HomeMy WebLinkAbout27676-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-27974 Date: 09/26/01
THIS CERTIFIES that the building ACCESSORY
Location of Property: 9905 NASSAU POINT RD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 119 Block 1 Lot 9.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 18, 2001 pursuant to which
Building Permit No. 27676-Z dated SEPTEMBER 18, 2001
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 "AS BUILT" METAL SHED AS APPLIED FOR.
The certificate is issued to WILLIAM HARD III & DEBORAH HURLEY
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ut rized Signature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 27676 Z Date SEPTEMBER 18, 2001
Permission is hereby granted to:
WILLIAM HARD III & ANO.
9905 NASSAU POINT ROAD
CUTCHOGUE,NY 11935
for
"AS BUILT" CONSTRUCTION AND RELOCATION OF AN ACCESSORY METAL SHED
AS APPLIED FOR.
at premises located at 9905 NASSAU POINT RD CUTCHOGUE
County Tax Map No. 473889 Section 119 Block 0001 Lot No. 009 . 001
pursuant to application dated SEPTEMBER 18, 2001 and approved by the
Building Inspector.
Fee $ 75 . 00
w
Auth rized gnature
ORIGINAL
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR.CERTIFICATE OF OCCUPANCY >� f
A. 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.
B. 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
1. 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 Buildinc - $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential
$15.00, Commercial $15.00
Date . . . . .� .:��.`�.: �. .�. . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . .. Gai q. . Olid Or Pre-^existing Buildg. ._ . . . . ' /
Location of Property. . . .`..1.�.?. . . . . . :::a.S a'. . . . n), . . . . . . . .. . . . . . .I lea . • . .. . . . .;l;l -T, . . . . .
House No. S reet Hamlet
Onwer or Owners of Property. . . . . . . . . . . . .11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County Tax Map No 1000, Section. . . . .! .( . . . .Block. . . . . . . . J . . . . . .Lot. . . . a : . J//. . . . . . . . . . . .
Subdivision. . . . .. ... . ..1 . . . . . . . . . . . . . . . . . . . . . . ;Iled
lMap. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . . . .�.� .�. 1`:. .Date Of Permit. . . /) 0. 1. .Applicant. . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. . . . . . . . . . . . . . . . . . .
. ✓ . . . . . 6�0.4 . . . . . . . . .
��,OCT APPLICANT
Applicant/ . i .�. -�cDate
iv
Owners Nae. Reviewed:
Architect/ Date
Engineer: Submitted:
SCTM #:
[district: 1000 Section: 7- I31ock: Lot:
Project S74,0 Subdivision
Location:
Single & separate Required
certification: (Yes/No)
!' !� icy. R01• �� '770
Zonin District: Y Lot size: Actual. I (l,ot covcrag Nropo,cd
Req. �— t �6 f Req. Req.
()-'ront Yard Proposed:�J (Side Yard Proposed: J [Rear Yard Proposed
, • �i^Los�C� /,
Project Description:
AGENCY4ERMITS Permit
RE_OUIRED FOR REVIEW N.A. NO YES Number
Suffolk County Health Dept.
New York State D. E. C.
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation???
Flood Zone: � �—
te • s�
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802 �� Survey
� ��7
PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
/q Trustees
Examined 4 • // ,20� Contact:
Approved ,20 OL Mail to:
Disapproved a/c
Phone:
-------- ,
- Building nspect
7 APPLICATION FOR BUILDING PERMIT
Date , 20
_ f 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 waterways.
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 issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupancy
is issued 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 building for necessary inspections.
(Signature of applicant or name,i corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
��9Y�Qr
Name of owner of premises
(as on the t roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed ork will be done: ` r^
House Number Street Hamlet
County Tax Map No. 1000 Section Block L Lot
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 5
b. Intended use and occupancy-S
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work s/
4. Estimated Cost Y dl- Fee (Description)
(to be paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front_____L0 Rear Depth 12,
Height 46 1 Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth_
Height Number of Stories
9. Size of lot: Front 02 I Rea13-`7—Depth
10. Date of Purchase I Rq 1 Name of Former Owner ZEa:x kn(, 1 Y)x Cw+
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: 11.0
13. Will lot be re-graded I \ 0 Will excess fill be removed from premises: YES NO
14. Names of Owner of premises UAo I Address t90T" / 1Jg"a u P4 &Phone No. V�?
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15. Is this property within 100 feet of a tidal wetland? *YES NO 7�
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
T)WAQ V'A f:�'a I t—10�.-4 - — being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contra t)above named,
(S)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 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 manner set forth in the application filed therewith.
Sworn to befgre me this
qday of 0<n
/
Notary Public Signature of Applicant
HELENE D.HORNE
!Votary Public,State of Now Yo*
No.4951364
Qualified in Suffolk Cou
Commission Expires May 22, 60
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