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Home My WebLink About19297-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTYLENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19347 Date SEPTEMBER 1t, 1990 THIS CERTIFIES that the buildin9 Location of Property. 560 House No. County Tax Map No. 1000 Section Subdivision ADDITION VILLAGE LANE ORIENT Street Hamlet 25 Block 01 Lot If' Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 30~ 1990 pursuant to which Building Permit No. 19297Z dated AUGUST 6, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING. The certificate is issued to JOHN DORMAN (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 lvo~ NO. o TOWN 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) N9 ~ 929/ Z Coun~ To× Mop No. ,00o Section ............ ~ B,o~k .......... ./.. ........ Lot No ........ ..4X.. ............ pursuant to application dated ...... ..?/:/.,~_,7... ................................. , 19...~....~, and approved by the / Building Inspector. Fee $....~....~ Rev. 6/30/80 Form No. 6 TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 Date ...... ... :;ew Construction ........... Old Or Pre-existing Building ..... ../... ....... ' ................... o a ion of Property. House No. ' '"~ .............. :. Street Ham/et ........ Property .... - · Onwer or Owners of ..~ 1000 County Tax Map No , Section ..... ~ ........ Block ......... ....... Lot ........ i - APPLICATION FOR CERTIFICATE OF OCCUPANCY · %- This application'must be filled in by typewriter OR ink and 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 ~lectricai 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 bu/ldings and nstallatzons, 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 (p~ior to April 9, 19~J) 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 ther6for 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 ~ertificate of Occupancy - $5.00 over 5 years - $i0.00 4.Updated C~rtificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.,90, Commercial $15.00 Su sion .................................... e Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Appitcant...~..~.~. ~fealth Dept. Approval .......................... Underwrlteri~ Approval .............. Planning Board Approval ................ Request for: .Temporary Certificate ........... Final Certicate .... .../... F£ELD m ..... FOUNDATION {1st) FOUNDATI0~,! 2. (2nd) ROUGH FRAME & ·PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FI;;AL ~MENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ~r~INAL DATE ~~~ 765-1802 BUILDING DEPT. INSPECTION ' F~~OUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION FRAMING FINAL ~//p I~NSpECTOR/~ DATE Examined ...... 19.~.o. Approved ............ rmit No. Disapproved ale .... BOARD OF HEALTH ~ ......... 3 SETS O.~PLANS ....... FORM NO., SURVEY ~..., ..... TOWN OF SOUTHOLD ,..,.CU~CK .~[~. 1~.~9.~. ...... ' BUILDING DEPARTMENT SEPTIC FORI'I TOWN HALL ...... '*' ........ $OUTHOLD, N.Y. 1'1971 NOTIFY ~ TEL.: 765-1802 ..... APPLICATION FOR BUILDING PERMIT ". Date .. ' INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter orin ink and submitted to the Building Ihspec'tor, with sets of plans, accurate plot plan tO"seale. 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 giv~g a det~led description of l~yout of property must b~ drawn on ~he diagram which is pa~ of t~s appE- c. The work covered by t~i application may not be commenced before issuance of Building Peril d. Upon approval of this application, the Building Inspector will issued a Building Pe~it to the appHc~t. Such pe~it shall be kept on the premises available for Nspection throu~out the work. e. No buildNg shall be occupied or used in whole or in part for aoy purpose whatever until a Ceni~cate of Occup~cy sh'all have been granted by ~e BullriNg Inspector. ~ APPLICATION IS HEREBY MADE to the BuildNg Dep~ment for the issuance of a B~tding Pe~it punuant to the . = ', , the const~ction of buQdNgs addi ' ns nr .It .... '- . . pp 1. ~ble ~. Ordm~ces or ~ne appncant a-roes t -m-/~ ~i*~ ..._w,-' L~ ~zo .... E----aauns, ~r ~or removal or demolmon, as hereN desc~b~ = O C~ F-v ....... · a~pllCaul¢ laWS, ordinances, budding code, housing code, and regulations, and .droll authorized ~specto~ on premises and ~ buildNg for necessa~ inspections. (Mailing addresx%f applic~t) .... ;tare whether applicant is owner, lessee, agent, ~chitect, enginee contractor, ctrician, plumber or builder. (as on the tax roll or latest deed) ' ' ' ' applicant i~ a corporation~ signature of duly authorized officer. n itl f Plumber's License No ........... Electrician's License No ..................... Other Trade's License No LOcation of land on which proposed work will be done: ouse Number Street .......... ~ln' ' ........... H let '" %5" ty Ta 1000 S ' Coun x Map No. oction ................... Block ................. (j ,. , ' · ........... Eilcd Map No. (Name) .............. Lot ............... x~stmg use and occupuncy of prgmi~bs and intended use und OCCnpancy of proposed construction: B. Intended use and occupancy ............................ · Nature'ofwork (check which applicable): New Building ....... Addition~. Alteration Repair .............. Rl~movalI .............. Demolition" .............. ~ Swimrain,.'" pool ............ Tennzs Court '''2~ ..... Acdessory Building .......... Fehee.-~,%,. Other Work 't~oo l~e';.~i~ on riling this application} ltd Iii b fd Iliad nii Nt be fd Iii it h fl ' we ng. hum er o we u s ............... tm r o We ng un s on eac eot , . , . ...... , . , . If garage, number oCr,,~ . ~ ... If u' , . . T .......................... b s,ness, commercml or m,xed occupancy, specify nature and extent of each type of use ................... Dimensions of existing structu.rg~,,i~,any: Front .... J..~. ....... Rear ..... ~.~[ ...... Depth . ~.~.. : w,,c,a~o~.S~OlSa~.c~st;uctufe~.-wltll attcratlons or additions' Front ~o,. ........ to~menstons of entire new c~.tmction Front I ~ ~ - / ~ .- ' -' ' ' ': '-: ....... Size of lot: Front .............. i o r,.. e,, . ........ sxt. a ....................... l. Je O Ill ....... _ . . · ." · .. ........ , ............... Name of Former Owner ........... ~.one or use dmtnct tn which premiies are situated .................. ' ................ r ~ ,~uiiatsu~t~ull ViOlate lany zoning law, ommance or regulation: ..... .~, ................... wm excess mi oe removeu xrom premises: Yes .... No ^rcnimet ............. i ............. Address ................... Phone No ................. Name of Contractor ' i Address Phone No ' i.Is Chis property located within 300 feet of a tidal wetland? ~YES .... NO .... · If yes, Southold Town T:rustees Permit may he required. PLOT DIAGRAM Locate clearly and distinctly.all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~perty tines. Give street and block number or description according to deed, and show street names and indicate whether crier or COmer lot. ' I ' ATE OF NEW YORK, $$ ,,- UNTY OF · ...................................... being dnly sworn deposes and says that he is the applicant (Name of individual signing ontract) ......... ' >vt nam'ed. : is lite ' (Contractor. agent, corporate officer, etc.) ~md owner or owners, and is duly nulhorized to pc,rform or 'have performed the said work and to m~e and file this licntion; that all state~nents contained[ in this application are trne to the best of his knowledge and belief; and that the, k will be performed in the manner set ,fort t in the application filed therewith. ~m to before me this .......... County