The URL can be used to link to this page

Home My WebLink About17601-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Bulldlng Inspector Town Hail Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19141 Date JUNE 13~ 1990 THIS CERTIFIES that the building Location of Property 870 VILLAGE LANE House No. County Tax Map No. 1000 Section 114 Subdivision ACCESSORY MATTITUCK~ N.Y. Street Hamlet Block 6 Lot 16 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore flied in th~s office dated NOVEMBER 3, 1988 pursuant to which Building Permit No. I7601-Z dated NOVEMBER 14f 1988 was issued, and conforms to all of the requirements of the applmcable provisions of the law. The occupancy for which this certifIcate is issued ~s ACCESSORY SHED AS APPLIED FOR. The certificate is lssued to SONYA GEIS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERM. IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ bl?GO1 Z Permission is hereby~/anted to: .... ~ ...... ~*ef.. ...... ~ ........ ...~.: .................................. ~..~ ........................................................ ~:~ ....... .. premises located at ...... ~....~..~. ......... ~~ ..... Z~ .............................................. County Tax Map No 1000 Sechon .... /'/~..~. , pursuant to apphcahon dated ......... ././' /~,.~ Budding Inspector. Block ............ ~. .... Lot No .......... ./..~ ..., 19.~.~, and approved by the Rev 6/30/80 UL ~ 765-1802 MLDG O£PT TOWN OF APPLICATION 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 state'cut from plumber certifying that the solder used in system cont~-s 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 o~ 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, Additmons to accessory building $25.00. Busmnesses $50.00. 2. Certificate of Occupancy on Pre-ex~st~ng 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..~.~-i.~'~ .~.. ............ iiiiii~)~.fz'~.. ................ Ho~se"~:~'' '' S t:e~t~' Hamlet County Tax Mmp No i000, Section .... (J.~/ ..... Block ..... .~. .... Lot. /~ 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: $ .......................... FOUND~T!O~ -- (1st) fOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Dmapproved arc .............................. APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N Y. 11971 BOARD OF HEALTH 3 SETS oF PLANS SURVEY CHECK .................... SEPTIC FORM .............. NOTIFY CALL ...... Date /t'..~ ......... 191 INSTRUCTIONS a. Tins application must be completely filled in by Wpewnter or ~n znk and submltted to the Building Inspector, wit sets of plans, accurate plot plan to scale Fee accordmg to schedule. b Plot plan showing locatmn of lot and of buddings on premises, relatmnsinp to adjmmng premises or pubhc str~ or areas, and giving a detmled descmptmn of layout of properW must be drown on the dmgmm winch is part of tins ap caUon. c. The work covered by ttus apphcatmn may not be commenced before ~ssuance o f Buildmg Permit. d. Upon approval of tins apphcatzon, the Bmldzng Inspector wdl issued a Bmldmg Permit to the applicant Such per shall be kept on the premises available for mspectmn throu*daout the work. e. No budding shall be occupmd or used m whole or zn part for any purpose whatever until a Certificate of Occup~ shall have been granted by the Budding Inspector. APPLII~I~I~II~t~ MADE to the Budding Department for the msuance of a Building Permzt pursuant to Budding Zone Qr~ll~ance of the T~t~ ~tof Southold, Suffolk County, New York, and other apphcable Laws, Ordmance Reg~rhr~r?ITYo~ ~h~ ~n of 15ufldings, ad&irons or alteratmns, or for removal or demohtmn, as herein descn~ ~ d Thg_a~.p2tcallg2gfiffis~a:~mag~l¥ w~fl/all apphcable laws, ordinances, budding code, housing code, and regulatmns, an adffi~p[l~¢~e~¥se_~s and m budding for necessary ~nspectm. ns /. _ 4~/tOfrg~:~/~ ~,~WO_ ~ t ....... ~. . . ~ .................. (~O~"le · ~lT$~l~q;JOa t (Signature or applicant, or name, ~f a corporauon) ~ll~Jt!t*~ g (Marling address of applicant) "q ~Y State whethe,,~;~~/~essee, agent, arcintect, engineer, general contractor, elecmcmn, plumber or bmld ~--~ (as/on the tax roll or latest deed) If apphcant is a corporatmn, mgnature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... O.