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Home My WebLink About19186-z TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19304 Date AUGUST 20~ 1990 THIS CERTIFIES that the building ADDITION TO ACCESSORY Location of Property 375 PRIVATE ROAD ~10 SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 87 Block 1 Lot 3.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 5, 1990 pursuant to which Building Permit No. 19186-Z dated JULY 12, 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 ADDITION TO EXISTING ACCESSORY BUILDING 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 KEVIN & KAREN BOERGESSON Building InspeCtor ~ Rev. 1/81 FO~ NO. 9 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER/V~IT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ................ ~;,.i:- ~-~;'-~/..,~?'~':~ ......... :'-~ ............. ................. ~.~.......~~,.----.~.~'.iii ............................................... County Tax Map No. 1000 Section ,..~.,.~.... ,~,,. ..... BlocE ... ,~,.~,,./, ....... Lot No. pursuant to application doted ......~ ......... ,~....~. ......... , 19..~...,~ond approved by the Building Inspector. Fee ................... Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 i - J~PPLICATION FOR CERTIFICATE OF OCCUPANCY i!~ -' .%. 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 locat~ion 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 contn~ns , less than 2/10 of 1% lead. 5. Commercial building, indus, trial building, multiple residences and similar buildings 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-exmst~ng 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 o£ Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. =. Fees 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 $i0.00 puaLeu Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ....................................... ~un ........... ol~d Or Pre-existin~ Bu~-~ ' :. ca.on of Property.. 7.V..r. . 7.:. 7::::: ....... Street Hamlet %./ . County Tax Map No 1000, Section.~.~. ...... Block.../ ........... Lot..~.'.~.~ .......... gubd l~ision ' .................................... Filed Map ............ Lot ................. ~;ealth Dept. Approval .......................... Underwriters Approval ............... g App 1 ' "~' Plannin BOard rove ....... o .... · .... ,: Request for: .~emporary Certificate ........... Final Certicate ........... Fee Submitted: $ " "-. - · . ................... ~0 ~- 1~30~ ~ A~IC..?~.. ' '. FOUNDATION (1st) FOUNDATIO~,I 2. ROUGH FRAME & .PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE FI~IAL ADDITIONA'L COMMENTS: Examined . FORM NO. 1 TOWM OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTltOLD. N.Y. 11971 TEL.: 765. t802 BOARD OF HEALTlt ............ 3 SETS OF PLANS SURyEY c,,Ec : ................. SEPTIC NOT~FY; HAIL TO: DisapproVed a/c~. ........... . .................. (Building Inspector) APPLICATION FOR BUILDING PERI~/IIT INSTRUCTIONS a. Tiffs application must be Completely filled in by typewriter or in ink and submitted to the Buildin~ ifi-qaector, 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 premi.~s or public streets or areas, and giving a dote/led description of lhyout of property must be drawn on the diagram which i~lra~ of this appli. cation. , ¢. 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 ~pplic:mt. 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 Certifiea~ 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 Imr~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yoxk, and other applicable Law,& Ordinances or Regulations, for the constmctinn of buildings, additions or alte~'ations, or for removal or demolition, a~ l~rein described. Thc applicant agrees to comply with all pphcable laws. ordinances, building code, housing code, and re',rntations, and to admit authorized inzpectom on premises and in building for necessary inspections..-, . · corpoml;~on) % (Mailing address of applicant) State whe'ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildhr. w fp se ~-~g*J ~oe~. If api~licant . (as~on th~ tax roll or latest deed) . is a corporation, signature of duly authorized officer. officer) Builder's License No ......... ~'~ Plumber's License No Electrician's License No Other Trade's License No 1. Location of land on which proposed work will be done: ilouse Number " ' ' ............................. Street " .............. .~ ....... Hamlet .~,3 ....... County Tax Map No. 1000 Section 0 ~'7 ' ~0 / / .................. Block 00~l ? Subdivision... ' ............. · ~';. .......................... , ...... Riled Map Nor '-. (Name) Lot ' State existing use and Occupancy of premises and in tended usc aud ............................. occupancy of proposed construction: - · .,s,,..u ..... ,, _ . · o sCand occupancy . Nature of work (check which appilicable): New Budding .......... Addition .......... Alteration ........... Repai.r .............. P.~mo~ai .............. Dcmolilitm .., ............ Swi,,'nn. ing pool ............ Tenn~.$ Court ......... A'ceessory Buildlng.. 4. Estimated Cost ......... ?.o.?:? ................ - ~'~ ~ '~ tO' ' ' (to be paid on filing this application) $. If dwelling, number of dwelling ubits .......... ; .... Nttmbcr of dwelling units on each floor ................ If garage, number of cars ...... i ................................................................. 6. If business, commercial or mixed 10ccupancy. spccify_0at)tre and extent of each type of nsc ................. 7. Dm~cnsmn~.f/existingstructures;ifany:Eront.,...~....' . ... II,,ar o~CJ' .. Hm_-ht ..1 ............ Number of Stones..[ .................................................... ~Dunensmns of same structure wit~t alterations or additions: Front . .~:~.l{> ........... Rear ~..O. .... · ~. pth .. .... i, ................ I-fought ...... ,,_ ............. Number oGStones . . ~ .......... u~mensm~p, Lenure new construction: Front ...~ ........... Rear ..... ~. ........ Depth J.0 .......... Heieht . ./..1~. ..... u ..... L_ ~,- o. . ~ ' 9. ~zc pt lot: Front ..... ¥ .7. ! ',-. ,,~ --t ~ , ~, ~ ' ...... I I. Zone or se d~stnct ~n ~vhtch nremiscs nr~* ~itn,*~c~ ' ~'-~/~ 12. Does proposed Constructlon violaie any zoning law. ordinance or regulation: .............................. 13. Will lot be regraded .;... } .... ! .................. Will excess fill be removed from premises: . Yes ... No. l,k, Name of owner of premises .... i ............ ' ....Address ................... Phone No ........... Name'of Architect ........... l ................ Address ................... Phone No ................ Name of Contractor .......... ] ....... i ........ Address ................... Phone No ..... ;~'; .....i .... IS.Is this property located within 100 feet of a .tidal wetland? *YES .... ~0 .... · If yes, $outhold To~nlTrustees Permit may be required. PLOT DIAG ELAM Locate clearly and distinctly all ~uildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block nuraber or description according to deed, and show street names and indicate whether interior or coruer tot. .i STATE OF NEW. yORK, ..... ']'~'~' l//'a'/''' '~'q '~'~d~'t~'~' 'O'~/' · ................. being duly sworn, deposes =d says that he ~ the applicant (Name of individual signi:}g contract) % is the ' i (Contractor agent officer gtc) ' ' ' ' . , corporate . . d ~f said owner or owners, md is u yiauthorized to pe,rform or have perfo~ed the said work and to m~e and file this :Pplication: that all statements contai{~ed in this application are true [o Iht best o~his knowledge and belief; and that the york will be perforated in the m~ner let forth in the application flied therewith. ;worn to before mc this [