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Home My WebLink About17629-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Offmce of the Bumldlng Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17539 Date NOVEMBER 22r 1988 THIS CERTIFIES that the buildmng. ADDITION TO ACCESSORY Location of Property 580 L'HOMMEDIEU LANE SOUTHOLD~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 64 Block 02 Lot 53 Subdmvmsion Filed Map No. Lo% No. conforms substantmall¥ to the Applmcatmon for Bumldmng Permit heretofore filed mn this office dated NOVEMBER 21r 1988 pursuant to which Building Permit No. 17629-Z dated NOVEMBER 21~ 1988 was issued, and conforms to all of the requ3_rements of the applicable provmsmons of the law. The occupancy for whmch thms certmfmcate ms issued is ADDITION TO AN EXISTING ACCESSORY GARAGE AS APPLIED FOR The certmfmcate Ks mssued to of the aforesamd bulldmng. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLLrMBERS CERTIFICATION DATED NANCY S. GRISSINO (owner, N/a Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) b17629 Z Counb/ Tox Map No 1000 Section .(~(~ .kJJC. , Block .... .0...~,.. ........ Lot No...~..~ .. pursuant ,o application dated ..../~..~J~.....~'1 .... , 19~.., and approved by the Building Inspector. Building Inspector Rev 6/30/80 FORM NO. $ TOWN OF SOUTHOLD Buildmg Department Town Hall $outhold, N.¥. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This apphcatlon must be fdled tn typewriter OR mk, and submitted m m to the Building In~ec- tor w~th the followmg; for new buddmgs or new use: 1. Fmai survey of property w~th accurate location of all buildmgs, property hnes, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposal--{S-9 form or equal). $.Approval of electrical mstallat~on from Board of F~re Underwmters. 4. Commercml buddmgs, Industrml buildmgs, Multiple Remdences and similar buddings and mstalla- t[ons, a certificate of Code comphance from the Architect or Engineer responmble for the buddmg. 5.Submit Plannmg Board approval of completed rote plan requirements where apphcable. B. For existing buddings (pmor to April 1957}, Non-conformmg uses, or buildmgs and "pre-ex~sting" lartd uses: 1 Accurate survey of p=operty showmg all property hnes, streets, buddmgs and unusual natural or topographic features. 2.Sworn statement of owner or prewous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety mspectlon of buddmgs or premises, or other pertment mforma- t~on required to prepare a certificate. C. Fees: Additzons $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificateofoccupancy New Dwelling $25.00, Accessory ,$10.00 Buszness $50.00 2. Certificate of occupancy on pre-exist~n§ dwelhng $100.00 3 Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~ 5.upaated C.O. $ 50.00 Oate .... ..... New Cons t r uc t i on Old or Pre-ex~stmg Bu dding Vacant Land Location of Property ' ~ '~J~ Jou~'No. ~'~P-o¢~ ~ ~Z Street /"/am/er Owner or Owners of Property ..... ,,;~¢ c~ County Tax Map NO. 1000 Section . O...~..O~ Block 0% O..'~, Lot..O..~."~.; OO(::) Subdtvimon ............................... Fded Map No ........... Lot No .............. Perm,tNo. Date of Perm,t .Apphcant .~. ~.~.¥~. ?. ~----~'~"~ Health Dept. Approval ........................ Labor Dept. Approval Underwriters Approval ....................... Plannmg Board Approval ...................... Request for Temporary Cert~hcate .................... Final Certlffcate ....................... Fee Submitted $ ............................ Construction on above described buddmg and permit me. ets all apphcable cod.cs and regulanons. FOUNDATION (1st) FOUNDATIO~ (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDIT~AL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, NY 11971 TEL.: 765 1802 BOARD OF HEALTH ......... 3 SETS OF PLANS ......... SURVEY CHECK ................... SEPTIC FORM NOTIFY CALL ................... MAIL TO: Disapproved a/c .................. . .......... ; ............................ ..... (Budding Inspector) APPLICATION FOR BUILDING PERMIT F Date ~ o,~O4 ............ ,19 INSTRUCTIONS a. Tlus apphcat~on must be completely filled in by typewriter orln tnk and subnutted to the Building Inspector, w sets of plans, accurate plot plan to scale. Fee according to schedule b. Pict plan showing location of lot and of buddings on premises, relahonstup to adjmnmg premises or pubhc st or areas, and giving a detmled descnptmn of layout of pmperW must be drawn on the dmgmm which ~s pa~ of t~s a caUon. c. The work covered by flus application may not be commanced before issu~c~ of Building Pe~t d. Upon approval of th~s apphcanon, the Bmld~ng Inspector will msued a Braiding Pe~t to the apphc~t Such p~ sha~ be kept on the premises ava~able for mspechon throu~out the work. e. No braiding shali be occupmd or