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Home My WebLink About17521-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17418 Date OCT. 14, 1988 THIS CERTIFIES that the building Location of Propert~ 1295 ELIJAHS LANE House No. County Tax Map No. 1000 Section 108 Subdivision ELIJAHS LA EST ACCESSORY MATTITUCK Street Hamlet Block 04 Lot 7.7 Filed Map No. Lot No. 5 conforms substantially to the Application for Building Permit heretofore filed in this office dated OCT. 6~ 1988 pursuant to which Building Permit No. 17521Z dated OCT. 11, 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 ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to PETER & JUDITH VICTORIA (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Rev. 1/81 Building Inspector FO~ NO. ~ TC~VN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N_O ~17521 Z Permission is hereby gronted to: . J..~, ....................... ;;.-?.%, ..~ .......... ..~.~A,....u...~..,...t...~.:~., ~ ' ............... ~ . - . . ................................................................. ';;'*;";-7~';'"'""/~;~ ............ ~' .............. T~"-')' .................... pt premise, located at/....-.~'..c~..'~.. ......... ...--~?.~..~......(~...~ ........ ...~..~ .................. ..'.~.~...~.~..~:~ ................................................................................. / County Tax Map No. 1000 Section ..... 1...~....~.. ........ Block ....... .~;~.~ ....... Lot No.....'~. -:.3 ............ pursuant to application dated .... (~.o~..~.....~. ...................., 19..~....~.., and approved by the Building Inspector. Fee $.~..., ............. Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, NeY. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A, This upplication must bo filled in typewriter OR ink, and submitted m ~mmaa~ to the Building In~pec- 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 unu~al natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-{S-9 form or equal). 3. Approval of electrlca[ installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- lions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing ail 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 premlsas, or other pertinent informa- tion required to prepare a certificate. C. Fees: . ' ' 1. Certificate of occupancy Hew Dweltxn8.$25.00, Acco,aery ,,$10.00 2. Certificate of occupancy on pre-existing dwelling ~ 50.00 3. Copy of certlficate of occupancy $ 5.'00, ove~ 5 years 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Oste .' .... ~ ............. 6, hlteration $25.00 NewCons t~uction Old or Pre-existing Building Vacant Land /~¢.s~ ~/~,~ z~ ; ~~<~ Location of Property ................................................. Hou~ No. ~~ ~ ~ ~?~$freet Hamlet Owner or Owners of Property../......,....... ... .. .................................... · co~t~ ?=~ M~ ~o, mOO S=tio....~ ...... mo~, ...~ ......... Cot,., Z. ~. ....... ~. ~ ~s ~,~d mo. No Co,~o ~.. Subdivis' P~rmk No .... , . ~ .................................. Hea{{h ~ep{. Approval ........................ Labor DepL Approva{ ........................ Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and perr~t meets p!l applicable codes and regulations. Applicant.. ? ............ ; .............................. ,,.~.,o-,o.?~ ~ 3'~- ? (iELD I,,S,_~lO, t[DATE 1t COMMENTS FOUNDATION {1st) FOUNDATION I 2nd ) ROUGH FRAME & .?LUMBING I~SULATION FERN. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: APPROYE~ AS USE'IS UNLAWFUL ............ ~Or ~OURED C~NCRE~ WITHOUT CERTIFICATE ......... OF-0CCUPANC¥ " 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. *ALL ~ON~'i~RbCTI-ON -~NALL MEET' THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTIONal ~-&' ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS BLDG. DEFT, TOWN OF $OUTH.O_.~ APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765 - 1802 Instructions A. This application must be filled in typewriter OR ink, and submitted ,m'~-----~- to the Building Inspec- tor with the fo~owing; 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 featu res. 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 $25.00, Accessory ,$10.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ IO0.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacanb Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewCons bruc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property / ................. House No. Street ~ Ham/et Owner or Owners of Property ./~./.--..~. ?...J'~.~.~.,.7~.. ~ .~.. (./z?., Z~,~,/-./;~. ....................... County Tax Map No. 1000 Section .. 1..