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Home My WebLink About19411-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19647 Date JAN. 9~ 1991 THIS CERTIFIES that the building. Location of Property 155 House No. County Tax Map No. 1000 Section ACCESSORY GOLDIN LANE SOUTHOLD Street Hamlet I35 Block 02 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 14, 1990 pursuant to which Building Permit No. 19411Z dated SEPT. 24, 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 AS APPLIED FOR AND TO CODE. 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 FRANCES ADAMOWICZ Rev. 1/81 /B~ilding Inspector TO~'N 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) Permission is hereby granted t: , , ...... .~...~ ....... ~7...7...~...~ ........................ , ,.....,,~,~.~,...~..,.~,.~..z/..~--"""'"-- ~.~ -". ~. ~...~....:~~.... ........ ~ ......... ;.......: ........................................................... ~/ot Premises located at ./..~. . ' p ~...,.~.. .'_~/.~,..../~.~., ............................................. County Tax Map No. 1000 Section ...../,.~... Block ...... A ..........Lot No .......... Z..,~.. ...... pursuant to application dated ........................................................ , 19 ......... and approved by the Building Inspector. Rev. 6/30/80 TOWN OF SOUTHOLD 765-1802 f - APPLICATION FOR CERTIFICATE OF OCCUPANCY ~.%- This application'must be filled in by t'ypewriter 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 ~lectrical installation from Board of Fire Underwriters. 4. Sworn state,eat from plumber certifying that the solder used in system contains ~ less than 2/10 of 1% lead. $. Commercial building, indus, trial 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. B. For existing buildings (prior to April 9, 19~) non-conforming uses or buildings and "pre-existing" land uses: ' I. Accurate survey of property showing all property lines, streets, building amd 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 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. Certi~ic.~te of Occupancy on Pre-existing Building - $i00.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated C~r~ificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15..90' Commercial $15.00 Date ::ew Construction .... ~ ...... Old Or Pre-existing Building ................. House No. ~tree~ ............... ! Hamle~ ......... PrOpert ' Onwer or 0wuers of y ..... · ............. ....................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit.' ............... Applicant ............................. [{eal~h Dept, Approval .......................... Underwriters ......................... Approval ,, Planning Board Approval ................ .? " ~eAuest for: .Temporary Certificate ........... Final Certicate ........... ~ee Submitted: $ " '" .. Fi£LD 1. FOUNDATION FOUNDATION 2. ROUGH FRAME & -PLUMBING (lst) (2nd) e INSULATION PER N. STATE ENERGY CODE FI:IAL ADDITIONA'L COMMENTS 765-:i802 BUILDING DEPT. INSPECTION FOUNDATION 1l$T [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSU_LATION FRAMING ~NAL INSPECTOR ~ '" SURVEY OF LOTS 17 & 18 SUBDIVISION OF PROPERTY 0 WNED B Y NA THAN GOLDIN FILED NOV. 2E, 193EFILE NO. 1106 A T SOUTHOLD CER T/FlED TO~ SECURITY TITLE & GUARANTY cOMPANY TITLE NO. S 968666 FRANCES ADAMOWICZ SHERYL ADAMOWlCZ TOWN OF SOUTHOL D .~ SUFFOLK COUNTY, N.Y.. /./.~ ~~ Scale I _ 30 I1~1 ~.~!;=.- -- ~ June 1, 1988 ~~~Rs, P.C. . y. 11971 88 - 352 · ~. BOARD 3 SETS FORM NO. 1 SURVEY TOWN OF SOUTHOLD CI1ECK BUILDING DEPARTMENT SEPTIC TOWN HALL BLDG. DEPT. $OUTHOLD, N.Y. 11971 TOWN, ~O. LD~.,~. TEL.: 765.1802 ....... Disapproved a/c ..................................... OF HEALTH OF PLANS~.. .);~--~:.-. NOTIFY ~ MAILCALL~;.~.. 'i ........ ~'~''' --.:..~: >..~ .... ? :3'./7'..~... .~ .... ./~.~. z~.. Date ................... 19... INSTRUCTIONS a. Tiffs application must be completely filled in by Wpewriter or in ink and submitted to the Building Ihspector, with 3 sets 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 public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of th/s appli- cation. e. