The URL can be used to link to this page

Home My WebLink About19281-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19863 Date APRIL 22, 1991 THIS CERTIFIES that the building Location of Property 55415 MAIN ROAD House No. Street County Tax Map No. 1000 Section 62 Block 1 Subdivision Filed Map No. ADDITION SOUTHOLD, N.Y. Lot Lot No. Hamlet 12 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 24~ 1990 pursuant to which Building Permit No. 19281-Z dated JULY 30, 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 HANDICAP RAMP ADDITION TO EXISTING STRUCTURE 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 JERRY GAMBONE & KESTUTIS ZAPKUS Rev. 1/81 / Building Inspector I~OB~ NO. 0 TOWN OF SOUTHOLD JUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No_ ', 9281 Z Permission is hereby granted to: ~ / I~ ~ ....... ~./_~'~,~.....z~~' J__.u......~...~L~ .......... ~ ,~ ........................... ~.....~..~ .......... ~ ....... ~.....~~...~ .............................. ....................................... Z'~;',';';~'"';:~ ...... 7""~ ................ ~__~..:.~.~ ....................... at premises l~aJed at ,~]~,~...~.....[~.~..-~ ...................... ~ ...................... County Tax Map No. 1000 Section ...... ..C~..~....~...... Block ....... ...~..I ....... Lot No ......,J...'~... .......... pursuant to application dated ....... ...~.........-~...~. ................ , ,9.~...0..., and approved by the Building Inspector. · "l~uilding Insl>ector ........................ Rev. 6/30/80 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING ,r~NAL DATE INSPECTOR 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 a'zchitect 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 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 ...% [.~. ~..~.~..\ ....................... .. New Construction ........... Old Or Pre-existing Building ....... Location of Property.. ~..~..~..Iff... ~..~ .~...~6..~.[...%~.~!~. ~ i i .~.'il i ~[.~..3. .~. ............. House No. Street Hamlet Onwer or Owners of Pronert,, T.~.~.~--OI '~--'~/l"k6~/'-,l~'' ~eS-~-~ { 5 .'.~...~...~..~. .... ogg o Connty Tax Hap ~o 1000, Section .............. Bloek................Lot ............. ... . . subdivision .................................... Filed Map ......... Lot ......... o/So A i Health Dept. Approval .......................... Underwriters Approval ........................ . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~. ..... Fee Submitted: $ ~.OO ...................... FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE (1st) (2nd] FINAL ADDITIONA'L COMMENTS'. )00o0o00oo0.0 0~o ~o 'O~x3 @or @uoloA3 ~ue~p~H ~::~od'i~n- 0 ~puno~O @^oqv M.OO~£gollN alOd,i~gf/ '1 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ...~. ,'~. Approved Disapproved a/c ........................... (Bt~ding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ~.j........ . 3 SETS .Off-PLANS .... ...... . .... : :iii SEPTIC FORH NOTIFY~ j~.~/~t~dd~,~ CALL MAIL TO: BLDG, DEPT. _ TOWN OF SOUTHOLD Da e .... ......... a. This application must be completely filled in by typewriter erin ink and submitted to the Building I~spector, with 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 this appli- cation. o. 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 femoral 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 inspectozs on premises and in building for necessary in_spe, ction_~_ ~ _ - t a , ~fa corporauon) (Mailing address of applicant) ~(Jk/) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises (~-¢,'etf-4~q~ ~A/-~ ~7. ?..~..~."~..~..~.~..~_~¥.~..~..~t~..~.,~,3,~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ( nme and title of corporate officer) Builder's License No..~.C..~.O.~l..4~q~O .C:). .O c*~) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No 1. Location of land on which proposed work will be done; lie' 'e Nu 'b .................. ' ........... ...... ~ .............. i. · . ~ .~. ........................... . . us m er Street, Hamlet ' County Tax Map No. 1000 Section 0 ~c~ .................. BlOck .... ..... .... Lot Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) State e ' · mst ng use and occupancy of premises and intended use and occupancy of proposed constroction: A. Ex±st±ng use and occupancy... .t...~.[..~;_: .'~...~5~.~t_..,.(W' i Alterati 3. Nature of wo~rk (check ~vhic. h applicable): New Building .......... Addition .......... on ........... epmr ..... ~ .~ ..... /;. ov ..... , ...... 7' mohtlon .............. Swimming pool,J~..^ ............ - Tennis Court :.' ....... A¢cessor uzldzng .......... Fehce ....... Other Wor ~ . 4. Estimated Cost... & ...... · ............................. Fee ..................................... ' ' i (to be paid on filing this application) $. If dwelling, number of dwelling upits ............... Number of dwelling un!ts on es? floor... ~ .......... . · . 6. i~ ~'~e;s, comm~'~cial o~V~mi,~ed ~cc-uPahCy,~pecify nature and extent of each type of use . .-5', .~--~w....~...~...~. ...... 7. Dimensions of existing strUctures¢ If any: Front &3. ~.. ....... ;... Rear ~.q.. ~ ....... ;' P · ~ .......... Hmght ~,.6.. ~.. ........ Number of Stones . ..~. ................................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ' ~ ' ' Height Nuqlbe~'~f Stories ................ , ..... 8 Dimensions of entire new c0nstmction F/ont Rear Depth 9. Size of lot: Front Z .~>.~;.e.:; ....., .......... Rear ,P.~ .................. Depth l.gO. ................ 10. Date of Purchase .... Lk. ~1 i, ~.~. ~. ................. Name of Former Owner ,~...~..~..t~. 12. Does proposed constructi6n violnte any zoning law, ordinance or regulation: .............................. 15.Is this property loeaSed within lO0 feet W.r"IP'"ti--da.l Wet,aaa. YES--- ~_~M~v-. ~If yes, $outhold Townl Trustees Permit may .be requzred. - I PLOT DIAGRAM Locate clearly and distinctly all Ibuildings, whether existing or proposed, and, indicate all set-back, .din~.~n.sions. f.r.om property lines. Give street and block r umber or description according to deed, and show street names ana mmca~e wnemer interior or corner lot. STATE OF NEW YORK, ] S S COUNTY OF ................. I .. i .~q?..~.~..o, ~...C~,, .,.. ~} .~.. ............. being duly sworn, deposes and says that he is the applicant (Name of ind:v:dual slg0mg contract) above nam'ed. I ' lie is tile --. ' - [ (Contractor, agent, corporate officer, etc,) of said owner or owners, and is dully authorized to pegform or have performed the said work and to make and file this application; that all statements confained in this application are true to the best of his knowledge and belief; and that the Work will be perforated in tile manner set forth in tile application filed therewith. /. Sworn to before me this ! ' i ' ............. ...... day o; .............. , l ?a Notary Public ........ u' i~'~OE[' . County nr~a~ ~.~r. -'"~t .... .4 ........ ~. · ..¢1 .............. "'; ' llOT~ PU~.tO, ~'~" C'] U (Signature ' ilo. 4707~7~, .~* tl~/~/ of appheant) · Ten Ix#res M~. ~u, ~*-.---- -