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Home My WebLink About19883-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19949 Date JUNE 5~ 1991 THIS CERTIFIES that the building ACCESSORY Location of Property 910 NEW SUFFOLK AVENUE House No. Street County Tax Map No. 1000 Section 114 Block 12 Subdivision Filed Map No. MATTITUC~ N.Y. Hamlet Lot 8 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 16, 1991 pursuant to which Building Permit No. 19883-Z dated MAY 24, 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 ACCESSORY SHED (AS BUILT) The certificate is issued to HELENA & STEPHEN PEPJ~MAN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 'Building Inspector Rev. l/S1 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) N~- 19883 Z County Tox Map No. 1000 Section ..... ~', ./...~,,, ....... Block ....... ,~.~,. ...... Lot No ....... ~ ........... pursuant to application doted ....... ~ .................................... , 19.~./..., and approved by the Building Inspector. Fee $,, , Rev. 6/30/80 L Form No. 6 TOWN OF SOUTIIOLD 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 archiuect or engineer responsible for the building. 6. Submi~ 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 dwelli~ig $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 ......... Constructzon..~/. ....... Old Or Pre-existing Building ....... P r oPe r my.. ?./. ~..~/-~.-. ~C~-~/~'/./~A/~.~<.~f..g~ '~'7~_ .__ ~ ~_.~.~...._.. .... ..... House ~o.~ ~ ~ Streee ~ Hamle~ · , .................................. 7. .... .... ...... ubd~v~s~on .................................... F~led Hap ............ Lo r ...................... ~rmit No..~ .... Date Of Permit ................ Applicant ~alth Dept. Approval .......................... Underwriters Approval ......................... tanning Board Approval ........................ ~quest for: Temporary Certificate ........... Final Certicate ..... Submitted: ~. . . 765-~802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION FRAMING REMARKS: [ ] ROUGH PLBG. 2ND [ ] INSULATION [~]I~NAL DATE INSPECTOR FG;UNDATION (1st) FOUNDATION ~2nd) ROUGH FRAME & -PLUMBING INSULATION FER N. STATE ENERGY CODE FINAL ADDITION[L COMMENTS: r~. 1°~1~ .' ' ' ' ~. .......... Number of Stories ....... · · · · ~car .............. Dcp£h .............. om~cnslons otsame structure with alterations or additions: Front · Depth ..... ....... ' ......... Height ................. Rear ............ entire new construct ...... ................. Number of Stories 8. Dimensions of ion: Front ...................... ............... Rear Depth Height ............... Number of Stories . ' .............. 9. Size of lot: Front ..... ' .................. ' .............. '.0. Date of Purchase ................. Rear ................ ...................... Depth .................... ............... r~'~;*~,~,~'5 .... Name of Forlner Owner .. Zone or use district in wh ch pre nises'a' .~. Docs proposed Construction viol ........ , ....................................... ' ' .3. ,,,,,, . . ~,u ,my zoning law, ordinance or regulation- ', ............ wm ,et oe regraaed ............................ Will excess fill be removed from premises: Yes No 4. Name of Owner of premises .. Name of Architect ......... ' ................. Address ................... Phone No ........ ' Name of Contractor ........ ' ................. Address ................... Phone No ...... .................. Address ................... Phone No. ' ......... 5. Is thi~i~rpperty within 300 feet of a tidal wetland? *Yes ..... ' ......... yes, Southold Town Trustees Permit may be required[ -. No ......... · ... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether ~terior or comer lot. TE OF NEW ',,try s.s ..... ...... . OOI InOlglOUal signing contract) named. .. being duly SWorn, deposes and says that he is the applicant thc ................. (~ . t, corporate ' ' ............. ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 :xamined .......... 19 ..~X ;~)isapproved a/c ..................................... .......... ~o~,.~s,o~. ....... ,... ~ ~ 1. FOUNDATION ~O REQUIRED Date FOR POURED CONCRETE gOAKD OF HEALTH ......... ..-"3 SETS O~' PLANS .......... SURV£Y ................... ,/CIIECK .................... SEPTIC FOR,H .............. c^u, .... 2-.'t .t-: .'/.,r..~ q7 .... HAIL TO: 2. ROUGH - FRAMING & PLUMBING INSTRUCTIONS ~; ~d~q~.l.~t~e~ef~l~;do~inbgy ttoYsPce~ or in ink and submitted to the Building Inspector, with3 b. I~E[. .~.