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Home My WebLink About21970-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCt~umANGY No E-22923 Date MARCH 29~ 1994 THIS CERTIFIES that the buildin~ ALTerATION Location of Property 2750 PINE NECK ROAD ~OuT~LDr N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 10 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated M~RCH 23r 1994 pursuant to which Building Permit No. 21970-Z dated MAPX~ 29~ 1994 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 AL'£~ATION TO EXISTING ATTA~ C~A~A~E FOR STO~E & LI~IN~ AREA (BEDi~X~) "AS BUILT" The certificate is issued to ~.~ M~C NISH (owner) 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 FORM TOWN OF SOUTHOLD BUI~.DING DEPARTMENT TOWN ~ SOUTHOLD, N.Y. N£ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE~ON OF THE WORK AU~'HORIZED) 21970 Z Date .~.¢../'..i.;~.. .............................................. Permission Is hereby granted to: ./.~4~...~~ ............................................. ...~.,..... ~.....,.¢.:~.~ ........................................... ....... .... ..... ..-.~7::~ ................................................................................................................................... atprem~,es~o~at~d at ........ ~-.Z:~ ........ ~ ................................................. CountyTaxMapNo. 1000 Section ............ .~,E:;~ ..... Block ........... /.~. ......... Lot No. ...:..~... .................... pursuant ,o application dated ............ :~.'..~. ................................ 1.~ ..~...: ....... and approved bythe Building Inspector. ~ ~...2.:..:~.-~.~ ..... ? / /~/'~ullding Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 i% 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing'l 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-existinR Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.OO ~// Date ~ .~/~.~. .......................... .... New Construction ........... Old Or Pre-existinz Building ........ Location of Property...~.Z~.--.d2. .... ..~..~..~....~.~..~...i'"'''i'..~..-.~...~.-/.. ..... House No. Street Hamlet Onwer or Owners of Property.~..~....~...~...~ ................................ ... · . · County Tax Map No 1000, Section ..... .~..~. .... Block.. / ~ ...Lot Subdivision Filed Map Lot ............ Permit No.~/~? ~2' .... Date Of Permit~./.~/~..~ cant..~.~.'~ ....... .............. Appli ........... ~.'~ Underwriters Approval ./~.~. Health Dept Approval ............... Planning Board Approval ..................... ~ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ...... ~.~ ......... ~ ~~~,~ " FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~../~. TEL.: 765-1802 Examined .......... 19.~.~. .......... Approved ............ Disapproved a/c ..................................... (B~dir~l'nspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. t;O? I ~Y ~ CALL ................... MAIL TO: 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 inspectom on premises and in building for necessary inspections. ~ / t ' Iq (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,(as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corpora ~cer) i e Plumber s License No ..... / ................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. .................. ...... ............ House Number Street Hamlet County Tax Map No. 1000 Section .... ?..~. .......... Block ...... [.0. ......... Lot '~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use anda __°ccupancy of prop?sed construction: a. existing use and occupancy ......... Ct 7:?..v~..'w'. 7.')V ............. ~: ' :'~.' '" .... "' ' '~ "' ' ' :;~i .......... b Intended use and occupancy -~ ~ ~~.."~. ~. 3. Nature of work (check which applicable): New Building .......... Addition .......... /alteration d<~ ........ Repair .............. Removal .............. Demolition ............. Other Work ............... _ /~'~,~.:'~r~Jd/7 ,~"' (Description) , 4. Estimated Cost ................................... Fee .................... /]) ........... (to be paid on illin'g/this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ . If garage, num her 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 ............... Rear .............. Depth ............... Height ............... 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 ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. 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 .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. 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 corner lot. 15. COUNqTY .... .%: I,e.. ......... sworn, the (Name of individual signing contract) above named. He is the ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements contained M this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth ~ the application flied therewith. Sworn to before me this ........... ~ ~. ~..dayqf.. ?...~.~.., 19~: Notaw Public, . County ~ ( ~hl~ 8~ o~8~ ................. Oual~ in Surfak Cou~ ~ (Signature of applic~t) ~mmi~ion Expk~ O~em~ 8. 15-- If garage, number of If business, commercial Dimensions of existing Height ..... ~..4'.7(../. ......... Number 3. Nature of work (check which applicable):New Building .................. Addition .... .~. .... Alteration ..../.... .......... Repair .................. Demolition .................. Other Work (~cribe) ........................................ 4. Estimated ~ .........................Fee ......................... ~ ........................................................ ' (to b~/p6id on filing this application) 5. If dwelling, units .........../. .............. Number of/dwelling units on each floor ...... ..~. .................. 6. occupancy, and extent of each tyge of use ................... , ....... 7. if any: Front ..... .-~...~.., " "~ ¢/ '- ~ ~ Rear ....v..z .......................Depth .................... Stories Dimensions of same structure with 8. Dimensions of entire new construction: Height ....L~/.[. ....... Number of Stories 9. Size of lot: Front ...... /...~..' ........ 10. Date of Purchase ! 1. Zone or use district in which p~ 12. Does proposed construction 13. Name of Owner of prem or itions: Front .................................... Rear ............................ ..... Number of Stories ........ ~ ................ Rear ............................ Depth ~ ~/ ' Name of Architect ..~. ........... ~.~ ................. Address ............................................ Phone No ..................... Name of Contractor ...~'~.:.....J...- ................................. Address ............................................ Phone No.~...?....?..:...~..,~.././~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ~ndicDte a(l set-back dimensions from property lines. Give street and blnck number or description accordin.q to.deed~'ancl~b.~w street names and indicate whether interior or corner lot. . /oo . J/ , ~']'Z.4~/~' J STATE OF N~O~A [SS COUN~ OF .~ ........... (Name of individual signing application) above n~med. He is the ................................... ~ ................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke ~d file this application; that all statements contained in this application are t~e to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to before me this