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Home My WebLink About19120-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19175 Date JUNE 28, 1990 THIS CERTIFIES that the buildinG ACCESSORY Location of Property 425 PRIVATE ROAD #i6 House No. Street County Tax Map No. 1000 Section ~5 Block 8 Subdivision Filed Map No. ORIENT~ N.Y. Hamlet Lot 32 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 7~ 1990 pursuant to which Building Permit No. 19120-Z1 dated JUNE 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 STORAGE SHED AS APPLIED FOR. 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 JEANNE M. BRAWNER Rev. 1/81 /Bui/lding Inspector 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) N~_ ~91~0 Z Permission is hereby granted to: ......... .~ ......... ~...~.,....~ ............ County Tox Map No. 1000 Section ........ ./.~ ..... Block ...... ..~.. ........... Lot No...,.~.. ~'~. ........... 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 A. 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 fnrm). 3. Approval of electrical installation from Board o~ 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, indus.trial building, multiple residences and similar bu~/di~gs , 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, 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 . .~,. ~..w..~...~..~.d. / New Construction .... .~..... Old Or Pre-existing Building .......... Location of Pr~perty...~.~....~..%%.~.~.~.~...~...~.~...~.......~.z&............~.~`.~v.~..~. ....... House No. Street Hamlet 0nwer or Owners of Property.. . .. ............................. County Tax Map No i000, Section .... $ ......... Block ............... Lot. · · ' - Subdivision. .' . . .~t.~.~.~. ..... Filed Map ............ Lot ............. i ........ ~ f2.~' Permit~O~ ~'~ ' D -'~'~-Z~-,~'~,~ ~. Permit No./ ........ ~,~...Date Of ....... ¢...,[~.~.Applicant ............... ~..~.~,~.~? Dept Approval Underwriters Approval ~{ealth ........................... . ........................ Planning Board Approval Request for: Temporary Certificate ........ Final Certicate. Fee Submitted: $ ............................. ..... ....... APPLICANT FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .FLUMBING INSULATION FER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM ~JO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTliOLD. N.Y. 11971 ~ .~ .~/.Z 19 ./.~..~ TEL.: 765-1802 Examined .......... ......... :t D~approved a/c .............. ~t~g inspector) APPLICATION FOR BUILDING PERM IT INSTRUCTIONS BOARD OF HEALTh! 3 SETS O~F..-PLANS ] ' SEPTIC FORH ................ NOTIFY: MAIL TO: Date ..' ......... ,If*... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Im'Pector, with sets of plans, accnrate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining prcmise~ or public streets Or 3teas, and .' ' e, olYm~ a detailed description of layout of property must be draxvn on the diagram whichi~p-ag of this appli- ~ 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 throu~_hout the work. '-e. No building shall be occupied or used in whole oran 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 pnmuant to the Building Zone Ordinance of the Town of Southotd, Suffolk County, New Yin-k, and other applicable Law~, Ordinances or Regulatio~ns, for the construction of buildings, additions or alterations, or for removal or demolition, ~ herein described. T!m .applican.t agr. c~, ,~9:c0mply,wifli all applicable laws. ordinances, building code housin- ,, ' aclmzt authorized mspectox~ on premises and in buildin- for necessary i , . ~o . ., code, and reg, atanons, and to %,,~ ",. < ..