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Home My WebLink About17397-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17349 Date SEPT. 26~ 1988 THIS CERTIFIES that the building. Location of Propert~150 LAKE DRIVE House No. County Tax Map No. 1000 Section 80 Subdivision REYDON SHORES ADDITION SOUTHOLD Street Hamlet Block 04 Lot 01 Filed Map No. 631 Lot No. 10 & 11 conforms substantially to the Application for Building Permit heretofore filed in this office dated AUG. 24~ 1988 pursuant to which Building Permit No. 17397Z dated SEPT. 7~ 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 DECK & SHOWER ADDITON TO EXISTING ONE FAMILY DWELLING. The certificate is issued to JAN ASSOCtATE8 (owner, ~ of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Buildinq Inspector Rev. 1/81 FOR~ bO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017397 Z Permission is hereby granted t/o: / ~, .~ / ~,, , . / ,o .~~.....~..~.~..'.~....~Z~..'.~.:.....~..........z~,4/...~.- .~-.. - ..~.......~~ ....... ~~.. ........ ~.. ....... ~~.....~.~,...........~. at premises located at .,.../.~../. ........ ~'..~.~.._..,.~... .............................................................. coun~ Tax Mop No. ,000 Sect,on ......... ~ ....... B,ock ............... ...~... Lo, No .................. /.... pursuant to application dated ........................................................ , 19 ........ , and approved by the BuiJdlng Inspector. Fee $.. o~~ Rev. 6/30/80 Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,= ~====~ 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 similar buildings and installa- 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: 1. Accurate survey of property 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 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling~$25.QO, Accessory~$]O.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5. Updated C.O. o.oo ............. NewCons ~.ruction ~. ,~... . Old or Pre-existing Building ............ Vacant Land ...... Location of Property /. . . House No. Street Hamlet Owner or Owners of Property ........ . ............................... County Tax Map No. 1000 Section ~ C_~.. . Block ,,~,. . Lot ...... ) ..... Subdivision. ,~..'< .~. ,¥,~ .X~,,'., .~.. ,~,~/. ,~,..~: ...... Filed Map No, . ~0, .~. ~..Lot No. ,~, .~.. ,~,../Z~... Permit No. //.~.~. ~ Date of Permit . f/.~/~ .~.Applicant...~-J..~).¥.~ .3..~_~..~,i~..4~.~ Health Dept. Approval... .......... . Labor Dept Approval Underwriters Approval ........................ Planning Board Approval . Construction on above described bui{ding and permit me.ets all applicable cedes aupd~r, eg~a)tions, Applicant ~~~. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. REMARKS: FOUNDATION ZND [ ] INSULATION FRAMING [//j/FINAL DATE INSPECTOR~, g~/~ / ~'/~/ * ' . . BOARD OF HEALTH . · 3SU~YS OF ~ANS ..v. .... FORM O. C mCX TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC l~ORiVl ............. : TOWN HALL ~0~[~ SOUTHOLD, N.Y. 11971 Examined. ~ ........ , 19fM 0 .M ~ $0 Disapproved a/c ..................................... ............... WITHOUT CERTIFICATE .................. '"'" O~ OCC~P~C~b INSTRUCTIONS I t 1 f 11 d by ~pewriter or ~n ~nk and submR~ed ~o the Building Inspector, a. T~sappficat~onmus~ ecompe ey i e ~n sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plo~ pl~ show~g location of Io~ and of bufld~gs on premises, rdafionsh~p to adjo~ing premises or public or areas, and g~v~g a det~led description of layout of property must be drawn on the dhgmm which is pa~ of ~his appl~- cafion. c. The work covered by t~s application may not be commenced before ~ssuance of BulldOg PermR. d. Upon approval of th~s application, ~he Building Inspedor will issued a BulldOg Pe~R ~o the app1~canL Such pe~t shall be kept on the premises ava~able for ~specfion ~hroughout the work. e. No building shall be occupied or used ~n whole or M p~t for any purpose whatever until a Cerfi~ca~e of Occup~cy shall haw been granted by the Building Inspector. ~PLICATION IS HEREBY ~ADE to th~ Building Dep~tmen~ for the issuance of a B~ldlng