The URL can be used to link to this page

Home My WebLink About17365-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20988 Date AUGUST 28~ 1992 THIS CERTIFIES that the building. Location of Property 555 VILLAGE LANE House No. County Tax Map No. 1000 Section 25 Subdivision ADDITIONS ORIENT.~ NEW YORK Street Hamlet Block 2 Lot 5.1 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 16, 1988 pursuant to which Building Permit No. 17365-Z dated AUGUST 26~ 1988 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 PORCH & DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DOUGLAS & KARIN CONSTANT (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HFAkLTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ~0~1~ biO. I~ TOWH OF $O~THOI.D BUILDIIqG DEPART/v~ENT TOWH HALL SOUTHOLD, bi. Y. N_o (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 0173~5 Z r>o~e ........ /..A ................................ Co.nW To× Mop No. ~000 Sec,on ....... ~..~... ..... B,~k ............. .% .... Lo, No ..... .~./.. ......... pursuont to oppliccltion doted ........... ~./~.~.~.. ................................ , 10~..~.~ ond opproved by the Building Inspector. 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 amd 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 i% 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.' B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and · '.'pre-existing" land qses: i. .Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. · 2. A properly completed application and'& 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 . ,~'~,, 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. Cer.tificate 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 $15.00 Date ........ ~..Z.~/~ ~ ...................... · lew Construction .... Old Or Pre-existing Building ................. ',ocation of Property: ~.$-~ .~.~.~ ~.~ House No. Street Hamlet ,.wet Owoers of Property hnzlJm · 'ounty Tax Map No 1000, Section...~57 ....... Block ...... .~. ........ Lot ...... ~.~ ........... ubdivSsion .................................... Filed Map ............ Lot ...................... ermit No.. . ' .... Date Of Permit ...... cant ............................. ealth Dept. Approval ...... ~ ................. Underwriters Approval .... ~ .............. lanning Board Approval .... ~quese for: Temporary Certificate ........... Final Certic~te ........... ..... ............. -.-. · ............ ' Co 20q 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ DATE INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION [Z/~/FRAMING [ ] FINAL REMARKS: DATE FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 BOARD OF HEALTH ............ 3 SETS OF PLANS .~..~ ..... SUHVE ........ K.. ...... CHECK ................... SEPTIC FORM ................ TEL.: 765-1802 Approved'-'~ ......... 19~..PermitNo./.7.~...g..J~.~ Disapproved ~~ ~ ....................... - ~ ~. ~.~.~~ ...... ~ ....... //~ ~ ~ 788-I~ ~ AM ~ 4 ~ ~ ~ ' (Buildin~nspector) . 1. ~ffi , ~~PLICAIION FOR BUILDING PER~IT .0TIEY 3Z3-Z&4¢ CALL ..................... MAIL TO: 3. INSULATI~ INSTRUCTIONS 4. FINAL CONSII~LJ~"'}I(~ MUS'r · a...~ C~P~L~~gp~y filled in by Wpewfiter or in ~nk and submitted to the Building Inspector, with3 sets o~n~~l~'~ee~~~--~ ~' according to schedule. or are~0~f~~ip~ of layout of properW must be drawn on the diagram which is pa, of t~s appH- c. t ne work covoreaDy t~s appficafion may nor ce commenced be[ore issu~ce of Bufld~ rermit. d. Upon approval of this application, the Building Inspector will issued a Build~g Pemit to the app~c~t. Such pe~it sha~ be kept on the premises available for ~spection throu~out the work. e. No bulldog shall be occupied or used in whole or in part for any purpose whatever until a Cedificate of Occup~cy shall have been granted by ~e Bulldog Inspector. APPLICATION IS HEREBY MADE to the Building Dep~ment for the issuance of a B~lding Pemit pu~uant to the Building Zone Ordnance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ord~ces or Regulations, for the construction of bufld~gs, additions or alterations, or for ~emoval or demolition, as here~ desc~bed. The applicant agrees to comply with a~ applicable laws, ordinances, bufld~g code, housing code, and regulations, and to (Signature o~pp[icant, or name, if a corpora[mn) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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) Builder's License No .... ~' '~'~" t ~"~'~" '~/'' '~' '~' ' ' Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ' OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY 1. Location of land on which proposed work will be done....'~..-.~..~7. ~g6.~..~..&.~...~../...~.~2.~P/..~.. ........ ~ 'o m,~e' 'ffer ............. ~S//St~?~~' ' ' '~' ?'/~'~'~ .......... '~'~' ' '~/'/'~" '~'Hamlet ........... County Tax Map No. I000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot .. '.a ........... (Name) State existing use and occupancy of~-. --premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ...~~..~. '~" '~' · · (.~..]'P~.. ~:i~::~.,~:" '~ ... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Altera~;~n ././~,.._.,... · Repair .............. Removal .............. Demolition .............. Other ~rk · ' (Desc~ption) 4. Estimated Cost ............. Fee ......... (to be paid on filing this application) 5 Ifd elli numb fdwelli hnit Nt be fdw Iii ~tson achfl · w rig, er o ng, s ............. tm r o e ng un e oor .... ..... ....... If garage, number of cars ..... ~ ........... If b i d cffy n~t~ h typ 6. usiness, commerc al or mixe occupancy spe e and extent of eac e of use ..................... 7. Dimensions of existing structure:s, if any Front.. ~ ....... -Rear .............. Depth Height ............... Number of Stories ........................................................ D~ensions of same structure w~th alterations or additions: Front ............. ~~ ........ Depth .................... ].. HeiSt ... .... Number of Stofie~a~.. .... :~..~ 8. Dimensions of entire new construction: Front . .~ ...... Rear ....... ..... ' . Height .... ~' .. Number of Stones ..... ~ .. ........... 9. S~ze of lot: Front ........... ; ........... R~ar .................. ~ ~.&~ ~.~.~ ,,~... 10. Date of Purchase ........... ] .................. Name of Foyer Owner .... :~g~l.;~g~'n.,.,'.,a. · 11. Zone or use district in which premises are situated ..................... ~~ ..... ~,a. ~.. 12. Does proppsed construction vi~te any zoning law, ordinance or regulation: ....... ~~.8~.~.. 13. W~I lot be regraded ....... ~ .................. Will excess fill be re~~ - ~ (No~) 14. N~e of Owner of premises ...~*~[~ ~. ~ddress . ~ ~.~ ~ .~. P~one No. N~e of Architect ~ Address ~.~~ ' ' ' N~e o~ Contractor ~ . Address, ~t~t';M~I~ · , IS.Is this property located within 300 feet of a tidaO~tt~'~~'~. · If yes, Southold Towq Trustees Permit may he requi~ ~ PLOT DIAGR~ ~ { ~T~ Locate cle~ty ~d dist~ctly ~l]bu~d~gs, whether existing or proposed, ~l~b~ot~ba*k*d~ensions from prope~y Bnes. Give street ~d block ~umber or description accord~g to deed, ~d show street nines and ~dicate whether interior or comer lot. ' STATE OFNEW~ZORK *,'~ ~, -' ::, ~ t ~ .... .................................. bein u sworn, deposes and says that he is the a cant (Name of individual signing contract) above named. He is the ...................... i ................................................................. i (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 this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this ............. ....... dayof[ .... ............ '~m~u,q (Signature of applicant)