- ,, .. ... · . (Szgnature ot appizcant, or name, l£ a corpor~n')' ~,~,; ~ c ~:~ ' ".'~ (Mailing address of applicant) tote vl~ether ~hc~nt,~m ,owner, lessee,~agent, archttcct, engineer, general contractor, electrician, plumber or builder. Name of owner ofpre,rgi~es , ~%.~ ~. c,~ ~ ,~ . f,~ :lW:~ :" · · . ' (as on the tax roll or latest deed) ......... ~t appbcant i%a ,go~ora,tion; ~gnfiture o f duly authorized officer. (Nfimc and title of corporate officer) Plumber's License No ........ ' ................. Electrician's License No ....................... Other Tradc's License No OCCUPANCy OR USE IS UNLAWFUL WITHOUt CERTIFICATE OF OCCUPANCY · Location of land on which proposed work will be done: ' ' q. 26- .~. ~, .~, ~ .~ ~/(~...' ~ " ....... ~' ~ .Q.r.~ '" llouse Number StreeL .............................. " Hamlet County Tax hl3p NO. 1000 Section ............... Block . , . ~ ............. ' .... Lot .~ ~.~ ~ ~ q..', L~.~. :~l ~ ......... Subdivision. ~' · < ~ ~ilcd Map No. Lot ~ ..... ' (N~mc) ................. ].: ." ':],:: '. . .: ' ' , oc,,p,,,, .... ~.,~.~.~ .... ~...~.~ 14¢~ .' o- ]ntende~ .. ~ / '~ ~ ~,> ..... ** .... '* ................ ' .se ~.d occupancy . .~.~r.~.~... A~ ~. '~.~R~ ~ ' 3. Nature of work (c.~eck which appiicabl~): New 0uilding .......... Addition .......... ,'d£cr:tma Repair ......... R~movnl ....... Demolition .,. ....... ' ' ' pool ..... Tennis Court ....... A~cessory Bu~ldlng.. ~ence O~her Work ..... 4. Estimated Co~t ......................, ~ee . .................... . ~ (to be paid on filing thi~ a~plication) 5. If dwelling, number of dwclhng uo~ts .......... ; .... Number of dwelling units on each floor ................ If garage hum bar o f cars 6. If business, commcrcial or mixed pccupancy, specify natnre and extent of each type of usc .... 7. Dimensions of existing st~cturcs ~if any: Front Rc~r Depth Height Num b~r of ~odcs Dimensions Of Same ~tmcture wi,h alterations or additio,s: ~r;~ Rear Depth ' }Icier Number of Stones 8. Dimensiofis of entire new construction: Front , .~.~ ........ Rear .A~'. ......... Depth ..~.~... 10. ~ate o~rurch~se ~ . ~ .... 12. Does prop~gB~.~ficti~n violate any zoning law, ordnance or regulation' ~* ..... ~ .......... W~I lot be regraded . ~'~. }, ' · ' . 15.I~ thzs property loeatied w~th~n 10o feet of a ,t~daI wetiand~ ~YES .... ~O.~ · If 7es, Southoid Icon Irun~ees Permit may be required. i PLOT DIAG ~M Locate cle~Ig ~d dist~ctly ~1 bu~d~gs, whether existing or proposed, ~d. indicate ~1 set-back d~sions ~rop~y ~nes. Give street ~d block n~mber or description accord~g to deed ~d show street nines and ~;te whether inter, or or corner tot. OCCUPANCY USE IS UNLAWEUL WITHOUT CERTIFICATE OF OCCUPANCYi' APBROVED AS NOTED DATE: ~s.P, # ./~/.2~ FEE'. ~OrlFV FOLLOWING iNSPECTIONS: i, FOUNDA~ON ~0 REQUIRED FOR POURED CONCR~E 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CON~TRUC~ON MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL THE REQUIREMEN~ OF ~E STATE CON8TRU~ION & ENERGY COOES, NOT RESPON~IB~ FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NEON{ YORK, _. CO U NTY~ 0 F .~.~_~, ....... above named. . ! ,, He is the ~ . I (Contractor, agent , corporate officer, etc. ) " of said owner or owners, and is duly authorized to perform or have performed tile said work and to m~e and file this applicat on: that all statements conta 0ed in this application are true to the best of his knowledge and belief; and that the Work w~l be per/bm;cd in d~a m~ner ~ct forth in the application flied therewith. Sworn tO be[ore mc this ; · , ................ d~v of ........... , ~o,:~ r~~'~~"!', ~County ~U "- , J ., .... ; .... ;- -'- ~ In 8u~o~ ~un~, ; (Signamr~ o ~ appllc~t)