~. )~, ....... Block ..... ,"'~/. ...... Lot ..... Z'. Z ...... Subd v sion gZl,Cntl /_/I . E')/Tkr~3 '~t"~..~.Filed Map No ........... Lot No. .-.~. Permit No ....... . Date of Permit ... ...... .Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .................................................... Rev. TOWN OF 'SO~flO FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK SEPTIC FORM ............ CALL ............. MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS · a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 lhyout of property must be drawn on the diagram which is part of tiffs 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 construction of buildings, a.d. ditions or alterations, or for ~:emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessa.~, in~s'' . o ', .~-~ . (Signature' ot 'applicant, o; nln~e', ]f'a'c'o~'l~o'rJt~on') ' ' ' · . ' , " ...... "' iM" ~iliJ~ address of appli"" ' ' ' ' ' ' ' ' ~1~;)' r"" r.-~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .qq (--.. ................................................................................. Name or owner of premises .. .*. 5 ........... (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 .... ~'.d.~.~. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ....................... ..................................... House Number Street Hamlet CountyTax Map No. 1000 Section . . .~.O..c~. ......... Block ~ Lot. Subdivision .C]i~.*-~.. /~.1[~.,. ~)T~F/'.~,,-q... ~-4-;/.'~,~.. Filed Map No ............... Lot....--).~.~. ......... (Name) 2. State existing use and occupancy of premises and intemlcd nsc an,d occupancy of proposed construction: a. Existing use and {.~..t~? ~¢ occupancy .................................................................... b. Intended Use and occupancy s~y .~.,Z'/½ 6~' 3. Nature of work (check which applicable): New Building .. ~"..vfi~.' ..... Add tiofi .......... Alteration ......... Repair .............. Removal .............. Demolition ........ 1 ...... Other Work .............. 4. Estimate'd Cost .~..~),. i (Description) (to be paid on filing this applic'ation) 5 Ifd Iii b fd Iii it N ' ' · we ng, num ere we ngun s ................ umberofdweliingiunitsoneachfloor ....... If garage, number of cars ..................... ...... If business, commercia, l or mixed occupancy, specify nature and extent of each type of use .............. Di .... 7. Pensions of existing structures, if any: Front ............... Rear .... : .......... Depth ....... igl fSt He it ............... Number o Dries ............ . ..... Dimensions of same structure with alterations or additions: Front Depth Iteight ......... ' ........ Rear .................. Number of Stories Dimensions of entire'new construction: Front · Rear ~ Depth Height Number of Stories .................... i ......................... 9. Size of lot: Front ...................... Rear .................... .. Depth .............. Purchase .......................... : .N..m. ' ' 10. Dateof · . a e of Former Owner .......... ' ..... 1 1. Zone or use district in which premises are situated.. ................. Does proposed construction violate any zoning law, ordinance or regulation: ........................ ~ ....... 13. Will lot be regraded ............................ Will excess fill be rem wed from premises: Ye No 14. Name of Owner of premises .................... Address .................. Phone No ................ Name of Architect ................ .,~ . Address ......... Phone No ................ Name of Contractor .......................... Address .................. Phone No ............ i... 15.Is this property located within 300 feet of a tidal wetland.* eYES .... NO~. mil yes, Southold Town Trustees Permit may be requir~d. ... PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from '~roperty lines. Give street and block number or description according to deed, and s low street names and indicate whether interior or corner lot. STATE OF NEW YORK.~ CO.kLbjrv OF...~.U,~?~..//~... S.S · .~.Z. .... . .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above nanled. Itc is the .................................... . (Contractor agent .......5 ............... co;p;ra't; ofri;;r ......... of said OWner or owners, and is duly authorized to perform or have performed theisaid work and to make and file this application; that all statements contained in this application are true to the best of l:is knowledge and belief; and that the work xvill be perforzned in the manner set forth in the application filed therewith. Sworn to before me this ........... ...... ........ ,._ / uueltf ed tn Suffolk County ' Commission Expires December 8. 19,'~~_ (Signature of applicant)