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HomeMy WebLinkAbout18929-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAR%~MENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z18953 Date APRIL 4, 1990 THIS CERTIFIES that the building Location of Propert~ 37130 MAIN ROAD House No. 'County Tax Map No. 1000 Section 085 Subdivision ACCESSORY CUTCHOGUE Street Block 03 Lot 03 Filed Map NO. Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 2~ 1990 .pursuant to which Building Permit No. 18929Z dated APRIL 2, 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 BUILDING (GREENHOUSE). The certificate is issued to RICHARD BRUCE LEBKUECHER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED B~in~ InspeCtor Rev. 1/81 FOIlM NO. II 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 18929 Z Date ~ ............................. , Permission is hereby granted to: .... ..... ~/..~ ....... ~f.~:-.-..;....~ ........................... ...~~~.. ....... :~.;....I.;...~..~.~ ..... at premises located at .....~...~.../...~...o..........~.. ~.....~... ............. ~~:>~.~ ................ County Tax Map No. 1000 Section ..... ..c:~..~...~'... ...... Block ...... ..~....~. ....... Lot No ....... ..~....~.. ......... pursuant to application dated ..:',~; ...... , 19..cj'..9.., and approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 AJPPLICATION FOR CERTIFICATE OF OCCUPANCY 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 engineer 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. 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 ................. New Construction ........... Old Or Pre-existing Building .............. __.. ~ Location of Property...'[.~.7.~..S.p. .... ..... ...... House No. Street Hamlet Onwer or Owners of Proper ty. ~./.~'./'.~.~..~..0 .... ~.~.~ ~.. ~./~..~. ~..~ ~. ~ ~/..-~.~..~ .......... County Tax Map No 1000, Section..'..~.....~....Block..~..~...~...~. .... Lot.~..~.~.f..~.~..~ ...... Subdivision .................................. . . Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ...................... Request for: Temporary Certificate ........... Final Certicate~. ...... Fee Submitted: $...~.ff.t. .................... ,~, , FIELD I~S'LECTiON tJDATE It COM~£NTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE (2nd) ADDITIONAL COMMENTS: FINAL d FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL .$OUTHOLD, N.Y. 11971 TEL.; 765-t802 BOARD OF HEALTH SURveY ....... .d..t~' ........... CHECK SEPTIC ...................... F 0 RH Examined '~fl ''~' .... , 19 ~.? Approved . .X,...-, 19c/..0. Permit No.l .~ .~..~.% .~. Disapproved a/c .................................... ................................ ~..~ (Building Inspector) APPLICATION FOR BUILDING PERMIT NOTIFY: CALL MAIL : INSTRUCTIONS a. Tlds application must be completely filled in by Wpewriter or in ink and submitted to the Building Ifispector, 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 parl of this appli- cation. ¢. The work covered by this application may not be commenced before issuance of Building Permit. ~1. 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. ¢. No building shall be occupied or used in whole or in 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 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for neCe~Zections - . (S,gnatur~ o~ applica~a'~ ~'~o~p~o'r~i~n')''' (Mailinga dress a i State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. n e co rate officer) Builder's License No ~ Humber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done; ouse um er Street ' ''' .............. Coun Tax Map No Section ........... Block . bdi ......... ......................... Eiled Map No. (N ) L existing use and occupancy of premises and intended use and occupancy of proposed construction: d cupan y ........................................ 3. Nature of work (check ~vhich applicable): New Building .......... Addition ......... ' Alterh/ion · .. ....... Repair .............. R~moval .............. Dem, oJition ..,. .......... ', Swim, i~gm P oo,~i~ ........... TennJ. s Cou t t'/! ....... Ac,ce,ssory Buzldzng, .,~ ...... Fence ....... o~ll[~./or .i~l~l~. .......... 4. est~matedCost :: ."-/.t.4.t,,,'~ ......: ...................... tee ............................... i (to be paid on filing this application) 5. Ifdwe mg, nmnber of dweilmg un tS ............ Numberofdwetlingunitsoneach floor ............... Ifgaraee_ .numbcrofcars . .... .. [ ................................................................ 6. If business, commercial or mixed olccupancy, specify nature and extent of each typ~ of use .................... 7 Dimensions ofex~stingstructures 'fany Front Rear Depth ....... Height Number of Stories ........ Dimensions of same structure with, alterations or additions: Front ................. Rear ........ .... .. ... .... ............. ......... ............ .............. :,:...,:::: ~t~8~ Dimensions ti're new construc:tion: Front.: ,//-~.: :,g,. ...... Rear.. ff.'/t( ......... Depth...~.O. Height ...~ .......... Number of St6ries ..... ; ................................... 9 Size of lot: Front ~ Rear .. .. Depth 10 Date of Purchase i Name of Former Owner 11. Zone or use district in which premises are situated........ ........................ . .. .... · ...... .. · · · · 12. Does proposed Constructjo, n violato any zoning law, ordinance or regulation: ......................... ~ ~ 2 2 'l'io'.'. 13. Will lot be regraded ../~1~. .... i ................. Will excess fill be removed from premises: . Yes Name of Owner of premises ' ~ Address Phone No Name'of Architect ' Address Phone No Name of Contractor ... .......... ; · . ............ Phone No ....... ~ ..... 15.Is this property located 'l~itil:i.'n {'(~0 Address ... feet of ~'ti~'l wetland? *YES...~.~'-' · If yes, Southold Town ~Trustees Permit may be required. I 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 number or description according to deed, and show street names and indicate wheth.? interior or comer lot. STATE OF NEW YORK, ~.S COUNTY OF ................. ... ~ ........................· · i ................... being duly sworn, deposes and says that he is the applicant (Name of individual signi~tg contract) above named. I'~ is the * ' ' (Contractor, agent, corporate officer, etc. ) i' of said owner or owners, and is dulyi authorized to perform or have performed the said work and to make and file this application; that all state~nents contained in this application are trne to the best of his knowledge and belief; and that the Work will be perforated in the manneriset forth in thc application filed therewith. Sworn to before me this .............. q~ ....... day of.,... , Notary Public ........ -.~ ...... County ~ ,~ ~ ~ < ~ . H~ffi~E~ ·.. ~ PUBLI~ ~ of ~Y~ ' ~ ~ (Signature of applic~O ~. 4707878, Su~tk ~ ' Term ~r~ Ma~h 30, l~'