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Home My WebLink About18822-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19418 Date OCTOBER 4~ 1990 THIS CERTIFIES that the building Location of Property 3025 STARS ROAD House No. County Tax Map No. 1000 Section 22 Subdivision STARS MANOR ACCESSORY Street EAST MARIONr N.Y. Block 2 Filed Map No. 3864 Hamlet Lot 20 Lot No. 22 conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY t4~ 1990 pursuant to which Building Permit No. i8822-Z dated FEBRUARY 28, 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 C~z~O 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 MARTEMMANAGEMENTr INC. Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. No_ BUILDING PERMIT (THIS PEI~AIT MUST BE KEPT ON THE PRF_/v~ISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 18822 Z Date ...~.../.~....~.. ................................... , 19.....?.z~ County Tax Map No. 1000 Section ,..'~..,.~ ......... Block, .... ~ ............. Lot No ...... ~ .......... pursuant to application dated ....... -~.../~... ...................................... , I0...~...~.,, and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLO Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted aa ~ to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and simitar buildings and instatla- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features, 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 ?OOLS $25.00ALTERATTON $25.00 1. Certificate of occupancy New Dwell£ng $25.Q0, Accessory ,$]0.00 Business $50.00 2. Ce~ificate of occupancy on pre-existing dwelling $ ]OO.OO 3. Copy of certif[cate of occupancy $ 5.00, ove~ 5 ~ea~s ~]0.00 5.Updatmd C.O. $ 50.00 Date. .~ .~.P ....... NewConstruction ...... Old or Pre-existing Bui[d~ng ............ Vacant Land .............. .......... ...... Hou~ No. Street CounwT~x Mao ~o. 1000 Section ..... ~..~ ...... Block ...~ ......... Cot...~ ......... ............ uo. ......... ........ aze ot Permit . Applicant = ........... Health Dept Approval ~ .'.~. 2 Labor Dept Approval ~ Unde~riters Approval ......... Planning Board Approval ........... Request for Tempora~ Certificate ........ ~ ........... Final Certificate . ~. ~ Fee Submitted $. ~.~ ................... Construction on above described building and permit meets all applicable codes and regulations, Applicant..~..~_..~.~ .................... Rev. lO-lO*?a · OU~D~TIO.; (1st) FOU!$DATIO~'! (2nd) ROUGH FRAME .FLUMBING INSULATIOn; FERN. STATE E);ERGY CODE Fi::AL ADDITIO~;A'L CO.U..~E~;TS: BLDG. DEPT. TOWN OF SOUTHOtD BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... TOWN OF $OUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ / Examined ~./. :~g..~. ........ , 19 .~9.. · Approved--.L~..~. ........ 19~..~. Permit No../2.~..a..~f Disapproved a/c ..................................... .... (lffu ildin~l'n sp e c t o r) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, wi, 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 str. or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this at cation. c. The work covered by th/s 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 pe~ shall be kept on the premises available for inspect!on throughout the work. e. No building shall be occupied or used in whole or,irkpar~ for any purpose whatever until a'~ertificate of Occup~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a )uildin~ Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descril The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, an, admit authorized, inspectors~, on premises and in buildi~g for necessary ~e/~tio~ . , x~ ,~ . (Signature of applicant, or name, if a corporation) - ,(Mailing address of applicant) Plumber's License No .... .-T. ................... Electrician's License No...-7. ................... Other Trade's License No..~ .................. Location of land on which proposed work will be done~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull Name of owner of premises .%. ~.. ~....~'/~..:: ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .... (Name and title of corporate officer, ,. , ;UPANCY OR Builder's License No. , ./. V¢ffHOUT CERTIFICATE (i!F OCCUPANCY Itouse Number Street Hamlet County Tax Map No. 1000 Section ... ,~.,,~ ........... Block .. ~. .............. Lot. ~ ~. Subdivision... ~.'...~..~ ........ i ..... Filed Map No. 3.~...~:.%q. ...... Lot..2~...~77 ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing t/se and occupancy .................................................................. 3. Nature of work (check which apphcable): New Bl~ild~ng ...~.. . Addmon . ,..t.~..~]..,.. A~eranon .. ~, iT .... . · t~',~ Repmr .......... Removal ....... Demohtmn . :1.,~. ~ther Work ......... ;.. .... 4. Estimated Cost../. ~. Fee .. 772'. .... '.'. '. ...... :.. ' (to be ~aid bn 'filing this application) 5. If dwelling, numberofdwellingunits ........ ~ ...... Number ofdwelling units on d~h floor .............. If garage number of c~s ~ 6. If business commercial or.mixed'occupancy, specify nature and extent of each type of use ..... ; ............. 7. D~ensions of existing st~ctures, if any: Front... .... 7: ....... Rear ..... ~ ....... Depth ............. Height ~ ' ~ ~ .'Number of Stohes ~ D~ensions of same structure with alterations or additions: Front ................. Rear ................ Dep~ ........ ~ ............. HeiSt ....... ~ ............. Number of Stories... ~ - 8. D~ensions of entire new construction: Front .... w ..... ..... Rear .... ~ ......... Depth ~ Height ...... ~ ....... Number of Stories ..... ~ ....... ' ......................................... 9. S~ze of lot. Front ..... /'~ ~k ....... - .... Rear .. J... k ............... Depth [.2 .................. 10. Date of Purchase ...... 1.~..~ ............... Nme of ~mer Owner .~ .......................... 11. Zone or use district in which premises are situated... ~~ .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .~.: ......................... 13. W~I lot be regraded ......... ~ ................ Will excess ~11 be removed from premises: Yes N 14. Nme of Owner of premises ~. ~~. Address }}~'~7 .... Phone No.~&.%Tgr2e*~= Nme of Mchitect .................... ~ ~' ........ Address A~.U .'.. ! .......... Phone No ............... Nme of Contractor . ........ Address ~~ ........ Phone No. 7.5 ~-¢. 7 ~. ~.. 15. Is this property locaced w~thin 300 ~eet of a tidal web'and? *Yes ..... No ~... · If yes, Southold To~ Trustees Permit maybe required. P~W DIAG~ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frm property lines. Give street and block number or description according to deed, and show street names and indicate whethc interior or corner lot. APPROVED .it,$ NOTED NOTIFY BULLDOG D~I~RTMENTYAY0 765-1802 9 AM TO 4 PM FOI~'THE FOLLOWING tNSPECT[ONS: 1. FOUNDATION . TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 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 YORK, S.S COUNTY OF ................ ..... ~.. ~....~.. ................... being duly sworn, deposes and says that he is the applican (Name of individual signing contract) above named. He is the .... : ......................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi application; that all statements contained in this application are true to the best of his knowledge and belief; and that th work will be perfo~rned in the manner set for~ in the application filed therewith. Sworn to before me this . - tELENIC DEVOE . . . ! ....-.. , N0. 4707878, S~ol~ _ _C~/ (Signature of applicanl