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Home My WebLink About19283-zFORM NO ~ 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OP OCCUPANCY No Z19256 Date JULY 31~ 1990 THIS CERTIFIES that the building ADDITION Location of Property 1815 AKERLY POND LANE House No. Street County Tax Map No. 1000 Section 69 Block 05 subdivision Filed Map No. SOUTHOLD Hamlet Lot 05 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 31, 1990 pursuant to which Building Permit No. 19283Z dated JULY 31, 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 CONSTRUCT ~ DECK "AS B~ILT" 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 JOSEPH C. CORNELL Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING I~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- ; 928~ Z Permission is hereby granted to: ...~£~¢,._"~.......~..,~..~..,.... ............ , ~...~..._~_,..~,~....././,~ / ................. .............................. ': .................. ..................... .................. ~ ............................................ ~'"7'"'; .................................................................................. County Tax Map No. 1000 Section .., .../. ......... Block ........ ~ ..... Lot No ...... ~ ..... pursuant tl application doted ...~ ...... 3..~........;...., 19.~. ,~.~ and approved by the Building Inspector. Rev. 6~30/80 Form No. 6 Receipt NO, 4015~ TOWN of SOUTHOLD OFFICE OF BUILDING INSPECTOR Town Hall Southold, New York 11971 Received of ......... ~....~....~ ..... ~ ...................... .......................... ~'~'"- ,~' ................. ./.....~ ............................................. /1 O0 Dollars For ~J ~ / ~ ~ - *- ~ ................... ?..~,.~% .. ~..~~ . ~ d r~... ~ Fee for Fee for Fee for Fee for __~'~'rtificate Yard Sale r-I ~ [] H.I.C. [~ Building Permit I~ of Occupancy [] Misc. Chsh eck ~; 7¢ S ...,~.~.~ .................... Building Department unusual natural or topographic features. ~ .' 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate o£ 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 - $i00.00 '' 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 ~. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .......... House No. Street Hamlet Onwer or Owners of Property ................................................ · ........ county ~a~ ~ap ~o 1000, Sectio. .... ~.? ..~oc~. ~ ~ Sn~d~ision ............. : ...................... PiZed Map ............ ~ot.~ ~j ........ '7 ..... ~ealth Dept. Approval .......................... Underwriters Appro~val ........................ ,~ Planning Board Approval ........................ ~* Request for:.Temp°rary Certificate ........... Final Certicate.../.. ...... Examin:d ..... BOARD OF HEALTH ............ FORMNO 1 3 SETS OF PLANS ............ · SURVEY TOWN OF gOUTHOLD ...~;I~I~CK ......... DUILDING DEPARTMENT S~PTIc 'EOR;! ..... ' $OUTHOLD. N.Y. 11071 NOTIFY: TEL.: 705.1802 CALL (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewrher or in ink and submitted to the Building lhspeetor, with 3 sets of plans, accurate plot plan t~eale. Fee ac¢ordin§ 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 l~yout of property must be drawn on the diagram which is part of tiffs appl/- cation. c. The work Covere~ by thi'.,~application may not be commenced before issuance d. Upon approvalof this a~ulica~i~,,~ ,u~ ~...,~. , ~ . . of Buildino Permit. ....... ,,c ouaumg mspecror will ~ssued 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 m3y 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 3uilding Zone Ordinance of the Town of Southolfl, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein described. f'he applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to · dmit authorized inSpectors on premises and in building for necessary inspect}o~ns. // · (Mailing address of applicant~ ' '~' '' :tare wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pluruber or builder· ........ :amc of owner of premises ...dc! ,f.~/.~....~... ...... (as on t'l e'ta'x roli or late t ' ' ' ' applicant is a corporation, signature of duly authorized officer. Builder's License No .... ~.'. Plumber's License No. Electrician's License No Other Trade's License No Location of land on which proposed work will be done; I louse Num bet ........................ Street, Hmnl;t ................ County Tax Map No. 1000 Section ........ ' ' ........ Bl~ck ... ... .~.Z ......... Lot .... ; Subdivision.. . · ...... .,. .................................. Eiled Map No. (Name) .............. Lot .......... St~te existing us6 and occupancy of pr~m~bs and intended usc and occupancy of proposed construction: ..... A. Existing use and occupancy ........... : .......... , ......... .'~.,,'..'., ..... ~- .......... . · Nature'of xvork (check which appli{able): New Building .......... Addition . . . rotation ........... Rep:fir .............. Rbmoval,' .............. Demolition .............. Swimming pool .......... Tennis Court .. ~5'ff; Ac!essory Buzldzng .......... ~n~'C>,.;...Other Work ............ (to be paid on filing this application} If dwelling, number of dwelling uni!s ............... Number of dwelling units on each floor·. If garaee, number of cars ....... ' ............. If busi ess. Commercial or mixed occupancy specify nature and extent of each t e of use i ] ] Yp .... Dimensions of existing structures ii any: Front Rear ........... Hcieht ' ' ' ~ ........................... Depth Num betI of Stories ............. Depth of same structure with alteratlons or additions: ....... .. . Height Number of Stories ........ Dimensions of entire new constructlon: Front ........... Heieht Numbe%of Stones ...................... ~ . · ............. Rear ..... Depth Date of Purchase ' ' ' ' · ...... · Zone or use district in which premis'es are situated Does proposed construction violate ~y zonin la[vl ~r~;n'a'n'c;'o'r'r'e;~;a't[c n':' i: ~ ............ .. ::'i ........ Will lot be regraded , Will excess fill be removed V~; ~'~ ~o'.'. · ' .......................... from premises: /- Name of O~vner of premises . )'.... Address · ' Phone No Name of Architect ..... ' ............................................ ............. ; .............. Address ................... Phone No ................. Name of Contractor ............ I. ' ..... Address ..: ........... Phone No ........... ; .... ~If yes, Southold Town Tirustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly.all buildings, whether existing or proposed, and. indicat~ all set-back dh'nensions from ~perty lines. Give street and block number or description according to deed, and show street names and indicate whethev erior or comer lot. i ' %TE OF NEW YQ, RK....or9 u rv s.s ' ~, (~indNidual signing contract) we named. is lira ........... , ............................................................ ;. (Contractor agent corporate officer otc) ' ~ ' ;aid owner or owners, =d is duly au horized to pegform or have performed the said work and to m~e and file this Hcafion; that all statements contained in this application are true to the best of his knowledge and belief; and that th~, k will be perforated in the m~ner set,forth in the application filed therewith. )m to before me this ' ....... X 4'l" i" . aV of ........... ,. ~ . . ........... , ...... ~47078~%~ ~",~- (Signature ofapplic~t)