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Home My WebLink About19817-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southbld, N.Y. CERTIFICATE OF OCCUPANCY No Z-19909 Date MAY 15, 1991 THIS CERTIFIES that the building~ ADDITION Location of Property 945 JOCKEY CREEK DIRVE House No. Street County Tax Map No. 1000 Section 70 Block 2 subdivision Filed Map No. SOUTHOLD~ N.Y. ~ Hamlet Lot 19.9 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 19~ 1991 pursuant to which Building Permit No. 19817-Z dated APRIL 26~ 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 EXISTING OWE FAMILY 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 WILLIAM J. & LORI ANN PLOCK Rev. 1/81 IPOR, B[ NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 19817 Z Co.nV Tax Map No. ~000 Sec.on ~'~ mo~k ...... .~. ......... Lot No ...... ./..~..~... pursuant to application dated ....... .~....~..~.. ................................. , 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. 2. 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 - Residential $15.00, Commercial $15.00 Date .... . .~.: J .~.. ] .~. ! ......................... lew Construction ........... Old Or Pre-existing Building ............... ,ocation of Property ..... ~.~. ..... .~..~.~-~....~..C.~,~.~.~..~ ...... ..~..~.l.3..~...~>J..~.. ..... House No. Street Hamlet nwer or Owners of Property...~.[']~]~,J..~Cp~)~...~.....~.nf....~.n~...~.J.~...~.. ounty Tax Map No 1000, Section .... ~..~..(~. .... Block .... .~..~.. ....... Lot...~7.~...~.~.~..7.~.%~. ubdivision .................................... Filed Map ............ Lot ...................... ermit No .... I..~.% !~ .... Date Of Permit.....~.l.~..~..I.9.1..Applicant. ealth Dept. Approval .......................... Underwriters Approval ......................... lanning Board Approval ........................ ~quest for: ~e Submitted: ......... Final Certicate.~ ....... Temporary Certificate . . ?'iELD il;S','ECTiON 1; · FOUNDATION (1st) ?ATE FOUNDATION (2nd) ROUGH FRAME & -PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ( ] ROUGH PLBG. FOUNDATION 2ND [ ] INFLATION FRAMING ~INAL REMARKS: DATE~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOU~ATION 2ND [ ] INSULATION [L/,]/FRAMING [ ] FINAL 'i'~-~02 9 AM TO 4 PM FOR F()LL(',)WiN (,~ ~NSPECTIONS: ~, FOUNDATION - ~IC) ~EQU FOR POURED 2, ROUGH ~ FRAMING & PLUM) ~}E COMPLETE FOR C.O. ,*~.L CONSTRUCTION SHALL TH~ REQUIREMENTS STATE CONSTRUCTION & ENE CODES, NOT ~ESPONSIBLE ~ES]GN OR CONSTRUCTION ERRORS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .. (/</c~ff' '" ..... , 19fi,/. Permit No../'.~.~.-/...? Disapproved a/c ..................................... . (Building I~cto~r) ' APPLICATION FOR BIJILDING PERMIT INSTRUCTIONS BOARD OF HEAL'I'll ......... '~3 SETS OF PLANS .......... · '--~S URVEY ................... - -CIIECK ...... HAIL TO: · ............. , .q / . Date ................... 1 ... a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building inspector, with 3 .~ts 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 publ/c streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 mil 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 tall 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 of 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. he applicant agrees to comply with all appLicable laws, ordinances, building code, housing code, and regulations, and to -- (Signature of applicant, or naYrr'e~, if~ corporation) (Mailing address of applicant) rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... .., ...................................... .: ....................... ame of owner of premises ...~./../-/-/.44't. ~ ./.d~..~..,~'...,.~.....~'g..[~..~.:..~..~..O..c~.. ........................ (as on the tqr:t'¥oll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~."....~.k/.~.~../.~ ........ 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 MapNo. 1000 Section.....~O. .......... Block .....~.. ...... Lot..~ ......... 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 ~'~r~ ~~ ' ............................ ~.,,~.q. ~ .'~;.'.. '.~- b Intended use and OCCUnanev ~~ ~/~ ~;' **: ~*'~ 3. Nature ' ' of work (check winch applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remo3al .............. Demolition ..... Other Work....~.~..~.(.~... e ription) 4. Estimated Cost .... *.~'~ , .~. Fee ............... antx, l.~'. · ~ .,~, ........ ' t ' ! ( o be prod on fill ~ applicat on) 5 Ifd b f d lli i . . welling, hum ero we ngulmts ............... Numberofdwellingunitsoneachfloor If garage number of cars . 6. If business, commercial or mixe I · d ]occupancy, specify nature ar)d extent of each type o~f use ............. .~ , .... 7. Dimensionsofe~istingstructures~ if any: Front .... ~$.,.~. Rear . .~'.~.-.~' De~th .~..~.~. Height....~. ........ Number of Stories ~ ........... v ............ Danensmns..,o,f ~ame structure with alterations or additions Front ~.~,/~'" ~oo, ~ ~, ~'" ....... ~,. w- ... · ~.,~,. · :.. ...........? Height ...... d-4~..:; .......... Number of Stories ... ~.. ............... 8. ~almenslons o~ ennre new construction: Front .... ~'$'.~. · · . Rear .... /~.O.~ ....... Depth . Height ....... .0,,~O~°;~'. . Number of Stories ........ ~d/~._.. ) ........... 9. Size of lot: Front ..... '/' ~O.'/' .i .......... Rear ..... /?~. ............ ' .............. '~ .............. · Depth . .~...2~. ................ 10. Date of Purchase ' - ' ........... i ................. Name of Former Owner ....~a/f/r.,~- ~. . 11. /~one or use district in which premises are situated ....... .~ ...................... 12. Does proposed construction violaie any zoning law ordinance or regulation' . .. 'q/O. .. . 13. Will lot be regraded . . ~O ........ ' ...................... ._z- Nam ~ ,., , '.' ..... g,;._.....,; .......... wm excess rill oe removed fi.om premises: 14. e m uwner o~ premises ... ~r. ~9..Crt~ ........ Address . ,7~.~. ~_,-4~c..%"~g. ,.. Phone No. ~.'. P~,;I.~ .-.~.-. Name of Architect .... ' ~ " Address Phone No Name of Contractor 7. 7" .. --~ --- ....... i .............. ttauress ................... Phone No ................ 15. Is this property within 30~0 feat o/5 a ~:idal wetland? ~Yes ..... No. · If yes, Soul:hold ToWn Trustees Permit: may be requir~12 .... · -. PLOT DIAGRAM Locate clearly and distinctly property lines. Give street and bl¢ interior or corner lot. ~ all buildings, whether existing or proposed, and~ indicate all set-back dimensions from ck n mbe.r or descriptioh according to deed, and show ,street names and indicate whether ,,'FATE OF N~I]~I~o f bore named. f said owner or owners, and is duly aUthori~'fto perform or have performed the said work and to make and ~phcation; that all statements containea jeFthis a~nlication are trno~tn th~ hoe ............ file th~s ' -~ ....... vv,,*-,,~a~ a~ uuu to utc o~u[ OlnlS Knowleage ana Oellef. and that h ork will be perfo~ed in the m~ner~or~ ~or, z