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Home My WebLink About19676-zFORM NO. 4 Town OF MOUTHOLD ~}ILDING DEPARTI4ENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20801 Date JUNE 22, 1992 THIS CERTIFIES that the building. Location of Property GLOAMING AVE. House No. County Tax Map No. 1000 Section 10 Subdivision ADDITION FISHERS ISL~t~D, N.Y. Street Hamlet Block 10 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 11, 1991 pursuant to which Building Permit No. 19676-Z dated FEBRUARY 21, 1991 was issued, and conforms to all of the requirements of the applicable provisions of the law. The ocdupancy for which this certificate is issued is ADDITION TO REAR OF EXISTING ONE FAMILY DWELLING ASAPPLIED FOR The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. #236665 PLUMBERS CERTIFICATION DATED MARIO & RONALD ZANGHETTI JUNE 11, 1992 - MARIO ZANGHETTI Building Inspector Rev. 1/81 ~vo~ NO. ~ TOWN OF $OUWdOLD 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-° 19676 Z Permission is hereby granted to: ............ .,, County ........ ~ .~... ....... Block ....... ~...~.. ...... Lot No....,~.. ........... Tox Map No. 1000 Section pursuant to application dated ....... ~....,,~...../.../.. ................... , 19.~.../., and approved by the Building Inspector. Fee ,...~...~ .~.~.. Rev. 6/30/80 FOP,2V[ NO. 6 TOWN OF SOUTHOLD Building Depo~tment Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the fotlowing; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site_ plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: l. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: ~ ~, ~ 1. Certificate of occupancy ~00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ....~ ........... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....................... w ...................................................... .......................... ~.~ ..................... Owner Or ~ners Of Property ................................................ .~, ....... r ........... ~ ........ ~ ...................... , ......... Subdivision ................................................................ Lot No...~ ...... Block No~ ............ House No .......... Health Dept. Approval ............................................ Lobar ~pt. Approval ................................................ Underwriters Approval .~..~.~.~...,~.%.~, .................Planning .B~rd Approval ........................................ Request For Temporary Ce~ificote ........................................ Final Certificate ....... ~ .................................. Fee Submitted $ .~.~.~..~ ....................... on described building and perp~it meets all applicable code~ and regulations. Applicant ...... ~...~~ ......... ~ ............... Sworn ~efore me t~'. ................ aay o .~ ....................................... ' (stam~ ~H~n~ ~. Notary Public ~ ~ ~. ~ ~ / * - '~ NO~ Public State of New Yer~ _ · ............................. O NO. 4805559 TOWN O~ SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL 765-1802 CERTIFICATION 'Date Building Permit No. / ~ ~Q_(~ ~___ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworo~to befor~me this THOMAS F. ~HER~ JR. -' No~ PubUc State of New Yor~ ?OUNDATIO:! ( l st) FOUNDATIO:~ ( 2nd ) ROUGH FRAME & .PLUMBING iNSULATION PER N. STATE ENERGY CODE FI;;AL ADDITIONA'L COMME~;TS: FORM NO· 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL Disapproved a/c ..................................... BOARD OF HEALTH 3 SETS OF PLANS SURVEY CItECK SEPTIC ...................... FORH CALL (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely fHIed in by typewriter or in ink and submitted to the Building I~mgmtor, xvith ~ets of pLans, accurate, plot plan to scale. Fee ~ccording 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. ¢. The work covered by this application may not be commenced before issuance of Building Permit· 'cl. Upon approval of this application, the Building Inspector wlil issued a Building Permit to the applicant, Such permit shall be kept on tile premises available for inspection throuo_~hout the work· e. No building shall be occupied or used in whole or~n 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 ~:emoval or demolition, as herein described. The applicant agrees to comply with all applicab'le laws, ordinances, building code, housing code, and regulations, and to · admit authorized inspectors on premises and in building for necessary inspections. .. ' (Mailing address of applicant) State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ (as on'the tax'roli o; latest dge'd') ........................ If applicant is a corpgration, signature of duly authorized officer· (Nam~nd title of corpor[te~'off'~;r-) ......... · BmldersL:ccnseNo. . .. ~ . .. Plumber's License No ..... ~5. ~'..../~. ............ Electrician's License No...~..'~zi~.7. ............. Other Trade's License No c9~-- ,q-/~ 1~ Location of land on which proposed work will be done; ...................... ' ...... ...... llouse Number t. .... ~ ............................. Hamlet ..... County Tax Map No 1000 Section ./.D.T/~O.;- .~. ' Block · ......... ' Lot ' SubdiviSion ..................................... Eile.d- M~p No (Name) ........... Lot ............... 2. State existing nsc and occupancy of premises and intended use and occtiPancy,~ of proposed eonstrnction: A. Existing uso and occupancy ..... B. Intended use and occupancy ...... 3. Nature of work (check which applicable): New Building .......... Addition .. · .. Alteration ........... Tennis Court . ' ' ........ ~ccessory Buxldzng .......... Femce ....... Other Work; ........... 4. Estimated Cost ...... ~.~3~ ...................... Fee ....... ~./.~ ....................... t.~x b.c. paid on filing this al~l~lication]. $. If dwelling, number of dwelhng UmtS ............... Number of dwelling units on each floor .............. If parsee number of cars ' 6. If business, commercial or mixedI occupancy, specify nature and extent of each type of use ................... Depth 7 Dimensions of existing structurej if any: Front Rear Heiuht ............... Number of Stones ...................................................... Dimensionsofsamestructurewithalterationsoradditions:Front................. Rear ................ 8. Dimensions of entire ne~v constn~mtion: Front ......... Rear ............... Dept ·. Height Number of Stories 9 Size of lot: Front ' Rear Depth 10 Date of Purchase I Name of Former Owner - · 11 Zone or use district in which premises are situated · 12. Does proposed construction violfite any zoning law, ordinance or regulation: ................................. 13. Wilt lot be regraded ' Wiil excess fill be removed from premises: Yes .... lq~. 14 Narae of Owner of premises I . Addre~ Phone No ................. Name of Architect .......... I ................. Address ................... Phone No ................. Name of Contractor ......... : ........ :.. ....... Address ................... Phone...N~o ..... :~,. l~_~s ~b.i~ property ~ocated withxn'~OO feet of a tidal wet,and? ~XgS...~'O' · If yes Southold Tow~ Trustees Permit may be required. ' i PLOT DIAGR~M Locate clearly and distinctly all{ buildings, whether existing or proposed, and, indicate ~11 set-back, .dlr[l..en~ions. f.r,o'm property lines. Give street and brock number or description according to deed, and show street names aaa mmca~e wnemer interior or comer lot. STATE OF NEW~YJ~.,, ~. e o COUNTY OF · ,'~. · ,?~, (Name of individual sig~iug contract) above na~ed. ~ is the ' (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have performed the said work and to m~e and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the Work w~l be perl~mmd in the m~n~er set forth in the application filed therewith. ......... ~ ~bli~ State of New Yor~ , ~ ...... ' ........ Ne. ~ua~ti~ {o su,~ coumy ~ (Si.nature of applic~t~