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Home My WebLink About21838-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22811 Date DECEMBER 22r 1993 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 490 MANOR HILL LANE MATTITUCK~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 108 Block 3 Lot 13.10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 2~ 1993 pursuant to which Building Permit No. 21838-Z dated DECEMBER 16~ 1993 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 SHED IN REAR YARD "AS BUILT" The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PI,UMBERS CERTIFICATION DATED BRIAN & BARBARA SHEEHAN N/A Rev. 1/81 -" //ilding Inspector F~RM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. SOUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) o,e ............. ................................ 21838 Z Permission Is hereby granted to: .......................................... ....~.~......~..~.~..~'//.....z,~...~.~ ..................... ~,~.,~2~,~ .×~,, //¢~. to ....... ~.~;:~.¢~..~......~ ......... ...,~...~-..c...~.~' ~,~/ .......... .Z~,,J ............ .K~ ....... ...TT..~.:..~. ...~ ...... ~r~<.,.',~ ....... ,,~: ........ ~,~;:.z..~ ....... ~: ....................................................... · '~-o~ i~// at premises located at ........ ,'~"_ ./~'..~... ........ ~ .................... ~.....~ ........................................................ ............................................. ~.~<..~.~ .......... .~:.....LLZ~ ................................. Coun~TaxMapNo. 1000 Sectlon...~.~ ...... Bilk O~ LotNo ~, /~ pursuant to application dat~ ...........~.~.~..'.......~ ......................... 19....~ ..... and approved by ~e Building Inspector, ~ee S.....~. ~ ...... / Building Inspector Rev. 6/30/B0 TOWN OF SOUTHOLD .:' BUILDINC DEPARTMENT TOWN HALL ~-: ' 765-1802 TOWN ',.)* S - C 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 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. 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 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-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 $I5.00, Commercial $15.00 Date ........ New Construction ........ Old Or Pre-existing Building ................. Location of Property. ~.~.~P...~/~.~.. ~.~..~ ........... .. . ~/~J~. ~..~/~ .................. House No. Street Hamlet Onwer or Owners of Property..~...~.~~....~.~..~..~.~.~. ....................... County Tax Map No 1000, Section. . .Block .............. L t ................ Subdivision..... ..................... -- -- .. Permit No ................ Date Of Permit .... Health Dept. Approval ...................... Filed Map Lot . ........... Applicant. '~,~,/~.~.. ,~..t//,~'/~"'~.~.. .... ...Underwriters Approval .... ..~. .................. Planning Board Approval ....................... Request for: Temporary Certificate .......... Final Certicate.../~....... Fee Submitted: . BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION ]FRAMING [~FINAL DATE /~//L~, ,NSPECTOR~ ~..~.~,/ ~ ,..- ,..,aa,,. · ~ ;. FORM NO. 1 "-~ ' · ." TOWN OF SOUTHOLD · 'I; BUILDING DEPARTMENT . TOWN HALL i''~ "' ~~f.'? .... :'" ' SOUTHOLD, N.Y. 11971 ~ TOWN OF SOUTH,['~ TEL.: 765-1809~ E a,n .ed .... .... , Approved /://; ....... 19 .~.. Permit No Disapproved a/c ..................................... BOARD OF HEAL/il ......... 3 SETS OF PLANS ......... SURVEY .................. CIIECK ................... SEPTIC FORH .............. C^LL .~; ~ ........ HA I L TO: 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 st?eets 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 i~sued a Building Permit to the applicant. Such permit shrill be kept on the premises avai/able 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 sl~ail have been granted by the Building Inspector. APPLICATION IS HEREBY glADE 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 inspec,.~on2., ~,..~ -- (Signature of applicant, or name, if a corporation) ..... .~.~.~,z.~¢/),~ ..~./~. ~././/:.: ..... ' .... · _ (Mailing address of applicant) -- /~/M~iT// c /< State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .q.w. ~. ~ ........................ : .................................. ... Name of owner of premises ,~,.~./- ~.d ~7" ~/)~/~,/z~d~'.., .~...~.~../~(~., -iff I~A'r~ .......................... (as on the tax roll or latest deed~;I NOTIFY BUILDING DEPARTM~:N'i' If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2. ROUGH · FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOB C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS* OF THE N.Y. STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FO~ Location of land on which proposed work will be done. ~'.~.,(2..,,'/~//~...~./.~.~.S!G..~ .~. ~?~~J.. ltouse Number Street Hamlet com~ ,~ ~ ~o. ~000 ~m~o~ ...g~ ......... ~o~ .... 5 ........ :... m...~./... Subdivision... ' Filed Map No .............. '. Lot ...... : ........ (Name) . Stat~ existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .. ffT~/~..~. .~.../,fiff~'~... :.~.b~... ,ztCfi...~...~./~ ...... i. ............. 3. Nature of work (check which applicable): New Bui~din'g....~.. .... Addition .......... Alte_~.~ion ......... Repair . . Removal .... Demo ition . ..' . . ~/"~ol[ ...... · ,~ .. · (Description) 4. Estimated Cost ....... /~'~,. Fee ..................................... (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 ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of shine structure with alterations or additions: Front ................. Rear ................. Depth .... ~ ................. Height ......... 35 ......... ... Numb,~y~of Stories .......... Z'/ ........ 8. Dimensions of entire new construction: Front .... ff. ......... Rear ... O ........... Depth ...~v ........... Hexer .... ~ ....... 7 Number of Stones../. ........ .? .......................... :, ............... Size of lot' Front f,~ Rear ~.~. ' De th Date of Purchase ....... /.~ 7v~..~.~. .............. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ,.g/~. ............................ Will lot be regraded ...... .~-.d? ..................... Will excess fill be removed from premises: ~Yu.~,? No Name of Owner of premises~/~J. ~..~.~.~,44~. .... Address ?~'&./0./~.b't{ ff./lei../--:.Ilv. Phone No. ~q~ .~..z~.. ..... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone N~ ................ 15.' Is this property within 300 feet of a t:±dat wet:land? *Yes ........ blo.~ ..... · rf yes, $outhold 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 hnes. Give street and block number or description according to deed, and show street names and indicate whet~her interior or comer lot. 10. 11. 12. '13. 14. oF {Name of individual signing contracO 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 and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the manner set forth in the application filed therewith. Swom to before__ ~:me this ,~ X~ ....... ........... ,... u . .. .. .:. ....... ~W ~bl)~ State of N~ Y~ No. ~79~5 ~ (Signature of applic~t) · Qual~ in Surfak Cou~ ~mmi~ion E~ires D~c~ber 8, 19 ~ /