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Home My WebLink About19501-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town B~ll Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z20056 Date JULY 5~ 1991 THIS CERTIFIES that the buildin~ ACCESSORY Location of Propert~ 1255 GOOSE CREEK LANE House No. Street County Tax Map No. 1000 Section 78 Block 08 Subdivision Filed Map No. SOUTHOLD Hamlet Lot 09 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCT. 31, 1999 pursuant to which Building Permit No. 19501Z dated NOV. 5~ 1990 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. The certificate is issued to JANE S. DENNY (owner) 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 Building In~eCtor TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 19501 Z Date ..../.~ ....................................... , Permission is hereby granted to: Co"nV Tax Map No. ,ooo S.ct,on ......... Z~ ...... .,=k ........... ~ .... Lot No. -~ pursuant to application dated .,../.~../~./. .................................... , 19..~....~., and approved by the Building Inspector. Fee $....~...~ Rev. 6/30/80 Form No. 6 TO%~ 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. C. Fees i. 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 - $i0.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ...... ~..~./.~..~ ?. ~ ...................... ~ew Construction ........ /~.~Qld Or Pre-existing Building. . Location of Prooertv..~'.~-f.P. ~.f~."%~ g ...~-/~'-~£2~ ~]._,,z~/,~ ...... ~ ........ House No. Street Hamlet )nwer or Owners of Property ............. ~ ..... ' .......................... ~ounty Tax Map No 10 ° '~ ~ ~/ i i~i iiiiii i iiiii 00, Sectzon .............. Block ..... ~ ......... Lot ....... ;nbdivision ................................... . Filed Map .......... .. Lot .................... . . 'ermit No ......~.~Z..~. .... Date Of Permit... ~//~/~.~. ..... Applicant ............ . ................ [ealth Dept. Approval ......................... . Underwriters Approval .... . .................... . 'lanning Board Approval ........................ equest for: Temporary Certificate ........... Final Certicate ............ . 'ee Submitted: $ ......... /~"'~'~' ~ /~ /~i~1..~~ A- · . ..... .... : ............. · OUNDATION (1st) OUNDAT!ON ( 2nd % OUGH FRAME & ·PLUMBING NSULATION PER N. STATE ENERGY CODE Fi'NAL/ ADDITIONAL COMMENTS: -g 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION ;ZND [ ] INSULATION I* '1 FRAMING ~"~INAL REMARKS: ~/"/J t ~'",. ('~ J _-~, ¢, 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ~FINAL When you purchase a North Fork Wood Design Storage Building, Gazebo, or any of our many o~her products, you own a high quality wood product, soundly constructed, with the finest construction materials, Built here on Long Island with pride. CARRIAGE HOUSE Our most popular model. An excellent "on loca- tion sales office", pool house, or general slorage area for your home. A beautiful way to meet your storage needs. Single or double doors are available on ALL MODELS. FORM NO. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL Examined . ./~/~.'~, ....... , 19 .q? TEL.: Disapproved Z~b,-~802 ~, A~V~ TO ,, FM FOR THE ~ ' ~OL LQW NC~ ~NI~¢~C~CTIO~S. ApPLICATION FOR BUILDING PERM 1' t. FOUNDATION 'D~O REQUIRED FO[~ POURED CONCRETE 2. ROUGH - FRAM{NG' & PLUMBING 3. INSU~TION INTRUSIONS BOARD OF HEALTH ..... 3 SETS OF PLANS ...... SURVEY ...... ' ' ' SEPTIC FORH ............... NO? I py ~ CALL '20. C..*M. 4 aFINt~i .~ T TI MUST '\,- ' · ' i .s~le completely filled in by typewriter or in ink and submitted to the Buildin-" ' n ' n lot and of buildings on remme . orT 'b~( ~ * ' ' s ..... ~&~~mi~J~tion of la-out o ca~IE' CO~R~I~ ~-~ ~ :property must h~ a ....... P 'cstrce, U~B~j~,2 RESPONBIB~ FOil ..... awn on me magram whmh is pa~ of t~s appk D I ~ t~cation may not be commenced befor ' snail be kept on the nremises a~-~,- ~- '.' ..... ym.g inspector wm ~Ssued a Build/n- Pem;~ ~o~_ ,. i ~2 i ~t ..... ~ wa~dol~ mr mspechon throu~out the wnr~ o ,, ,u ~::u appuc~t. Such peri . ~i ~0 uunomg sha I be occupied or used i- ,..~-' : ...... ,, ..om or ~n part for any purpose whatever until a Cemificate of Occup~c, snal~ nave b~n granted by ~e Build~gflnspector. ·. w?~l~.~°rr}~:~}~'~lEg~fld~gs, additions Y, ~ew York, ~d other apphcable ~ws, Ordm~ces : .ne a~?ni a~}~,-tff,.