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HomeMy WebLinkAbout19812-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19884 Date MAY 1~ 1991 THIS CERTIFIES that the building Location of PropertM 26200 MAIN ROAD House No. Street County Tax Map No. 1000 Section I09 Block 3 Subdivision Filed Map No. CUTCHOGUE, N.Y. ADDITION Lot Lot No. Hamlet 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 22, 1991 pursuant to which Building Permit No. 19812-Z dated APRIL 25~ 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 ADDITION TO EXISTING ACCESSORY SHED 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 NORTH FORK COUNTRY CLUB //Bufld~ng Inspector lvO~ NO. ~ 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) Map No 1000 Section J ..(~. ~ Block ..C~...~ ... Lo C~ County Tax . -p.~ ......................... t No ....... ...~ ............. pursuant to application dated .....~... ........... ~ ............... , 19..~..(., and approved by the Building inspector. Fee $. .~.., ............ Building Inspector ~ Rev. 6/30/80 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 c.f Code Compliance from architect or engineer rcsponaible for the building. 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 - $I00.00 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, Commercial $15.OO New Construction ........... 01d Or Pre-existing Building.. ~)./.%rF.~..~.... 7~ ~J~y~'~3~ Location of Property ..................................................................... . House No. Street Hamlet ooo. ..... .... ..:... ;ubdivision .................................... Filed Map ............ Lot ...................... / %~/ .~. ~. Permit.~ ~..~ /..~f~plicant 'ermit No ...... Date Of ............................... . [ealth Dept. Approval ........................ . . Underwriters Approval ....................... . . 'lanning Board Approval ........................ equest for: Temporary Certificate ........... Final Certicate ........... ee Submitted: $ .............................. ! FOUNDATION FOUNDATION 2. ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL (1st) f2nd) ADDITIONAL COMMENTS: /11 I1¢2-,~,,~.~ L~'~ I1\1,.,/~ ~ ~ ~/L,';? ..... "': ..... :~; .... TEL.: 765-1803 &pproved .~...~..~ .... 19 ?!. Pen'nit No..j. ~..?j..;~... )isapproved a/c .... . ................................ .................. (Builffing Inspector) APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOAKD OF HEALTtl ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK ................... SEPTIC F;RH ....... '.. CALL ......... FLAIL TO: INSTRUCTIONS 'a. This application must be completely filled in by typewriter erin ink and submitted to the Building Inspector, with 3 ~ts of plans, accurate plot plan to scale. Fee according to schedule. qb. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- xtion. c. The work covered by this application may not be c'bmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ~all be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy mil 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 uilding Zone Ordinance of the Town cf Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. tie applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and to lmit authorized inspectors on premises and in building for necessary inspections. ~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) / late whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrici;tn, plumber or builder. .. .......................................................... ... ....................... 'ame of owner of premises k[O. ((~.~..b.. Z~.O..~....~..2.0.6/. ..... ¢. ................................ (as on th/~ tal roll or la'test deed) ' · applicant is a corporation, signature of duly authorized officer. " (Name and title of corporate officer) · ' · Budder s L~cense No .... .Q ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 4.;.2 Location of land on which proposed work will be done .......... tS.~.. . ?. ........ House Number Street Hamlet County Tax Map No. 1000 Section ../..~..~ .......... Block ...~,~ ........... Lot..~ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction: ........... ~ ..... _.~..~r f'~-', ~.' '.;~,- %~,0'~1~,~4.'~, .,,,. r~ ..,~- ..... I interior or coruer lot. 3. Nature of work (check which applicable): New Building .......... Addition; ......... Alteration .......... Repair .............. Remdval ........ Demolition ....... Other Work ............... 4. Estimated Cost ~ , o ~C fD~scription) (to be paid on filing this application) 5. If dwelling, number of dwelling dnits ............... Number of dwelling units on each floor ............... If garage, number of cars ! ....... · mixed occupancy, ' ............................ 6. If business, commercial or specify nature and extent ofcach type of use ............. 7. Dimensions ot exmtmg structures, if any: Front. JO. .... Rear .~.~'. .......... Depth 'ght N ' /. DHei~l ............ umber of Stories ............... > .................... :~ ............ ensiGns of same structure with alterations or additions: Front · '' ~ Height N / ....... ................................ umber of Stories ..................... zmenmons of enhre new construction' Front · ~.~. ~ -- · ............. Rear ............ Depth ./.~. Height ............ Number of Stories /. ........... 9. Size of lot: Front ............ ~ .......... Rear. Depth 10. Date of Purchase : ........................................... 1 1. ' ........... : ........ ' ......... Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violalte any zoning law, ordinance or regulation: .~O.. ......................... 14. ')'r ............. Will exf~ess fill_hq rf~mo~ed from premises:~ . Yes N ' ame of Arcintect ; · '-~ .... , ................ ,~aaress .................. Phone No ............... 15. Is this property within 300 feet of a tidal wetland*' '~v~ ' ~;~ ~ ' ~ [~;' ' ' · If yes, Southold T6wn Trustees Permit may be required. .... I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ' · · ' number or descnpQon according to deed, and show street names and indicate whether ....... THE ~EO~IRE~ENTS O~ TNE N.Y. . ;TATEOF S~TE CONSTRUCTION & ENERGY , N~O~EE~. ~ R~SPONSIBLE FOR . (Name of individual signing [contract) ...... duly sworn, deposes and says that he is the applicant OOve named, i i' (Contr rporate officer, etc.) ~ s.~id pwner or owners, ~d is duly a~tborized to perfo~ or have performed the said work and to m~e and file this ]pllcatzon; that all statements contained in this application are true to the best o~his knowledge and belief; and that the ork will be perfomcd in the m~ner se[ forth in the application filed therewith. ,yom to before melhis ' ........ .... .... ..... ~ ' pp t.