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Home My WebLink About21849-ZFORH NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~R~IFI~A~ OF OCcupaNCY No [--23295 Date OCTOBER 19~ 1994 THIS CERTIFIES that the building ADDZTZO~ Location of Property 46770 CO~T~Y RO~D %48 House No. Street County Tax Map No. 1000 Section 55 Block 5 Subdivision Filed Map No. SOfT, OLDr N~NYO~K Hamlet Lot 9.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECemBeR 7r 1993 pursuant to which Building Permit No. 21849-S dated D~C~R 20~ 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 ia H~I~DICAP RAMP ~DDXTXON TO EXISTING RETAIL BUBI~F~S BUXLDI~ AS APPLIED The certificate is issued to of the aforesaid building. PKB PItOP~RTIES (owners) SUFFOLK COUNTY DEPARTHENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FORM NO,3 TO~I*I OF SOUTHC)W BUILDIN~ E:~PART f, ENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT {THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED) NO 21849 Z D~..../~..~ ....................................... ~..~,~... Perrnls,sfl3n Is herebygran .t~d to: ~ __ . CounfyTax Mop No. 1000 Section ....... .,,..~.,-,~,.~..... Block ........... ~ ....... Lot No ...... ~..~..../... .......... pursuant to application dated ..../,..~./Z. ~/. ......................................... 19,,~.... ...... Building Inspector, and approved by the Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 BLDG. DEPT. I . TOWN OF SOUTHOLD ! . 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 emgineer 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 "¥re-existing" land uses: 1. Accurate survey of property showing ail property lines, streets, buildimg 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 buildi~ $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 ~ Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..... /?. Z ...............................~M. ........... Old Or Pre-ex/sting Building.....~.. .......... New Construction Location of Property....~.&. 2Z~. ........................ .~.,...~. ?..././f ?./. .................. House No. Street Hamlet Onwer or Owners of Property...fZ~.~;)o..~fT~d~:~..~../.~.~) .......................................... County Tex No 1000, Sectio,..5. ....... Block ...... f. ....... Lot ..... f:/ ............. Subdivision .................................... Filed Map ............ Lot ..................... . Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................. , ~ ................. ~,. ~Z3,;~ 3 .~F~.lCAN'r ?'i'-'LD --,,-~- :-,-- .0,~ IfDATE I[ FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING' INSULATION PER N. STATE ENERUY CO'DE FI;'~AL ADDITIONAL COMMENTS TOWN OF SOUTHOLD DEPARTMENT APPLICATION FOR BUILDING' PERMIT INSTRUCTIONS' , Location of land on which proposed work will be 'done. .,,...... ................................... · " ' '- ' · -:"' House Number Strcet Hamlet -.'?., z. Con'nty 'Fax Map No. lO00 Section . Block ......... :,.. Lot ......... ' Filed Map No Lot Subdivision ........ . ..................................................... /:_~:~ 3: State existing usc and occupancy or' premises and intended use and occupancy of proposed construction: . "" ' ' -' - ' ' ":V./)Cn'.~.TT ~,v~ -'-" ... ~'-~ a. E×isting use and occnpancy ,....' ...................................... ., .,:: ,., plumber or bull Builder's License No,' Plumber's License No ........... 'V '/' ' t ...... Electrician's License No. .................. · .. Other Trade's License 1~o. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ~ ' ~ a. Tiffs application must be completely filled in by typewriter or in ink and subfidtted to the Building Inspector, w|l · sets of plans, accurate plot plan to scale. Fee according to schedule, ,- b. Plot plan showing location of lot and of buildings on pren~ises, relationship to adjoining premises or public sth ~r areas, and giving a detailed description of layout of pr.operty mu~t be drawn on the diagram which is part of this. al: on. -. · The work covered by this application may not be commenced before issuance of Building Permit Upoo approval of this application, the Building Inspector will issued a Building Pc,trait to the applicant. Such per mil be kept on the premises available for b~speclion throughout the work. · No building shall be occupied or used in whole or In part for any purpose whatever until a Certificate of Occup.a have been granted by the Building Inspector. j%',. '' IS HEREBY blADE to' the Building Departmer~t for thc issuance of a BulRbng ]?crmR_pu~su.q:,t to Zone Ordinance of the Town of Southold, Suffolk Cou~tT, blew York, and other applicable Laws. Ordinance RcgIJlatJon$, for tire construction of buildings, additions'or alterations, or for removal or demolition, as berein descri! .