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Home My WebLink About17181-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17056 Date July 5, 1988 THIS CERTIFIES that the building Location of Property 2575 SOUND AVENUE House No. County Tax Map No. 1000 Section 120 Subdivision ACCESSORY MATTITUCK, N.Y. Street Hamlet Block 2 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 25, 1988 pursuant to which Building Permit No. 17181-Z dated JUNE 30, 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 GAZEBOASAPPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FRANK Z. DOROSKI FORM NO. L TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1718, Z Date .......... ... .....J®........................ 19A� Permission is hereby granted to: ....................ef .... .... .....L.......4'f-1.............. ........... s........ . ........ .. :.............. .....:............ - .................................... to .......... :L..................... . ... .. .......�.�.... ' ... ......... ct•premises located.at .......�:...�` ......................... .. ':.......... .. ....................... ................................................................................ ................................................................................ ................................................................................................................................................................ County Tax Map No. 1000 Section .....1.�fP........... Block ........9............. Lot No. ....�................. pursuant to application dated ....... ..... .......................... 19..,fand approved by the Building Inspector. Fee $...,.4- :".... ....T�. ... ......................................... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 t~ to the Building Inspec- tot' 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 featu res. 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 instaila~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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 occupancv New Dwelling,$25.O0, Accessoryt$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date NewConstructi°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................ ' House ~ ,~ Street Ham/et Owner or Owners of Property -.~-~-,.~:~., ,~.~, /J,4~'~ .1 County Tax Map No. 1000 Section ... (~ Q. ......... B~ock .... ~ .......... Lot...~, ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [ .-L X Date of Permit Ap¢icant .............. 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 pc.r~qit mecets all applicable codes and regulations. Applicant. ,,¢. Rev. 10-10-78 CO ~ ~7o3& FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N, STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Approved ., 19 ~.. Permit No. 0./. 7/fi./.... Disapproved a/c ..................................... 'FORM NO, 1 TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT §EPTIC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 /EL.: 765-1802 CALL ................ MAIL TO: (]gui' = I spector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... FORM ............. : Date .................. , 19... 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 layout 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 construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildfl~g for necessary inspe£.t/jffns. .~ ,/) / ~ ...... ............ (Si=nature of apl~cant, or name, if a corporation) O/v . z:. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~..d~. ~. · .~'. · .ce'cl. ·~- ............................................... ~ (as on the tax roll or latest deed) If app icant i{'}-aor]~(3rafi6:h,~§ighatur, e of duly authorized officer. (~{~e an~e of c~orat~ ~officer) ALL CON~XCT~S ~f~SUFFOLK COUNTY LICENSED Builder'~'k lumoer s LicenSe t~o ......................... Electrician's License No ....................... Other Trade's License No ...................... ' 1. Location of land on which proposed work will be done .................................................. House Ntnnber Street Hamlet County Tax Map No. 1000 Section ..... /.~..O. ....... Block ...... ~ ......... Lot ~ Subdivision ......... ~ ..................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premis? and intended use and qccupancy of proposed construction: a. Existing use and occupancy .... . .~....--"f-X~.../<~.. ~ . .~.-:~~.. ................................... b Intended use and occuPancy ..... .~....~--:~...~.. ~. ~.~). ............................ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .... /~.: J. Repair ...~ ........... RemoVal ....... Demolition .............. Other Work~,~O~,~.ey~/~2 I It (Descriplibfi) 4 Estimated Cost / .~.~ ~'-- Fee i " (to be paid on filing this application) 5. If dwelling, number of dwelling fin;ts ............... Number of dwelling units on each floor .......... If garage number of cars ' 6. If business, commercial or mixedi occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existin~ s~c~j~Ks~ if any Front .... Rear . Depth D~a~n~¢~t~et[ti'~ik~[~ alterations or additions: Front ... j. i lJ ...... iii Rear ...... ii:iii ' 8. Dim~n:s~gns o~entir,¢~llWgn~i~ltCtion Front ..... /.a..-. ,Ir.. Rear /off .~.-. Der>th (.O.c_:,7o~aq) . 10. rate .o~.f~'e~%i. ;-.~:: ..... ............. Name of Former Owner ................ 1 1. Zone or use district in which premises are situated ................................. .............. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ......... , .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .,. i ................ Address ................... Phone No ................ Name of Architect .......... i ................ Address ................... Phone No ................ Name of Contractor ......... ~ ................ Address .... : .............. Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town TruJtees Permit may be required. i PLO'I' DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block ~ umber or description according to deed, and show street names and indicate whether interior or corner lot. NEW YORK, S.S ~ 0I~ SO~me;~Lm .............................. ! ................... being duly sworn, deposes and says that he is the applicant (Name of individual signigg contract) above named. He is the ....................... ~ .................................................................. 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 mannerlset forth in the application filed therewith. Sworn to before me this : ........... · ~..~. ........ day of.:.....~p~-~ ......... 19 .dv'~ ' NOTARY PUBLIC, state o! I~w Yod~ r F_./ (Signature of applicant) NO. 4707878, Su~olk ~ounty~ Te~m Expires M~mh 30,19..-.~