used m whole or ~n part for any purpose whatever until a Ce~ficate of Occup shall have been granted, by ~e Building Inspector APPLICATION IS HEREBY MADE to the Budding Dep~ment for the issuance of a B~Idmg Pe~t pursuant tc Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other apphcable ~ws. Ordm~c~ Regulahons, for the constmc~on of buildings, additions or alteranons, or for removal or demolmon, as hereto desert The apphcant agrees to comply w~th all apphcable laws, ordinances, budding code, housm~ code, and regulations, an admit authomed mspecto~ on premises and m building for necessa~ns~ns ~ , ~ (S~g~tufe'd/~ca~t] ~; ~me, ~f a co~poran~n)' (Mmhng address of apphc~t) State whether apphcant zs owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buff, Nme of o~ner of*premises z .... ~1~ (as on the tax roll or latest deed) If apphcant m a corporation, ~gfi~t~f duly authorized officer (Name and htle of co~ora~officer) b~ ~ ~ Bmlder's L~c~qs%N~ ~k,~ ....... ~n~h'.. ' ~. Plumber's License N9%- .'~.~(~I-.' ~ ......... X"O~ ,, n~,13 · ~W~t8~03 BTAT3 l. ko~tmjBa~%~h~pr~Xvork will be done ........................................... House Number Street Hamlet County TJ~ Map No I000 Secnon O~-o~ Block ......................... LO[ ............... Subdwm~on ........... Fried Map No ........... Lot ..... 2. State eMstmg use and occupancy of prerntses and mtended use and occupancy of proposed construcnon a Ex~stmg use and occupancy .............. .. ~ .............. b. Intended use and occupancy .................. ~ .... ,/ 3. Nature of work (check which applicable). New Budding ......... Addition ......... Alteration .... Repmr ........... Removal ............ Demolition ............ O 'hel~r)c ~- pti 4 EstlmatddCost. ~ 7.-~d ~ ...... : ......................... Fee ............................... (to be paid on filing this application} 5. If dwelling, number of dwelling units ........... .~.. Number of dwelhng unkts on each floor .......... If garage, number of cars ........ .Q.,.?$..Q.. 9.cq....-~..*y:~.,:.~..-T~....ofy...C.~3..~T.~.z?~. .................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ty~pe of use ........... 7. Dtraenmons of existing structures, if any Front..k.'%...T: ...... Rear . .~.~..77. ....... Depth ...2~.~ . He:ght ~' ~o" Number o f Stones O D~menmons of samE structure with alterations or a,dd.ztlons' Front ...Q--.~'.'zS.". ...... Rear . ."L..~..~ .~. :'.... Depth .... . .'~.o~ %.'. ........... Height .... ,.X ~'[ ........ Number of Stones ....O..~fc... ......... ' ' " . .............. Depth . 8. Dimensmns of entire new construction: Front .. 5%. .vt_ ........ Rear \~ Height ...~.V..~'. ..... Number of Stones 9. Slzeoflot'Front \<~ \'z° '~ ......... ~''~ .......... ~); ~t~' ''~. ........... ......... ' ............ l<.ear ..... ).-<~ ............. l~,ep . .............. I0. Date of Purchase ...b~.?.~...2-..q'.,.X..%.%..'~5 .......... Name of Former Owner.~.'~. .b' W..~....C.e~..~.%~?.... 1 I. Zone or use district in which premises are situated .... '~ ~'...V~-t) .~-.'?T.~.~.~- ................ 12. Does proposed constructlon v~toate any zomng law, ordlnance or regulatidd 1 3. W~II lot be regraded ........................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .~..°'r%~...~ .(..~.e.,?.,.~?. Address ~.o..¥???p.~.~,*...x?.oT.~..' Phone No.'q??'.-'.X.7-i~ .9:-... Name of Architect ......................... Address .................. Phone No ........... Name of Contractor ......................... Address .................. Phone No .......... 15.Is this property located within 300 feet of a tidal wetland*, mYgS .... NO.~ mil yes, Southold Town Trustees Permit may be r.equired. PLOT DIAG Locate clearly and distinctly all buildings, whether existmg or proposed, and. indicate all set-back drmensions ] property hnes. Give street and block number or description accordmg to deed, and show street names and indicate who interior or coruer lot If copper tubing is used for water d~str~buting system; p~ping shall be STATE OF NEW YOR[ oflypes K or L only, COUNTY F..~,,.,r~,~. S S- - · -,~. <- ~'_,* UNODtWRITERSCERTfflCATE (Name of individual s~gmng contract) above named. h~lll~'!ED_ ~_$ NI TED $. INSU~ON 4. FINAL CONSTRU~ION MUST being duly sw~~~ 8TA~ ~~ON & ENERGY ,.~ CODES. NOT RESPONSIBLE FOR He is the ................. k.).o, y~% ............ O~81~ pp.~p.c~.qa..~p.a.q~.s.,.. (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 apphcatmn, that ali statements contained m this application are true to the best of his knowledge and belief; and that work w~l be performed in the manner set forth in the application filed therewith Sworn to before me this .~..~' ......... day of... ~...~ · .. ....... 19 Notary P)~qic ............................ County ~ ~r~ ~>~ .... ) ~.~ ~: ~¢~ ..{~ (S:gnature of apphc