(4~: The applicant agrees to comply with all applicablc taws ordinances, building code, housing code, andfegulation~S4~m ": dadmit authorized inspectors on premiss and in building for neccssar7 i~pections. · ' ..Z/~.,.~:,~:.:: .... '%-..~ ._2 I[ (Signature of applicant, or name, if a corporation) ..q....&.~..~..~. 5oo~z.A~ "' : ' '' of applicant) ~ ~ ,/ ' ' {blailing State whether applicm~t i* owner, lessee, agent, architect, engineer, generai. . contractor, electrician, - :' · - Name of owner of premises ... : {'as on the tax roll or latest deed) · 3. Nature of work (check which applicable): ~4ew Building ......... on .......... Alteration .... ;.. · Repair .............. Removal .......... J.... Demolition .,..; .......... Other Work/~P>~. ,- . · ' i ,2~ ~qO.; ..... (Description) 4 Estimated Cost Fee · ...... - .~,.~ (to be paid on filing this application) ' Number of dwelling units on each floor 5· If dwelling, number of dwelling units .................. . .' ........... '. If g b of cars ................... . ................................ 6. If business, commercial or mi. xed occupancy, specify nature and extent of each type of use . ~/~..sq~r,e. .... , .. Dimensions of existing structures if auy: Front Rear Depth ileight Number o£ Stories · ' ' ' ' alterations or additions: Front Rear · Dmlcnslons of same stn]cture with ' .,~ Depth .... '. .................. Height ........... ' ........ :, ~ Number of Stories .................. ~'~ g Dimensions of entire new construction: Front .../ ........... ; Rear .... ~ ......... Depth ~- ........... } 9, Size of lot: Front ......... , .....' ..... ~,. Rear ..... '. ....... ; ........ Depth ................... I 0. Date of Purchase .................... · ....... v, N. lame of Fo.mrerJ3wner .................... ~: ..... I I. Zone or use district in which premises are situated .... g~.. f~q4v-~, ~..O..o. SO, 4g,~ ...................... 12. Does proposed construction violate any zouing law, ordfnanee or regulation: .... 47/.Q ....... ~ ............. 13 Will lot be reeraded ....... './640 ............ Will excess fill be removed from premises. Yes 141 Name of Owl]er of premiscs 40~.. ~O/~4~.,. Address ,.; ................ Phone ac ........... ~'. Name of Architect .' .......................... Address ................... Phon~ No ........... t' · :':' Phone No ' Name of Contractor ·. · Address ....... 15. Is this property within 300 feet of a tidal wetlaud7 *Yes ........ No ......... ~,~.~,~.L~.~;:~ eli: yes, Southol. d *l'own Trustees Pe==it may be required· ' '~' ~ PLOT DIAG P,.AM - ~ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions' ftc properly lines. Give street and block number or description ae¢ord~g to deed, and show street names and indicate whctl' Jntcdor or corner lot. STATE OF NEW YORK. co U,'37 Y OF~ .................. I I' I I THE REQUIREMENTS OF.THE. being duly sv, gtR1~e~'iq~l~l~tn&t Ii~l~q' applic, OCCiiPA Ey OR USE iS U a/', SFIJL . ,I.FICgT: OF OCOOPfi ey .- . ' . gP O D IS NOT[B/ / . -" NOTI~ B~L~FNe DEPA~T~T 765-1802, 9 AM ~ 4 P~OR ~E FOLLOWING INSPE~ONS: 1. FOUNDATIO~ ~O REQUIRED FOR POURED CONCR~E 2. ROUGH - FRAMING ~ PLUMBING 3. INSU~ON 4. FINAL -. CON~TRU~ION MUST BE COMPLETE FOR C,O. ALL CONS~U~ION gHA~ (Name ofindivjdualsigning contract) .CODES·, NOT RESPONSIBLE FOR above named · ~ : , ,, /,~~ ' .: '..,. DESIGN OR CONSTRUCTION. . ERRORS .'~te is Ihe .... . ............ ' . (Coatractor, agent, corporate officer, etc.) of said owner or owners, and is duly attthorlzcd to'perform or have performed the said work and to make and file t application: that all statcments contained in this'application are true tO thc best of hts knowledge ant behef, and that work will bc perforated in the manner scl forth in thc application filed therewith. - . · da of ,19. ·