The URL can be used to link to this page

Home My WebLink About19572-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19777 DATE: March 7, 1991 THIS CERTIFIES that the building ACCESSORY Location of Property 290 PRIVATE ROAD #32 SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 59 Block 9 Lot 10.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 4, 1990 pursuant to which Building Permit No. 19572-Z dated DECEMBER 11, 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 STORAGE SHED AS APPLIED FOR. DIANNE M. DANEK The certificate is issued to (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 TOWN OF SOU]HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ 19572 Z Permission is hereby granted to. ..~.~,....../~/~.....~/......~...~....~..~ a rem,ses I ated at. ~ ~... ......................... . ....... ~..~~ .................... ~ ...................................... County Tax Map No. 1000 Section ....~.~... ........ Block ........ .~... ......... Lot No .......... ./....~..'..~. pursuant to application dated ....... ./.i~.~... .............................. , 19...~..., and approved by th, Building Inspector. Fe, $.~'~..~.~.~ 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. 4o 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 ali 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 - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ......................... "ew Construction..%~.... .. Old Or Pre existing Building Locatzon of Property...r .......... .~. .................... ''. House No. Street Hamlet 3nwer or Owners of Property .............................................................. County Tax Map No 1000, Section....~...~. .... Block ...... .~. ........ Lot...t.~..~ ......... Subdivision Filed Map Lot ................ ...Date Of ..................... ............ Appli ........ Health Dept. Approval ........................ Underwriters Approval ..................... Planning Board Approval ....... Request for: Temporary Certificate ..... Final Certicate ..... Submitted: $ ......................... (~,~c WI.RIg ' ''"-~"~ ...... ~ ..... ; .......... ' ............ ~ ' APPLICANT CO ~ ~ 777 FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL · !!DATE ADDITIONAL COMMENTS: TClWN Oc SOUTHOL? FORM NO. 1 TDWN OF SouTHOLD BUILDING DEPARTMENT TOWN HALL TEL.: 7G5-1802 BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY .................. CHECK ................... SEPTIC FORM .............. ........ X'Z . Pc=it No .......... DisappFoved a/c ..................................... ... A.r,;R,..ED"" n,, A..S NOTED -~ . . /.---% ,.~ ~~ ~ ........ >~ ' (i}'- c. AP', ~-O · PM-FO~ THE .... ~PPLICAT O~ FOg BU kD NG PErM T ', ): C ,.:?gms(. m~gPEC FIONS' :~i :~g)AT~CIr,~ ~VO REQUIRED 2 ROUG~ FRAMING & PLUMBING INTRUSIONS te .~. fc- ....... I9. ~'a: h~l~lHs ;/p;i~_~'~i~'~RE~t~[~e ~letely nlled in by ~pewfiter or m ink and subm,ttcd to the Budding ~p=mr, sets.~~l~l~V tp,~. F= a~ing to schedule. A~ g~}l~n~~.~st and of builfl~gs on premises, relationship ,o adjoining premises or public stre or~~~-~i' ion of layout of property must be drawn on the diagram which is pa~ of t~s cau~ha~~~cationnnn ~_~ may not be commenced before issuance of Bu~dNg Pe=it. D~t~p~n ~~ ~ion, the Building Inspector w~l issued a Build/n= Pc=it to the appnc=t. Such shall bc kept on the premises available for ~spection throu~out the work. e. No buildNg shall be occupied or used in whole or in part for apy purpose whatever until a Ce~ificate or Occupm~ shall have been granted by ~e BuildNg Inspector. APPLICATION IS NERVY MADE to the BuildN~ Depmment for the issu~ca or a B~Iding Pe~it p~uant to t. Building Zone O~inance of ~.