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Home My WebLink About12337-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20829 Date JUNE 24r 1992 THIS CERTIFIES that the building Location of Property 29325 MAIN ROAD House No. County Tax Map No. 1000 Section 102 Subdivision ADDITION Street Block 2 Filed Map No. CUTCHOGUE~ N.Y. Hamlet Lot 12.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 29r 1983 pursuant to which Building Permit No. 12337-Z dated MAY 19~ 1983 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 ADDITION TO ANEXISTING ONE FAMILY DW~.ING The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH AP~ROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DEPOT E~T~F~I~ES~ INC. N-743962 - APRIL 9~ 1986 N/A Building Inspector Rev. 1/81 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 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 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 $15.00 · .../... 0 . Date .... ~'~. i..~.~.~ New Construction .... id OrPre-exmstzn' g Building ........... ~ .. . Location of Property ..... ~.~. ...... ,~,.~$ ....... .~...~.. ~. ~ ~ ~ ~ . House No. Street Hamlet Onwer Owners of Property County Tax Map No 1000, Section .... Z~.~. .... Block .... O..'~.. ....... Lot...O.t.~ ............ Subdivisio~...~.~.f~.~ ............................. ~ Filed Map ............ Lot ...................... Permit No~.f ,. ~.o-./ ..... Date Of Permit~./~/~. ~....Applicant ..ff~. ~. ~ .... Health Dept. mpproval...~...--.~. .......... ' Underw~pro~~ .~;I~....~.. ..... Planning Board Approval ....... f ....~ .......... Request for: Temporary Certificate ........... F±nal Certicate..~..,.... Fee Submitted: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12337 Z Permission is hereby granted to: --~ .~- , ............ ..J.~.?.~...~......~.:.~~.. .......... ,:~./.~/.~.=....,~..~.~....~.~/~... , .......... ~ .~'c/~...~.~..~./.....~.=~ ............ ,o .......... .~~~.~.. ....... ~'"~.~...~.~.~.'~.....~.~.~,~_~.....~. ............... o, o, ...... County Tax Map No. 1000 Section .... Z~.i~.~. ........ Block ..... .~.....~.,. ........ Lot No. ~..~....~...'../.. ...... pursuont to opplicotion dot'~l ...~....~.~.Z..........~...-- ~ ................. , I~ .~.~.,~-- ond ~pproved by the Building Inspector. Building Ins~tor Rev. 6/30/80 TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT · ACR. S W ge()~,{ L~H-: -- TYPE OF BUILDING RES. S~S. VL FARM CO~M. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS,-.[-/a/V//~ ~ ~ , , FARM Acre V~lue Per V~lue Tilloble 3 W~dlond Sw=mpl~nd FRONTAGE ON WATER House Plot / ~-~ / ~u DEPTH J q~ ', Totol DOCK COLOR TRIM Porcl~~ Breezeway Garage Patio Foundation ~asement Walls Fire Place reation Room Driveway Bath Floors Interior Finish Heat Rooms Ist Floor Dinette LR. DR. BR. Rooms 2nd Floor FIN. B. FIELD INSPgCTIQN FOUNDATION (1st) F,OUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN Of; SOUTHOLD BUILDING DEPARTMENT "~ ~ ~ TOWN HALL $OUTHOLD, N.Y. 11971 . .~...~/./ 9~..~ TEL.: 76'1803 Ex~m~ed.. ....'.~ i.'.,'i _-- ~ ,isapproved a/c ........ ......... ................... .......... (Building Inspector) iNSTRUCTiONS a. This application must be completely filled in by typewriter or in ink and submitted,to the Bu/lding Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to SChedule. , b. Plot plan showi~_g location o_f l?t ?d of b~dh!~s o~__.~e~, r~lati0~tg_ ~'~.~~.s 9~.public streets -. ~r.~areas, and g/~/~:~"ffet~deScrtl~ti6h Of [~'O~l~ l~/~Ih-~-6h ~/~dia~mm ~IHCh-~ p/~t of flii/;app-li: cation. ~ c. The work covered by th~ app.li, cati?n may.~lot b~ comme~e~i b~fo~e issuan~ of Building Permit. d. Upon approval of th/s appi/0/~tion~li/ie Boflding Inspector will i~u~d a Building Permit to the applicant. Such permit shall be kept on the prenfi~s avlfil~ble for ll~ction throughout the work. e. No buflcllng shall be c~al~, or us~iin whole or in part for any p~ wh~{ever until a Certificate of Occupancy shall have bec? granted by the Bu]~Ing ~pector. ~ ' ' B APPLICATION IS HEREBY MADE ¢o the l~l~lding D~'tment for the issuanc~ of a B~/ld/a~ P~,~.