excess fill be removed from preraixea: . Ye'- . .. . . 14. Name of Owner of premixes ..... Addrem Phone No Name of Architect ...... Address Phone No Name of Contractor - · ..... Address Phone No 15..Is t-kia property located trithin'to0 feet ot5 a tidal wetland? ~YES .... NO-Av'x- '~I£ yes, Southold Town Trustees Permit may be required. PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimen:ion', :': property lines. Give street and block number or description according to deed, and show street names and indicate wa::::. interior or comer lot.:__ ' ..> ' · STATE OF NEW YORK, COUNTY OF ......... $.S ...............................................' ' being duly sworn, deposes and says that he is the applica (Name ofindividuai signing contract) above named. ~ 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 th application: that all statements contained in this application are true to the best of his knowledge and belief; and that t:: Work will be performed in the manner set forth in the application filed therewith. Sworn Id before me this Nota~, Publ c - .... ...... &. ..... Count, ~.£N K. D~ V0[ . . . · .................... NOTARY PUBLIC, Sta~e of New · 1i*m bpit~ Catch ~0. l~N°' 4707878, Suffolk C0unlzt~_L.~ {Signature of applican ? DoRMAN; ! ~ iOl~_ ill ,-rd O N R,O ,E ( f '""N APPRJ~V£D AS NOTED NOTIFY BUILDING DEPARTMENT A'~' 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS 1 FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2 ROUGH . FRAMING & PLUMB NG 3 INSLJLATION 4 FINAL . CONSTRUCTION MUST SE COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY "~,&OOES, NOT RE~,P~0NSlSLE FOR I~J~SIGN OR CON~TI~rioN ERRORS