~o~l~ff~li applicable laws ~ratlon~, ~[.for removal or demolition, as here~ descfibe~ admit a~fi~svcctom on --~4~ ...... .... ' rices, ouuamg code, housin- c - 4. FINAL - CONSTR~(:T~fi-~t[~ff~ an~ m ommmg tot necessa~ ~nspections. t . ode, and regulanons, ~d tc THE 8EOOISEMENTS OF THE N,Y. ' . t~fnatureotapphcant, orna~,ifa~orporfir]dd)''- sm~ co,smu~o. ~ ~,~,~v g~ & ~(~. Z%.,..~4 ..... ~ ...... ~2.. CODES. N~ RESPONSIBLE FOR ' ' ck!%~4x~-/~'7~ ' DESIGN OR CONSTRU~ION'ER~ORS St=re whether ~ppHcaut Js owner, ]essee, ~ge~t, ~chJtect, e~gJ~eer, ge~er~] co~tmc~or, electdcj=~, plumber or buHd~n : ...................... -. Na r p scs . .. If applicant is a corporation, Signature of duly authorized officer. ' ' ' (as on the tax roll or latest deed) ,:,i; o; a;;, OCCUPANCY OR Builder's LicenseNo. ~..~ (,~* A [~ ~. · '-' "' USE UN WFUL Plum bet's License No ......................... W THOUT CErTiFiCATE ............ 0F OCCUPANCY 1. location of land on which proposed work will be done; ' · ........... (&..~'~ .... ~c,x j~.~ /?~¢/ . llouse Num bet ' ' .................... Strce[ 2 ........ .. Hmnlet .......... tV Ta 1000 S V~ · Coun x Map No. ection ................. Block .. . bdi ......... Lot . ~ .... Su vision ........................ · ...... ,... ............. Eilcd Map No. ' State exist (Name) .............. Lot ......... " /ng use and occunano, of nremisesa d intended use and occuPan,... ~ ' .... ~' ~ " ~ cy ol proposed A. Exxst~ng use and occupancy..~~ ........ ~ '; ............... ~ ................ . · -.- _d._.~...~ ............. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair' . ............ R~moval . Demr~liti~n Swimmin. ,~oo~ Tennis Court ~.. j .... Acce-'-' .... -":~']:' '<~ ........ J .......... ^~- ~ ~ ............ >5 u a,ng..eX ...... 'e ee .. ........... 4. Estimated Cost ....c~.). 0.Oca ~ .~, ~ ..................... Fee .... .~...,5~.~ ...................... · (t,a he p~id on filing this application} 5. If dwelling, number of dwelling units .............. . Nnmber of dwelling units on each flour ............ If garage, number of cars ....................... ............................................. 6. If business, commercial or mixed occupancy, specify natnre and extent of each type of use ................. 7. Dimensions of existing structure~, if any: Front ...... ' ......... Rear ............... Depth ........... Height ............... Number of Stories .................... Dimensions of same structure wi'th alterations or additi0ns:'F'r;~; ..iiii~ i~ l i~.i'l~;~i~il~.~i~.~.. Depth ...................... Height ...................... Number of Stories ............. } ........ 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... .Number of Stories .............. ; ............................. ; ........... 9. Size of lot: F/'d'fit ~...'.' ....... ........... Rear. [ .................... Depth ...................... 10. Date of Purphese .............................. ' Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated .... ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...................... .......... 13. Will lot be regraded ......... ,...; ......... . ....~. Will excess fill be removed from premises: . Ye: .... l,c. 14. Name of Owner of premises ., .: ............ ; .... Addres~ ................... Phone No ............... Name of Architect ........................... Address ................... Phone No ................. Name of Contractor ................. i ........ Address ................... Phone No .... 'i .......... l~.l~ ~hi~ l~roperty loca'ted within ~00 feet of a tidal wetland? *YES .... NO .... · If yes, Southold Towj Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all: buildings, whether existing or proposed, amd. iJdiea¢e ~11 set-back dimen~ionq property ~ines.~ivestr~etandb~cknumber~rdes~:~pti~n.ac~rdingt~dee~d~4;~ee~~te`~`~' w:::::. interior or comer lot. ' 16 t I2/ STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the appfic~-:: (Name of'individual signing contract} above named. He is the .................. . . . (6o~tr~ctc~rl , . of said owner or owners, and is du)y authorized to perform or bare performed the said work and to make and file th: application; that all statements cont'ained in this application are true to the best of his knowledge and belief; and that il: work will be performed in the manndr set forth in the application filed therewith. Sworn to before me this ............. .~'../ ........ dayof ...... (~..c.~.. ........... 19 ~..d. Notary Public ..................... County HELEN KDEVOENe ¥ ~ Ni~'ARYPUBLIC, Ststeof W~en~ No. 4707878,$uffolkCoum?j[~/ YermExpiresMsrch 30,19..,-,~