Pe~t pursuant to the Building Zone Ordinance of the Town of Sou~hold, Suffo]k County, New York, ~d other appl~cabl~ LawL Ord~ces or Reguhfions, for the const~cfion of bulldogs, addRions or aRerafions, or for removal or demol~on, as here~ desc~bed. The applicant agrees to comply w~th all applicable laws, ordinances, bulldog code, hous~g code, and regulaQons, and admi~ authorized inspectors on premises and ~ build~g for n~cessa~ct~ ~gn~ur~ of applicant, or name, ~f a corporation) ......... (~ai1~ng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · 0-. ............................................................. Name of owner of premises..~1~1~.. '~ 5'~'a¢"'m"¥' '~' '5~'o'n'~l~e'~a'll}Al~~~~' ' '~' '~a :mll_~ a--- d-' --- - ..... If applicant is a corporation, signature of duly authorized officer. 7{15-1~1~ ~ $g1~'4 ~ ~ ~ Builder's License No..J..Q .Q qo.~.. ~l [[ ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ALL ~ ~ MEET mE RIN~JIRB~IN~8 OW ~HE ~rATE (X)NI'[IIglIOII & ~NER(~Y 1. Location of land on which proposed work will be done. DESIGN 01~ ~ERROR8 ..... tO.O. .................... a,k ............ 6.0. IA ........... ............. House Number Street Hamlet County Tax Map No. 1000 Section .~-~'~. ·..~. ·~. .... Block...~-7.. ...... d ..... Lot...~9:4~... / ..... Subdivision... ¢.~',lC~t~$~....~...~..~ ............... Filed Map No...(-~.'~1 ...... Lot..I.~..~..I.] ...... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of. proposed construction: a. Existing use and occupancy . . . .~i5~ . . .~...:YP..~%. .... ~-~.6~&-~9.'-,°-. ....................................... b. Intended use and occupancy ...... ~h,ViXo,., ....... ' .~O.~. d~..C!(.. J..~..Ocd~--x~ .... . ..... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alter. A~on ........ .. Repair .............. Ren oval .............. Demolition .............. Other Work 4. Estimated Cost ~['j~.(JO, ~'~ i Fee ........................... ' (to be paid on filing this application) 5. If dwelling, number of dwellin units .... ' ........... Number of dwelling units on each floor ................ If garage number of cars i "~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. if any: Front ................ Rear .............. Depth ............... H of Stories alterations or additions: Front ................. Rear .................. ·. Height ...................... Number of Stories ...................... ~cti0n: Front .......... . ..... Rear ............... Depth .............. bet of Stories .... ...................................................... · ..~ ...... Rear .... ....... ........... De ¢ ............ , .......... 10. D. ~"~' m '../. ~ ......... 'Ne e of Former Owner ': . '" 11. Zone or use district in whic emises are situated............ .,.'~ .L .... · ..... · 12, Does proposed construction violate any zoning law, ordinance or regulation: . .~: :' 4,. ;~ F?.*..~.~-,.:... .... ,...~...- .... 13. Will lot be regraded ............................ Will excess fill be removed from~premi~es~ ~ ' ' Yes- No 14. Nme of Owner of premises .. ~ .................. Address ........... ~. ¢~,..7.... 'pho~. ~o::.. Name of Architect ......... ' ..... Address ....... ~. Phone,No ....... . Nme of Contractor ........ ' .................. Address .... : .............. Phone No.~ ............... 15. Is this property located[within 300 feet of a tidal wetland? *Yes ..'... No~.. · If yes, Southold To~ Tr)stees Permit maybe required. . PLOT DIAGRAM Locate clemly and distinctly ~i bufld~gs, whether existing or proposed, and. indicate fll set-back d~ensions from property Hnes. Give street and block~ number or descnphon according to deed and show street nines and indicate whethei being duly sworn, deposes and says that he is the applicant He is the...?'.~.).~fi.~.~~.~.~..~.q'~?! .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this application; that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manne~r set forth in the application filed therewith. Swoim to before me this Notary Public, ...~.. HELEN I~ DE NOTARY PUBLIC, State . No. 470787~, .. County (Signature of applicant)