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Home My WebLink About27569-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-27884 Date: 08/23/01 THIS CERTIFIES that the building HEATING SYSTEM Location of Property: 195 VILLAGE LA ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 18 Block 5 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 17, 2001 pursuant to which Building Permit No. 27569-Z dated AUGUST 21, 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 INSTALLATION OF NEW OIL BURNER IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WENDELL B. & RAMONA E. TABOR (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. PENDING 08/13/01 PLUMBERS CERTIFICATION DATED N/A Q94 -;b je&-t�2!1 Authorized Signat re 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. 27569 Z Date AUGUST 21, 2001 Permission is hereby granted to: ESTATE OF WENDELL TABOR PO BOX 285 ORIENT,NY 11957 for INSTALLATION OF NEW OIL BURNER IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 195 VILLAGE LA ORIENT County Tax Map No. 473889 Section 018 Block 0005 Lot No. 008 pursuant to application dated AUGUST 17, 2001 and approved by the Building Inspector. Fee $ 150 . 00 Authorized S ' nature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD call Mary Ann Bollman BUILDING DEPARTMENT for access (477-0551 ) TOWN HALL 765-1802 APPLICATION FOR.CERTIFICATE OF OCCUPANCY 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 I-'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 Building - $100.00 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 7/13/01 Dace . . . . . . . . . • . . . • . . . . . • . . . . ► . • . . . . • New Construction. . . . . . . . . . . Old Or Pre-existing Buildingi—04g. . ,on�familydwelling with Location of Property Village Lane, Orient 8�•Eacl��d garage House No. Street Hamlet . Ot{c�er or Owners of Property.. Wendell B. &• •Ramona•E. Tabor. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . County Tax Map No 1000, Section. . . .18. . . . . . . . .Block. . . . . . . . . . . . . . . .Lot. .. . . . . . . . • . . . . . • . . . . . Subdivision. . . . . . . . . . . . . . . • .. . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . RTS RELIABLE Permit No. . .??569�Z. . . . . .Date Of Permit. , . . . . 2.1.. 2001.Applicant. . , 44 . . . . . . . . . . . . . . x • . • • • • • • • Health Dept. Approval. . . . . . . . . . . . . . . . . • . . . . . . . .Underwriters Approval.l�i.ID.ING. . . . . • . . . . . • • • • • • Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . .Y?�. . . . . Fee Submitted: $, . -.V00.0. . . . . . . . . . . . . . . . . . . . . C 0 7e, a 7$' APPLICANT TOWN OF SOUTHOLD BUILDING PERM APPLICATION CHECKLIS' BUILDING DEPARTMENT Do you have or need the following,before appb* TOWN HALL Board of Hoalth SOUTHOLD,NY 11971 3 sets ofBuilding Plans TEL: 7654802 PERMIT NO. t?7 S Co R Chxk Septio Foam N Y.S.D.E.C. T=stoes Examined -.20 co Approved __120 Mail to: Disapproved a/c Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date. �117 2001 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 whatso-ever until a Certificate of Occupan 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,Ordiw=w 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•inspoctions, l le Ro s 1(e/�6 _7,�c (Signature of applicant or name,if a rporation) D x14 �fi.fclf/� (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engine �gener�alcont�uactq �eect,4;--��Ior builder Name of owner of premises lWlelvlell r (as on-the tax 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. _ -3�� -Ile Electricians License No. Other Trade's License No. 1. Location of 1Vd9 which pro osed work will be done, House Number Street Hamlet County Tax Map No. 1000 Section I Block S Lot 8' Subdivision Filed Map No. Lot (Name) Mate existing use and occupancy o premises anVnt7d us and occupancy of proposed eonstt tenon: a. Existing use and occupancy b. Intended use and occupancy Nature of work(check which applicable):New Buillin Addition Alteration Repair Removal Demlition (Description) Estimated Cost Fee (to be paid on filing this application) If dwelling,number of dwelling units N ber of dwelling units on each floor If garage, number of cars If business, commercial or mixed occupancy, speci tore and extent of each type of use. Dimmer of existing structures,if. Front Rear Depth Height Num r of Stori Dimens n of same structure with Iteration or additions: Front Rear Dep Hei t Num r of ries. Dim ns o fire new constructs : Front Rear Depth Height N ber of ones �. Size of t:From Rear ePth 0. Date of base* Name Former Own 1. Zone or a district which premi are si ted .2. Does ' osed on violet any zo g law, or ' ce or regulation: .3. Will to a re-graded Will s fillbe removed premises: YES NO .4.Names f Owner of es dress Phone No. Name Architect dress Phone No Name Contractor ddress Phone No. .5. Is this erty within 100 f a ti etlan *YES NO IF YES, SOUTH TO TRU ES PERMITS MAY BE RE D .6. Provi survey,to sole,with accurate undahon plan and distances to property lines. 7. If elevation at any point on property is t 10 feet or below,must provide topographical data on survey. )TATE OF NEW YORK) SS: :OUNTY OF__� 40 ec)mG Iell' By rf 1 1�e/e-6/e being duly sworn;deposes and says that(s)he is the applicant (Name of individual signing contract)above named, S)He is the (Contractor,Agent,Corporate Officer,etc.) >f said owner or owners,and is duly authorized to perform or have performed the said work an to make and file this application; hat all statements contained in this application are true to the best of his knowledge and beli and that the work will be )erformed in the manner set forth in the application-filed therewith. )worn to before me this 447 day of 20_ rQ.rs�cJ —r Notfiry Public Signature of Applicant UNDA J.COOPER Notary S State Cevnty Term Expires December 31,