~t to the uildinE Zone Ordillance of the Town of Southol[~/,~lff. olk-Couaty, New York,' ~nd other ~p~ ~ ~ano.? or Regulations,. for the~construction of buildings, or for r~noval or d~olttion, ~s ~ ~bed. The " . gs, sddit~ O~ alterations, appucant a~ees 't° c°mply w~th all ~l~l/'le '[al~'"~rdinanceS' build"m" c°/ ~ ,,~ ..--- admit anthorized in,spectom on premises a~d inbvjlding for necessary,/~ d~ , and to address of applicanO State whether '.al~plicant is owner, lessee, agent, arch/tedt~,- ~r'-~eneral contractor, electrician, orbuilder. .... ~i ~..~,.. ......... ~.... ............................. -' .;.-,~ ;.. (as on the tax roll or latest deed) If applicant is a corporationysi~atul/e of'duly authorized officer: (Name and title of corporate officer) Budder s L~cense No ................. Plumber s L~cense No ......................... Electrician's Licen~ No..,.~... . Other Trade's License No ...................... 1. Location of land on which proposed work will be done ...... ~. ~... ~ .~. ......... ~.~ .~O~ ...... .... .............. ....... ................ House Number Street County Tax Map No. 1000 Section ./../~..O...~-['./~ Block....~. ............. Lot .... Subdivision .......... ~. .......................... Filed Map No....k. .......... Lot....)( ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................ b. Intended use and occupancy ............. [.~ ~ ...... ~..~· ................. 3. Nature ofwt~i~ck which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Wotek ............... 4. Estimated Cost ~000 ~.~.~... (Description) ...................................... Fee . A~. ......................... (to be paid on f'fling 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..D. imensions, o£existi~g, srtmctures, if any: Front..-.~..~ ......... Rear ... ~-.~ ....... Depth.. ).~..~ ....... freight .. J.%.-...;g~.... Number of Stories ................... Dimensions of same structure with alterations or additions' Front / t~ 'l~r ~ ~'~ ............ De th ..... "~ ................................ P ...................... Height ...................... Number of Stories .... ~ ................ 8. Dimensions of entire new construction: Front 2?. ('D... ~.~-/. Rear .... ' ........... Depth ............... Height ......... Number of Stories .(/-- 9. Size of lot Front (~ o Rear ~0 t~ Depth 10. Date of Purchase .... l.~.~'/. ..................... Name of, Former Owner t-3 t~ [~-* .ki., ............... 1 1. Zone or use district in which premises are situated .... ~ .............. ~ ...................... 12. Does proposed constructiqn violate any zoning law, ordinance or regulation: ..~.~.~_~.....Cy~..p-~.%. 13. Will lot be regraded .... ~ .................. Will excess ~l be removed from premiseff. Yes 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Add~ess ................... Phone No ................ Name of Contractor ~' Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and b~ b.~ck number or dgscription according to deed, and show street names and indicate whether interior or corner lot. ~ ~. 4 STATE OF NEW YORtL cOUNTY OF..~.~.[.~. ..... S.S ..... ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate 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 statements 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~" '~l' J J' .... I .......~lay of. ~ ....... ,19 ~ ( / l~ota~Pubh~t. ~-J-~3~,~ ...... ', ...... County ~ / ~ ~ ,, -.~ ..... aW ¥Ofll ..... ~ ...................... i \ / ,/ ~ ~ . No. 0!-~0-4,37422 '~' --''~ .... /~" ': ~i~'~a~iure ofappllcant) - ~ ~, x I~esidiag ia Sv,% k County ~J U ~'~ ~.J'""'~ Cenmissien Expires Marc, 30, 19.~