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Home My WebLink About19688-zFORM NO. 4 TOWN OF 80UTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z~19973 Date JUNE 12, 1991 THIS CERTIFIES that the buildin~ Location of Property 895 VILLAGE LANE House No. County Tax Map No. 1000 Section 114 subdivision ADDITION Street Block 6 Filed Map No. Hamlet Lot 11 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 22, 1991 pursuant to which Building Permit No. i9688-Z dated MARCH 4, 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 DECK ADDITION TO REAR OF DWELLING 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 GEORGE GRATTAN & WIFE Rev. 1/81 Inspector TOWN OF SOUTHOt. D 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~- 19688 Z ~ote ..~/,'~- ........ ~.. .................... , ,~..~/ Permission is hereby granted to: . ... ./.,..~.....6.~....Z.~...&...........................: - ~ ' . . at pre:ises I:ated at ..........~...~/..~R....~V..~.....~.:...~ ................................ County Tax Map No. 1000 Section ...... /./....~.. ...... Block .....~ ............ Lot No .....~...L ............ pursuant to application dated ........... ..~..~....~,.~ ........ , 19.~'...~, and approved by the Building Inspector. Rev. 6130180 APPLICATION FOR CERTIFICATE OF OCCUPANCY TO~CN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 This application must be filled in by typewriter OR ink and sdbmitted to the building inspector with the following: for new building or new use: i. 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 archiuect 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. ]. 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 - Residentia~ $15.p0, Commercial $15.00 Date . ?.~"/~.7~ ,ew Constructzon .... .~.....~,.(~ld,,,.,.Or Preexisting .ocation of Property ...... ~ ~o~ No.' ...... ~ge'7 ......... ~' _'-'" ~'~"~ ........... o . rs ............... :o~ ~ ~ ~o ~000, ~.o~ ..... ~5 ..... ~o~ ..... ~ .......... ~o~ .... ~ ................ ............... ;; .......... ........ ...... erm~t No .... . ....... Applicant ealrh Depr Approval - HnderwrSters ~pprova~ lann~ng Board Approval ........................ eques~ ~or: Temporary CortSf~cata ........ . ~ '.~..' ee Submitted: ~ ...................... ~ ' ~"~"x;~;~'"~ ..... ~, ~ .... . ............... FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .?LUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: HUIq'T DEVELOPMENT CORP( P, 0. l~OX 158 APPROVED AS NOTED 765~i802 9 AM TO 4. PM FOR THE FOLLOWING ~NSPECTIONS: ')' FOUNDATION . '~0 REQUIRED FOR POURED CONCRETE ~O~TRUCTION MUST 8E COi~PLETE FOR C.O. ,~L,. CONSTRUCTION SHALL MEET ~H: REQUIREMENTS OF THE N.Y. ,.,~4}[~ CONSTRUCTION & ENERGY Cf'~r~FS, h~OT RESPONSIBLE FOR ' ,,u~/lON ERRORS 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [/~'I~L DATE INSPECTOR X\ HLS~'T DEVELOPlVIENT CORI~ )RATION APPROVED AS NOTED FEE ~BY: ~T NOTIFY BU LD~NG DEP~ 76E,-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOU~,IDATION TWO REQUIRED FOR PouRED CONCRETE 2, ROUGH - FRAMING 8~ PLUMBING 3. IIISULATION ~.. FIN.'NL CONSTRUCTION MUST BE COMPLETE FOR C.C. AL[. CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. sTATE coNSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR cONSTRUCTION ERRORS OCCUPANCY OR USE IS UNLAWFUL ~.~'/~THOUT C:RTJ~ JCATE OF OCCUPANCY FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined ................ , 19... Disapproved a/c ..................................... (Building Inspector) ~APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH r~ SURVEY ...................... CHECK ................... §EPTIC ~OR~ ................ CALL ..................... ~AIL TO: Date .................. 19... 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. 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 lhyout 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 commenced 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 whole ordn 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 iemoval 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 necessary inspections. ] .......... ? (Si~ature ot applicant, or name, if a cSorporauon) . ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............. ~ .... d~od~' · ":4' · · ?' · · '~'' ........................... ~" (as on the tax roll or latest ~t'eed) If a~a corpor~i~~ulDt.,horized officer. ...... .... ~ '~' (Nat~e and title of corporate offic ) ' ~uilder,s/License No.../.4~, ~.&.~....~..~. ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on/which proposed work will be done./ ............... ' ...... ' ", ......: '7 '...' * ............... .... ...... ..................................... House Number Street ~ Hamlet County Tax Map No. 1000 Section ...... / ./.~. ....... Block ...... 6 ........... Lot JJ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing pse and occupancy....'~./.~. ~.- .~ql*~,~-- ........................................... b. Intended use and occupancy . ·..'~. - ....................................................... Nature of work (check which aplplicable): New Building ..... ' ..... Addition ... Alteration Repair .............. Removal .......... Demolition .............. Other Work ~l~ Estimate'd Cost ........... I.!.~. ~).~ 0 *. ~. . . If dwelling, number of dwelling Units .......... (Description) ........ Fee ..... ... .................... (to be paid on filing this application) · · Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................ 6. If business, commercial or mixed occupancy, specify nature an~d extent of eaqJz.type of use/ .......... ,-. ........ 7. Dimensions of existing strnctur~s, if any' Front ~ ~ ~ . ' '}Rear ~ ~. eT) ~" Height .............. Nun~ber of Stories . ,I ................ I ..... / . .. Dimensions of same structure with alterations or additions Front ............... Depth .................... i. · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front·.~.~ ..... t:.. Rear ...ea~ ........ Depth .. l~ .... , Hight N n)ber of St ' 9 Size of lot: Front i. ;.'.: ~ Rear ~ *"" Depth I0 Date of Purchase ' Name of Former Owner I 1. Zone or use district in which pr~mises are situated .................................................... 12. Does proposed construction violate any zoning law, ordinanee or regulation: ..~ ........................... 1'3'/Will lot be regraded ~ ........ i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...! ................. Address ................... Phone No ................ Name of Architect ........... i ................. Address ................... Phone No ................ Name of Contractor ......... J ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block inumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ COUNTjIL.O~' .......... ~l ...... .............. ~ .................... being duly sworn, deposes and says that he is the applicant (Name of mdw~dual signing contract) above named. He is the ..... :. ~ ............................................................... of said owner or owners, and is dul,y authorized to perform or have performed the said work and to make and file this pphcatmn; that all statements cont~uned m th~s apphcation are true to the best of his knowledge and belief; and that the work will be performed in the manne~r set forth in the application filed therewith. Sworn to before me this .............. · ~. ........ day o~ ...... ~..~..~. .......... 19 .qr. [/// Notary mubhc, .~ .... :... ....... . .~.~. ....... y HELEN K' I)£ VpE"ew "- ~' NOTARY PUI~LIC, StYe o 4707878, Suffolk County,~. 'refill Expires M~rch (Signature of applicant)