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Home My WebLink About17404-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20147 Date THIS CERTIFIES that the building AUGUST 15, 199~ ADDITION Location of Property 300 INDIAN NECK LANE House No. Street County Tax Map No. 1000 Section 86 Block 4 subdivision Filed Map No. PECONIC~ N.Y. Hamlet Lot 1.6 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 26, t98~ ................ ~ursuant to which Building Permit No. 17404-Z dated SEPTEMBER 9~ 1988 was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 RALPH & ELIZABETH SCl{EIDER I~OBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST DE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 017404 Z pursuant 13uildlng Inspector, Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 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 statement from plumber certifying that the solder used in system contains 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. Bo 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 of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees i. 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. Certificate of Occupancy on Pre-existing Building - $i00.00 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 .....-~.~. ~_.1.~ .........................~C~.~ . . New Construction ,w~.. _ ........ Old Or Pre existing Building .............. Location of Property · ~.~ ~>. -~ House No. Street Hamlet Onwer or Owners of Property.?..~.~+..~.~..Z~...~..~3..~...~J.~?..f~ ............................ .. .. County Tax Map No 1000, Section..~.~.~. ....... Block....~,. .......... Lot .... ~i.~. .............. Subdivision. ~.~¢f~ ..... .~.~.~ .... d~ ~?r ....... Filed Map. 2J5'.~ ..... Lot .... ~z..~. ............. Permit No ........ Date Of Permit ................ Applica ................ . Health Dept. Approval ........................ .. Underwriters Approval ........... . ............. Planning Board Approval ..................... ... Request for: Temporary Certificate .......... . Final Certicate .......... . Fee Submitted: $ ............................. ¢.a:, ¥ .... ............................... c o 0 I9 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. / FOUNDATION 2ND [ ]/~SULATION Z FRAMING [/] FINAL REMARKS: ' iNSPECTOR~./~/ i.~l ELD i.o ..... o~ FOUliDAT~O~ (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ............ NOTIFY CALL .... MAIL TO: Disapproved a/c ..................................... ............................... (j~ruild ino~jatp e ~t o r) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Buildi/~g Inspector, with 3 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 streets or areas, and giving a detailed description of lityout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this 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 permit shall be kept on the premises available for inspection throughout the work, e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the~l~lgyg,~lttil~dings, a, dditions or alterations, or for removal or demolition, as herein described. The applicant agrees"t'o hom~.ly with all ap~lfi~a~ie laws, ordinances, building code, housing code and regulations, and to admit autho~~o~'Ftelffise'~Tffd''itl building for necessary inspections. ~141 lll!~ ~ t, fyi"- ' ~'e .... ' '~' (S~gnature ot appbcant, or name, tfa corporanon) ~5 ~1~ ~ (Mailing address of applicant) State whethe~ ~ owner, -~l~,~l~t~e~t,~architect, en~neer, genera] contractor, electrician, plumber or builder. ....o.w. oe ..................................................... --'"'--°'~m .~'" ' ' ' ~ '' N ne of owne m-'s ....... e .d¢ ....................................... ~lll~J~ ~ ;~glffir~ ~!;'~?' (as on the tax roll or latest deed) If applicant ~s a~*~po~fi~r~kf, d~g aueaorizea officer· (Name and title of corporate officer) Builder's License No ..... ~ ............. , . ~ Plumber s L~cense No ......................... Electrician's License No ...................... Other Trade s L eense No ...................... 1. Location of land on which proposed work will be done ........ ' ............................ · eo.Q ................. .'?.od,.on. .e.e..k.Loe. e .............. .................. House Number Street Hamlet - CountyTax Map No. lO00Section ..... 0.~..~... Block .... ff ............ Lot .../'.~a Subdivision .~COg..~..~.O(~[/.C. .................. Filed Map No. . .-T L Sc[ Lot .../:./~. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...(~ 1Oe.. ,.~ . .~.qO¢.//½0.~. ................................ b. Intended Use and occuoancy b..~.~ ,O..~.. ,(~. ,'..~..9..0~..~' ,, 3. ~Nature of work (check wh]chlapplicable/. New Buzldmg .......... Addition ;.~. tto be prod on fihng..Uns,flpphdmt~o'r~) 5 If dwelling number of dwelling units Number · ' ............... of dwelIing units on each floor If garage number of cars ! ................................... ' ......... 6 If busi~d'~s commercial or mixed occupancy specify nature and extent of each type of use .................... 7 Dimens'onsofex~stingstructqres fany:Front Rear ................... 'Height Num[~er of Stories ............................. Depth .............. Dimensions of same structure iwith a terations ........................................................ or additions: Front ................. Rear .................. ~D.epth .. ....;.... ......... i ....lteight .......... ~ ........... Number of Stories .......... ' 8. w,mensmns, o~entlre new construction. Front ,:3 o,,' ,~ ~ ~-~/ _ ' ' ' ' ,.~ ........ 9.e,on~ ..~ ............ :/NHmber of Stories .............. '' 'i" 9. Slzeoflot: Front ].~-.)..! .. r~,, /',~-:.'~/ ........... ~'D}'/ .......... ~" ,~ .......... :. 'O'.'. i ' ' ............... .. ~ame of Former Owner ,gCednO..o.O.c[. I l, ~uztu tar use O. lStrlc[ in WlllCll premises are situated .......... ' ....... ' 12. Does proposed Construction rib ate any zonino law or-'inan ...... '" '" ' '. ..... /~ ......................... 13. Will lot be regraded AlO ,,, ' .... ~' .'r., .................. wi, excess fill be removed from premises: . Yes No 14. rqame of Owner of premises t;Cd~.~.~h~.c.~.,~hetc/eeAddress~.o?~;~gg~ .~,2e.t.~ ..... Phone No. '7.3.q. XTO.q.f .... Name of Architect : ........ Address .......... Phone No ...... Name of Contractor ... ~/rt~ .... Address r-,~ZYrg'-.a,~ .... Phone No. ~.~ i... IS.Is this property loclated within 300 feet of a tidal wetland.* ~YES .... NO .... ~If yes, Southold Toon Trustees Permit may be required. ... i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give Street and block number or description according to deed, and show street names and indicate whether interior or comer lot., OCCUPANCY OR USE IS UNLAWt-UL W THOUT CERTIF C TI'E OCCUPANCY AP DAIm FOLLOWING 4. FINAL . DESIGN OR C~~ STATE OF NEW YORK, COUNTY OF S.S · ' .................... being duly swam. deposes and says that he is the applicant 6' . (Name of individual sign,,mg 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 this app~lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the work w~/l be perlbrmed in the manner set forth in the application filed therewith. Sworn to before me this ..................... day of ............... 19 Notary Pubhc ...... ...... County HELEN K. DE E ,. N O'[A~ PUBLIC, StYe olNew ,mm . Tem~ Expires Ml~mh 30,119-'-t't-/ (Signature of applicant) ~d