~{ Southold. Suffolk County, New York, ~d other npplicabt~ ~ws. Ord~ces, Regulations, ~o~ .th= cons~tipn of bu~dNgs, additions or alterations, or for removal or demolition, as her=~ descNbe Th= =pp~g~nt agr~ ~:gOm,~lpi~applicable laws, ordinances, bufld~g code, housin= code, and regulations, ~d ' admit,au~q~pectom on ~rem~es and ~ build~g for neces~a~~~/rinspections. B; CO~iF'LETE FO~ C.O (Signature of applicant, o~ name, if a corporauon) (Mailing address of applicant) agent, architect, engineer, general contractor, electrician, plumber or builde: (as on the tax roll or latest deed) aLL CONSTRt)CDON SHALL MEEt THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. N~ RESPONSIBLE FOR S Late ...... ................... Nam. or owner or pr~ises . ~. ~ g. OCCUFANCY OR USE IS UNLAWFUL W!THOUT CERTIFICATE C;F OCCUPANCY If applicant is a corporation, signature of duly authorized officer. '' (Name and title ofco~orate ~ncer) Builder's License No. O ~ .~. ~-- C-" Plumber's License No ......................... Electrician's License No Other Tradc's License No ...................... I. Location orland on which proposed work will be done: . ' llousc ....................................... Number ' Street// .............................................. ' Halnlct County Tax M~p No. lO00 Sectio ...... Block ........... Lot .. 2;~ ..~.. (Name) -' and occupancy or premises and i~cndcd usc un, occupancy n u tlr ' n A Existing usc and occupancy ........................ B. In[ended use and oceucancy 3. Nature of work (check which ap'p]icabie): New Buildin~ .......... Addition .......... /dictation ,. ....... R~epair. '?"r ........ Rbm9val .............. Demolition .............. Swi"~l~41~..: ..... · enn~ ~our~ .~.../ .;.. ~Cce%~ry Building .... ~ .... Fence ~ .... Other Work; ....... 4. Estimated Cost ~0..~.%.~ ........... - ' ' ' - ~ ~_ ~,~.~ ........ ~e~ ..................................... ~'~ ~ ~' ~ ~ ~ ~ (t~ bc ~aid on fil ng Ibis a~plication} S Ifa Il' b old tl ' N b old Iii its h floor ...... · we mc, Bum er we mg umts ............... um er we ng un on ese ....... Ifgara=e number of cars ' 6. If business, commercial or mixe~ occupancy, specify nature and extent of each tyke. of use .................... 7 Dimensions o~existing structure, s if any: Front Rear ~ Depth Height Nunibcr of Stories Dimensions of same structure w}th alterations or additions: Front ................. Rear ............... ~?th .. ................... ~.. tlei~t ...................... Number of Stodes .......... ~ ........ 8. wunenmonx ofegtiro new construction: Front .... ~ ......... Rear ... ~ ....... Depth ...~ ........ Height ..... R ........ Number of Stories ..l ........... : ....... ~"..~ .......... ' ......... ' 9. Siz~oflot: F?ont .... l~. i... n~,~ /~ ' '' ~ 0. ~' ~ . -~ ~. ....... ,-~ ...... ,~.~ ........ ,... ~cpm ..~.;t.~ ............ 10. ~ateot~'urchase ..~:~7..~ ....... ' ' ~ ~ ........... ~ ~a~e or Fo~cr Owner' J.~ ~. · ~.~. ~.~.~ I 1. Zone or use district in which premises are situated.. ~ & l~ e ......................................... i ' 12. Does proposed construction vie at~ any zoning law, ordinance or regulation: ...~ ....................... 13. ' ~ ' ' - - .......... Will excess fdl be removed from prm~: . N~¢ of Architect ; Address Phone No N~e of Contractor ........ ~ .... tx-r .... :" ....... Aaar s .......... : ........ e o%No .... withxn'300 feet of a tidal wetland~ '-YES.-;~ ~If yes, Southold Town Trustees Permit may be required. PLOT DIAG~M Locate cle~ly ~d dmtmcfly ~ buHdNgs, whether existing or proposed, ~d. indicat~ MI set-back d~enrio=c f: · prope~y Hnes. Giw street ~d block~number or descfi~ to deed, ~d show street n~es and ~dicate w:::::. interior or comer lot. STATE OF NEW2YORK, ! ..... ~ .k.~. n ~ .~... ~ ~.~ ~,~ .......... being drily sworn, deposes ~d says that he is the apptica:' (Name of individual sig~iug contract) above named. ~ is the (Contractor, agent, corporate officer, etc.) f said owner or owners, ~d. ts du)y authorized to perform or have perfo~ed the said work and to m~c and file th application: that all statements con[ained in this application are true to the best of bis knowledge and belief; and that work will be perforated in the m~n~r set forth in tim application filed therewith'. Sworn to before me this Notaw Pubb ........ County . % ' I Ns. ~2-~63712~ . (Signature Of applic~: