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Home My WebLink About19384-zFORM HO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19553 Date DECEMBER 3~ 1990 THIS CERTIFIES that the building. ACCESSORY Location of Propert~ 440 GRANGE ROAD SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 01 Lot O1 Subdivision SOUTH HARBOR HOMES Filed Map No. 4096 Lot No. 5 conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 6, 1990 pursuant to which Building Permit No. I9384Z dated SEPT. 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 SHED The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 EDWARD D. & PATRICIA H. RICHARDS ~/ B~(ilding Inspector BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- '; 93,~4 Z Dote .... ~/. ........................................ ,-~9.~...~. Permission is hereby granted to: __ ~,~ .~.....~4~..~ ....... .~./.. ........ ...~~/.~.;.....~. ....... ~; .................................................. ~ .............................................. o,p,,m,,.,,~o,edo, ............ ~.~: ....... ~~~..........~../,.. ............................................. COUnt~/ Tax~ Map No, I000 Section ............ Bilk .................................... pursuant tO application dated .... .~.....-~.....~. ................................... , 19.~....~.~ and approved by the Building Inspector. Fee $... ,,~...~-~ Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEPT. TO~ OF Sou~O,LD 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 architect or enginear 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. ~. Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00,~A~cessory building ~2-~0~0;~ Additions to accessory building $25.00. Businesses q~50.00. -- 2. Certificate of Occupancy on Pre-existing Bnilding - $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 ................. .ocation of Property .... .~..~O ................. ~.F/JL~?/.~.. ~c~ ........... .~.6.4.~.0. l~ ....... House No. S~reet Hamlet ;nwer or Owners of Property ...... ~--~..~q'-~..~,..~. ~.°4~C-~Q% .l~:. ~ ~.K.~ ......... ,ounty Tax Map No 1000, Section. OF.~.qO.~.,..Block .... ~/.,.~.~. .... Lot.~..~/.,.~..~.. ......... . ubdivision ~ ~ ~ ..................................... Filed Map .... Lot .... ~ ............. . ~ermit No ~.~.~.~.Z/ Date Of ......................Permit . . Applicant ..................... ....... . fealth Dept. Approval .................. Underwriters Approval . 'lanning Board Approval ........................ .equest for: Temporary Certificate ........... Final Certicate .... ~ .... Submitted: $ '.~.'~.~.~ 6~ ~1 ~$.$ ' · ......... ?'IELD l ........ ~ FOUNDA'TION (lst) FOUNDATIO:; 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FI;;AL ADDITIONA'L COMMENTS: 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2NO [ ] I~ULATION [] FRAMING [v~/FINAL REMARKS: Exanlined ..... ^pprovcd ........ Disapproved a/c ......... FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 7(35-1802 BOARD OF HEALTH :.// ....... 3 SETS OF~-~PLANS b< ....... survEY ............... ........... [ ' ' SEPTIC FORM ................ CALL .................. MAIL TO: ' / (yilding Inspector) APPLICATION FOR BUILDING PERMIT Date ......... l f.e hq building for necessary inspectio~ls. t l=nature et appucant, or name, if a c?poratlon) (Mailing address of applicant) INSTRUCTIONS a. Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Ihspector, 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 parz of th.is appli- cation. c. The work covered by th~s application may not be commenced before issuance o£ 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 shal~ 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, housin~ code, and regulations, and to admit authorized inspectors on premises and State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~'-q~.' ~. -~. ~..~C~...~ ..... ~.a.JCV~ Ora.. . ,. · .................... ... . .. (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No ........ ~).t~.' r/.~. ......... Plmnber's License No ...... (~t.~T7-~./~. 7 ........ Electrician's License No .... (~9~'d. ~¢/.k% ........ Other Trade's License No .... ~.~0.¢.l.'~/37'. ....... I. Location of land on which proposed work will be done; .q.Y.o. N b ' St ...... ' Ouse um er reet:' · Hamlet County Tax MapNo. 10OOSection....~., .... ...' Block · ~ · ......... Lot. ., ..... ..' Subdivision ..................................... Eited Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: A. Existing use and occupancy .... '~ ~ .~ ......... B. Intended use and occupancy .... ~.]~ Nature of work (check which app able): New Building ..... Addition .......... Alteration ......... '. · Repair. .............. R~movai .............. Demolition .............. S~'immlng pool .............. Tennzs Court ~ ......... ~Aclcess°ry~0.r~O.C)~)~r~dFecBUilding .......... Fence ....... Other Work; .......... ... 6. If business, commercial or mixed occupancy, spec fy nature and extqnt of each type of use .................... ?. D r~ensions of existing structures, jf any: Front.., ............ Rear ............... Depth ............. ~Height .............. Number of Stories ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ............... D~pth ..................... : Height ......... . ............. Number of Stories ........ ~ ' · /~. /. ~ pth construction: Front .. ;,. ........ Rear ............ De · . Dimensions oftiP-) entire ?,new ' -.: ...................... '-,,r' '........... _ ,, ~, Heaxt .... N · ' ~..Numb~rofStories .... : pth S~ze octet: Front ... 1.0~ ...... ~-.,. ....... Rear ... ;/00 · · .. ............ De ......... Date of Purchase .l:~.~d,. I .~.~.~ ............... Name, of F, ormerrP,vner · ~* ~ ......... Zone or use district ;n wtuch pre roes are situated..ff.g~$ltff~,~o~J ~t(_~... :~ ................... Does proposed constructiog violaie any zoning law ordinance or regulation: ................... Will lot be regraded ... AJF4)... i ............... .,.. wiil excess fill be remove, d from premises~/[//~Yes .... Ne.. Name of Owner of premises .~B~c~,k~t. ~tt~dfAddress . .~/ffO .Or~:~ao~;~ ~t:~. .... Phone No.~r~-~-~/.~.2 ....... Name of Architect ~. ...... //.t Address ....~L *~ .. Phone No. ,//. .la ......... Name of Contractor ......... /~i ....... : .... ~.. Address ... 1~ ..... t, ~ ....... Pho, n~N~o,,,d V... 1~..,..~.. · ~Is this property locatied within 300 feet of a tidal wetland, x~o .... NO..I~%. x-'zmIf yes, $outhold Town iTrustees Permit may. be required. ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nhmber or description according to deed, and show stree~ names and indicate whether interior~r~corner~7~ lot. APPlIO D AS NOTED DA.: FEE. - , NOTIFY BuILb~G DERA~NT AT ~ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING ,3.INSULATI~N 4, FINAL CONSTRUCTION MUST BE 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 STATE OF NEW Y<O[}~,, b :~ S .~,~xr ~ e ,~ ~ ~.~..~ .0 ~-,0c~ c~ .,~' being duly sxvorn, deposes and says that he is thc applicant (Name of :nd~wdual s~gnmg contract) above named of said owner or owners, and is duiy authorized to pe,rform or have performed the said work and to make and file this application: that all statements contained in this application are true to the best of his knowledge and belief; and that the work xviil be performed in thc manner set forth in thc application filed therewith. Sworn to before mc this ...... ,". ? DATE ..... '~ ~ ~74 N. D. ~EF. ~: , ..c . . ~ .' . , The Sewage dlsposal and water supply ' .,':.:.. facilities for this location have been '" '""'" "- ' :,,..: ': :,'. .... : '~.' '. inspected by this depa~ment and founa Io~:a~|on frbm' ~ou~e peoI~.'me, not .vidb~e them ..... · .'~', . ~i',.~. / ,7. · '~., ~ ~.'~-~'.~,:.",.. ,~' Unauthorized a~lerafion or addition Io t~s ~u~ey I~ a wolafion of 7209 of he N6w~or~ State Ed~calion Law.' ~"~, .;. of Ihis su~ey map not beanng ~he Jond su~eyo~s inked ~antees' o~ ce~lificafion~' indJcafe~ ~e~eon' ~11 run ~n~ to fhe "I': for ~om t~e ~u~e~ 'is p~epar~d, ~nd on his behal~ to the' J company, fiov~rnme~a~ agency, an~ ~e~ding tn,fituti~n~.fi~t~d ~ J/ a~d to tho assignees' ~f Ihe'~e~d~ng ~slitulion. G~rant~s/~'l ~m not Ira~sferable lo'additiona~ Jnsfilul~on~ er-'J ~ .'REFERENCE .,~.MAP OF SOUTH HARBOR F£O£RAL SAWN(ES ~'L TITI.~ INSURANC£.COMPANY UVERNEAD