¢m~. ~l:aSUtaM M[~r!l~d of buildings on premises, relationship to adjoining premises or publ/c streets .a. reas,Tp~, flLaltlllREffittl~l'~t O~-scl'htEidl26f layout of property must be,drawn on the diagram which is art of this :ion. STATE CONSTRUCTION & ENERGY p ' appli- a..q~l~E_. I3I~S'~R~(~T~I[I~,~e Building Inspector Mil issued a Building Pe~it to th~ ~ Ecant ~uc~ pe~it SI be ke~[~ ~,=mi~=~[ble lot inspection throughout the work. PP ' d~ h~w ~ ==~=~_ ~=~=~tn~ ~n whole or m p~t for =ny purpose whatever untd = Certific=te of Occup~cy 76R-~802 9 AM ~ 4 PM-FO~THE ua~n~ ~~~x me~R~old, Suffolk County New York mid other a ~cable ' guiattons f ' ~ u~Idh ' ' Pp . ~ws, Ordm~ces or 9~~ ~ gs add~tions or a terations, or for removal or demolition, as here~ described. e .~pp~.ca~,t ~tg,~~BOM~able laws, ordinances, buildin- code houstn- c~ mt auth~z~~ on premises and ~ build~g for necessa~ inspections. ' '7~ .......... ,~,auons, aha re __. ....... ALL CONgT8OCT[O~ 8~ALL ME~ (Si=nature et applicant, or name, if a corporation) ~HE REQUIREMEN~ OF T~ N.Y. ~,/ ~ ) ~ · CODES. N~ RESPONSIBLE FOR ~ (M~ilin~es~ffappJic=nt) _ ''' SI. R ONSTRU~ON ERRORS' ' ........................ mc of owner ofpremkes . ~.. . . las on the t~,t roll o~ latest deed) ...................... pplicant is = corporation, ~ignaturc of duly authorized officer. ,' ..................................... (Name and title of co~orute officer) .... t N nb St ....................... ouse m er reet Hamlet ~ounty Tax Map No. ]000 Section ............ Block Lot ;ubdivision ............ Filed Map No (Name) tare existing use and occupancy of premises and intended use and occupancy of proposed construction: .......... , ........ :'....:::::: Intended use and occupancy . . ~~ . . . . ....... 3. Nature et work (check which applicable): New Building Add lion Alteration .......... Repair ...... Removial .............. Dem/olition .... . . Other Work ............... /J o '4. Estimated Cost , ~ (Description) · ' ' · 'i ........................ Fee ...... . ii (to be paid on filing this application) 5. It dwelhng, number of dwelling u ts ..... · If garage, number of .......... Number o£ dwelling uoits on each floor ............... ears .... , .............. . 6. If business, commercial or mixe ccupancy, spec nature and ex tent o£ eec lc of ns ........... exmtmg structures, lit' · 7. Dimensions of ' ' any: Front .. Rear .... Depth ...... igt bi ....................... He it ............... Num r of Stories .................. · ........ Dimensions o£samc structure, with alterations or additions: Front ' ' ' Depth ... j., L · ................ Rear ......... ............ i nmgnr ............ . ......... ..... i .... Number el Stories ..... : .:... . 8. Dimensions of entire new constmotion: Front ......... igt ' ' ........... Rear ............... Depth ..· He ~t .............. Numbir of Stories ........... . . · ........ 9. Size of lot: Front . Rear ...... ' .................. ............... I0. Date of Purchase , ............ D.eptb ........ ............... ......... ' ....... ' ......... Name of Former Owner ,. ............. .. I. Zone or use district in xvhich premises are situated ............ o'r ................ 12. Does proposed construction violet any zoning law, ordinance re ula ou: ... ~3. Will lot be regraded ..'. ....................... ........... I ................. Will excess till'be removed f~om premises:; Yes No 24. Name of Owner of premises .................... Address .............. .~ ....Phone No .......... Name of Architect ............ ~ ............... Address ................... Phone No. ............... Name of Contractor ........... ] .... Address ......... Phone No ................ 5. Is this property within 30 feet of a tidal wetland? *Yes ........ No ........ ,'. · If yes, Southold To~n Trustees Permit may be required. PLOT DIAGRAM Locat?. clea~y and distinctly all b~ildings, whether existing or re osed a .i ' " . ' · · ,roperty lines. ~ive street and block nu bet or ScHnt{o~ .,-o .... P, '.P . , nd lld~cate, ~1. set back dml enmons from aterior or comer lot. m de ..~. ...... ommg re aces, and show stree~ names and indicate whether '\TE OF NEW YO'~K, · ' .... ~i' · ·,. being duly sworn, deposes and says that he is the applicant (N, ne et ~nuiviaua~ signing,contract) ge named. ' is thc ' ~t~ , corporate officer crc ) aid OWner or owners, and is duly authorzed to perform or have performed the said work and to mfiko and file this '/cation; flint all statements contained }n this application are true to the best of his knmvledg= and bel{ef; and that tho k will be perfo~ed in the manner sgt fprth in the applieatiou filed thorewith. m to before me this .......... . ay or .... i~ Public, ........... ' Tm'm ~Xokes Ocloh~r~l, 19~