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall 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 shall 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti~,~ ~, ~ , · (Signature of hpplicant, or name, if'a'c'o~l~o'r,~ [i~r' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... :~: ~..~.<~. Name of ow, ncr ,of premises~..~.A[.* .~.~. .~..~0./? .~.. ~d/~..- (as on the tax roll or latest deed) If applicant ,is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~.q~.-~.,~...?..~. ......... Plumber's License No ......................... Electrician's License No ....................... Other Tradc's License No ...................... 'OOCU?^NC¥ OR USE IS UNLAWFUL W~IHOUT CERIIFIC^TE OF OCCU?~NC¥, I. Location of land on which proposed work will be done; ". ............ ~;;;;/ .......................... tlouse Number r , Hamlet ' ' Coun,yTa.,,,,ap~o.,000S,ct,on ..... /.~. .~. ..... ' B,oc~ ...~.. ........... Lot..../.~ ......... .:.. Subdivision ............................... Eilcd Map No. .. (Name) ..... '~ State · ' ' -. ex~st~ng use and occupancy of premises and intended use and occupancy of proposed constrnction: A. Existing use and occupancy ................................... B. Intended use and occupancy. . 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration, .. J ,...,. · · · '. · Repair. ........ 2 ..... Rl~moval .............. Demoli_tion .............. Swiraraing pool ....... ',: ....... Tennis Court ....... :,. ~ccessory Building.3~0 .... Fence ....... Other-:.~[pztk[~;~ ...... ....... 4r /loo. o19 .. . ..... ·. i (to be paid on filing this application} 5 If dwelling ' ~ ' Number of dwelling units on each floor · , number of dwelhng umts ................................ If garage number of cars } ......... ' ' 6. If business, commercial or mixedl occupancy, specify nature and extent o f each type of use ...................... 7 Dimensions of existing structure~ if any: Front Rear . . Depth ' o f Stories Height Number ................. Dimensions of same structure wi{h alterations or additions: Front Rear· . ' Depth .................... i. Height ...................... Number of Stories .......... .... ......... D'mensions of entire new construction: Front Rear Depth ... Heieht .Number of Stories ' 9 Size of lot: Front ! Rear Depth 10. Date of Purchase ....... ; ................ Name of Fon'ner Owner ....... i ' d I 1. Zone or use district in which pre[nises are mtuate ............................. 12. Does proposed construction violCte any zoning law, ordinance or regulation: ............... ~ ............ 13. Will lot be regraded ......... ~ ............. ...... ~Vili excess fill be removed from premises. , 'Y~, ~.. No.. · Address Phone No 14 Name of Owner of premises ' ' "''' ....... ''' ' ' Address Phone No Name of Architect i" ' ''"' '" ................. Name of Contractor ......... i ............... Address ................... Phone No ................. 15.Is this property located within 300 feet of a tidal wetland? mYgS .... NO .... mil yes, Southold Tow~ Trustees Permit may be required. i PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block immber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEIV YORK, S.S COUNTY OF ................. , AP, PR'OVED AS NOTED 76,G, 1802 9 AM TO 4 PM FOR THE FOr,LOWING INSPECTIONS: I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. ~NSULATION 4, FINAL CONSTRUCTION. MUST RE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ............................ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the { ................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and ]s dr'dy authorized to pe,rform or have performed the said work and to make and file this app cation; that all statements con:tamed ~n tlus appbcatmn are trne to the best of his knowledge and belief; and that the work will be performed in the mandcr set forth in the application f~lcd therewith. Sworn to before me this, ............. day 6f ............ 19 .~q. licant)