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Home My WebLink About21844-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22810 Date DECEMBER 22~ 1993 THIS CERTIFIES that the buildin~ Location of Property 395 ALBO DRIVE House No. County Tax Map No. 1000 Section 126 Subdivision ADDITION Street Block 2 Filed Map No. LAURELr NEW YORK Hamlet Lot 10.2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 7, 1993 pursuant to which Building Permit No. 21844-Z dated DECEMBER 17~ 1993 was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is DECK ADDITION TO EXISTING ONE FAMILY DWF3~.ING "AS BUILT" The certificate is issued to (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 ELIZABETH L. ~UALEY Inspector FORM NO,$ 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] Dote ................ /..>../.../..Z .......................... 21844 Z / Permission Is hereby granted to: ...£L.,.~.~.~.~ ....... ....c~.. ~.~..L..:.~..~ ......................... ..... ~.~ ....... ~.~ ......... b~:.~L. ......................... ..... ....... .......... ............. ~..~...x.. ........... ~ ......... .~.~ ~.(~ ........ 4 :~..~,L~ '.~,,,, ........ ~ ......... ~ ........ ~ ::~i ~.~: .................... at premises located at ........ .~...?...~-. ,. ........... ...~,...~.. ~...~' ~..........~....~....~.....................................................................~.~.....~.~.............................'.........', ...................................................... ~,~Z.......z~:...y.:'"' ........ ~.L~ .................................... Coun~ Tax Map No. 1000 S~tion ....... ~ ........../Bilk ........ O~ ..........LotNo. ,,~,~ .............. pursuant to application dated ...... ~.:......~ ............................... 19...~ ...... and approved by the Building Inspector. Fee $.. ~ .,~,r....~?.. ........ ~ Building Inspector Rev, 6/30/80 TOWN OF SOUTH~qt,. 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 conuains 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: I. 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. 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 Date ................. New Construction ........... Old Or Pre-existing Building ................. Location of Property..~..~...~.~.F-~O.~.~J.O.~. .............. .~. J~¥~l.,...~: .~'. J.l.~.~..~ ........... House No. Street Han~l e t Onwer or Owners of Property...~-!!?~. ~.~..~:.~.b/G.l~-~- .......................... ........ County Tax Map No 1000, Section...t..~.!~ ..... Block...J~%.. ......... Lot../.~..'...2~. ............ Subdivision..... .................. ------..-- · .. Filed Map ............ Lot ................... ... Permit No.~.l.%-~.~.~.-.Date Of Permit.[.~J.?l.~ ...... Applicant.~:..~.~ .............. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ....... .~ ~ ............. ........ .......... APPL I CAj.x~ 7G5-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT BOARD OF' HEALTII ..~*. ..... SETS OF P~A?,'S SURVEY CIIECK .... SEPTIC CALL : .... '~ ..,~ .......... HAIL TO: 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 no/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 CounW, 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. -- . .... x, ........... -- . (Signatare of applicant, or name, if a ek~'poration! .... (I~l~iliJ~ a~l~tre~ of applicant) / I~'¢(~ State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . l~.ll.'2~/~..~.....~.'. ~...t:4~....~..~ ................... i .......... ' ........... (as on the fax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electr c an s License No ....................... Other Trade's License No ...................... Location of land on xvhich proposed work will be done .................................................. · ....... Itouse Number Street Hamlet Cottnty Tax Map No. I000 Section .. j;:')r..~' .......... Block ~ ' Lot / O. ,,~ Subdivision ........ . ............................. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ' ' 3. Nature of work (check which applicable): New Building .......... Addition . ... Alteration ......... Repair .............. Removal .............. Demolition .... : ......... ~ >tion) 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, hum bet of cats ....................................................................... 6. If business commercial or mixed occupancy specify nature and extent of.each type of use ................... 7. Dimensions or' existing structures, if any: Front .... ~0. ! ....... Rear . .-/)..?.%. ...... Depth. ?.q./'. Height ............... Number of Stories ... I ................................................... Dimensions of shine 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 ..../.0.0/ ........... ~.. Rear ...................... Depth ...................... 10. Date of Purchase .~. O.~. !9~-/~ ................ Name of Former Owner .'-~. ~7. [,.,. l ~ ................... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . 1]0 ............................ !3. Will lot be regraded ....... ; .................... Will excess fill be removed fr~om premises: Yes No 14. Name of Owner of premises .'~>-S2~,.(~ .0'.9 J..o~ .... Addres~lg.K ~30. l).g :l.qu r. q3?. Phone No..Lq ~.-~.. ¢-. 3~.%.... 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 cornerlot. ~ 7/~c,2' 15. STATE OF NEW YORK~ S.S N . COUNTY OF % f..f.v..~..~. ..... ........................................ · ......... being duly~worn, deposes and says that lie is the applicant (Name of individual signing contract) above named. He is the .. LA, Jq .~. (. . 0. .%. ~.O .)L. C O .... . .~"-. ................................ (Contractor, agent, cor'porate 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 statcments 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 before me this c' r-/v . .day of. ..... l0 7.? ALtA~ F. TUTHILI. Notary Public, I'IOTARY PUll-lC, ~¢afe o{ New YOi'h County , =o=< ~.~,...o · ,r~ · SUFF. CO, HEAL~ OE:PT, APPROVAL H. ~. NO. OWNER: ~9 ~ '---". -.//.' .... ,.:~ .= . '"~"~ .~.r'-.-.~'"-.:./ -~, -'--. '- r3 - ~- ~ '~',ct]- -: \ \ '"~ ¥ .,'F- J,,.. F'- -':..T '"~' . _'~ , r: ' ~,o,,~ ~1 " '1 ~'~,~. ~ 4, - ;~: ...... '~' ' ! ' ~, . ~rc= , · *~ ,FF .33 .TA~' I"d,e~ ¢,~,TA: ~'3OO-, ~- 2-: '2 2 · ?.,¢-.4- '4', ,_~,',',/..-4.'¢'.,,L,~,i.. ,.,.,..- ..4:....,...._,, x . . ............. ,~_j_~9 /~ ~- .?~ '~' ; - tcbeav~l~e~Y- ~kvE,¢£O-OCT, AS,;9't6 ~.~. . ' . . .'?']'.:,.. "."~: · - '"'" ,~. V¢.--,..- '7 ...-,¢ ~ SUFF ~ DEII~"r OF HEAt.TH I~I ITATI~IINT OF FOR APPROVAL ~ ~~ ONLY