~q. Tc*.'~. .......... Plumber's hcense No .................... Electmc~an's hcense No .................. Other Trade's License No .................. I. Location of land on which proposed work wall be done OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY House Number ?.%,:: ........... ............. Street-- Hamlet County Tax Map No 1000 Section ....//..ZJ. ........ Block ..... ~? ......... Lot .... /.~7 .......... Subd~v]smn ...................... Fded Map No .......... Lot ............ (Name) State existing nse and occupancy of premises and intended use and occupancy of proposed construction a. Exzstmg use and,',--- ?24c~.t:,L %ccupan?y . } .../... · ~.~,-~-- - . .................... b. Intended u,e and~pancy .... ~l ~--'~ '/'' '~ ............................... / 3. Nature of work (check which apphcabie). New Building ........ Addition ......... A1te ation ., .~... Repaxr ........... Removal .............. Demolition .......... Other Work ........... 4 E~txmnt/d Co~t ............. Fe~ ............................ (to be prod on filing t~s apphcatmn) 5. If dwelhng, number o[ dwelhng umts .......... Number o [ dwelhng umts on each floor ........... If garage, number of cars .............................................................. 6. If business, commercml or m~xed occupancy, specify nature and extent of each typ~ of use ................. 7. D~ensmns of ex~stmg structures, ~f any Front .............. Rear ............ Depth ........... Height .............. Number of Stones D~ensmns of same structure w~th alteratmns or addtaons' Front ................ Rear Depth ..................... tte~t ................. Number of Stones ................ 8. D~mensmns of entire new constmctmn. Front ...... ~. ~ ~.. Rear ............... Depth ............ Hmght .... ~ ........ Number of Stones ...... l ....................................... 9. S~zeoflot Front ....... ~ ............ Rear ................. Depth ................... I0. Date of Purchase .. ~v.~qf~... ~ .................. Name of Foyer Owner ........................ 1 1. Zone or use d~strict m which premises are s~tuated ............................................ 12. Does proposed construction wolate any zoning law, ordinance or regulatmn .4'. ....................... 13. Will lot be regraded ~' ~ ............... ~ .......... ~V~ll excess fill be removed from premises. Yes 14. N~e of Owner of premises , ~i~ . ~ ~ ! ~... Addre~ ~{ .e,A~ ~. ~- ~ ~'~ Phone No. ~;~.~. -~-~ ~ Nme of Architect ........................ Address ................ Phone No ............. N~e of Contractor ......................... Address ................... Phone No ........... ~.. 15.Is ~his proper~y located ~ithin 300 feet of a tidal vecland? *~ yes, SouEhold To~n Trustees Permit may be requi~ed. PLOT DIAG~ Locate cle~ly ~d d~s~ctly ~1 buddings, whether ex~stmg or proposed, ~d, indicate ~1 set-back d~ensmns fr~ prope~y hnes. Gwe street ~d block number or descnptmn accord~g to deed, ~d show street n~es and md~cate whetl interior or co, er lot. FEE: ~~/':. ~ 765-1802 g AM 11~ 4, N F0~ THE STATE OF NEW YORK, S S COUNTY OF ................ ................... being duly sworn, deposes and says that he is the apphcz (Name of mdivldual signing contract) above named, He is the ............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, :md is duly authorized to perform or have performed the said work and to make and file application, that all statements contained m this apphcation are true to the best of his knowledge and belief, and that work wdl be performed m the manner set forth in the application filed therewith, Sworn to before me thzs .......... ......... day of ............. Notary Public, flg..EN IL DE VOE Yolk. NOTARY No. 4707878, Suffolk County~ Term Expires .... County (Signature of applic~z