HomeMy WebLinkAbout14077-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-33965
Date: 09/21/09
THIS C~TIFIES that the building PATIO ADDITION
Location of Property: 475 ALOIS LANE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 123 Block 6 Lot 4.9
Subdivision
Filed Map No. Lot No.
MATTITUCK
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 21, 1985 pursuant to which
Building Permit No. 14077-Z dated JUNE 21, 1985
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 CONCRETE PATIO ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to HARRY M & ARLENE M JAQUILLARD
( OWNER )
of the aforesaid building.
SuFfOLK COUNTY DEPARTMENT OF HE~J~TH APPROVAL
EL~-£RICAL c~KTIFICATE NO.
~LU~E~S C~KTIFICATION DA'£~D
N/A
N/A
N/A
Rev. 1/81
l"ORZ[ NO. B
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)
N~ 14077 Z
Date .................................................. 19 ....
Permission is hereby granted to:
· ..~.~;~-os..47.. ~, ~..l.~rx.
,~ ......... ~ ............................ ~ ..................... ~ .......................................................... r. .........................
et premises located ..............................................................................................................................
nty Tax n~ap mo. 1000 Section ........................ mock ...................... Lot No ....... ~.. .... ~
pursuant to application dated .................. .~...../...~.~ .......................... , 19...?..'..,5~and approved by the
Building Inspector,
Fee $....,.~,..~,.~. .....
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTHENT
TOWN HALL
SOUTHOLD, NEW YORK
765 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDINGo~...VACANT LAND
Location of Property. ''
HOUSE NO. STREET BAHLET
p ~ -/-~ ~...~. s ~ =.. .~~ .........
cou==~ ,~ ~op ,o. ,000 ~==~o./.~.s. ~o=~ ..4... ~o~ .~~
Filed
No ........... ua.. of .-{---.~;-.app ..
Health Dept. Approval .................. Underwriters Approval ..............
Planning Board Approval ................
Request for Temporary Certificate ....... Final Certificate ...............
Fee Submitted: $ .........
rev. 10/14/88
FORH NO.
TO~ OF SOUTHOLD
BUILDING DEPART~gNT
TO~N ItALL
765- 1802
APPLICATION FOR CERTIFICAT~ OF OCCUPANCY INSTRUCTIONS
A. 'T~is application must be filed in type~rriter OR ink and submitted to the Building
Inspector with the following; for new buildings or new use:
I. Final survey of property with accurate locatlon of all buildings, property llnes,
streets, and unusual natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Under,wirers.
4. Sworn statement from plumber certifying that solder used in system contains less
than 2/I0 of Il lead.
5. Commerclal buildings, industrlal buildlngs, multiple residences and slmilar
buildlngs and installatlons, a certificate of code compliance from the Architect
or Engineer responsible for the buildlng.
6. Submit Plannlng Board Approval of completed site plan requirements.
B. For existing buildings (Prior to April 9, I957] non-conforming uses, or buildings
and "pre-existing" land uses:
I. Accurate survey of property showing all property llnes, streets, buildlngs and
unusual natural or topographic features.
2. A properly completed appllcatlon, a consent to inspect signed by the appllcant
and a certified abstract of tltle issued by a tltle company which shall
show single and separate ownership of the entire lot prior to April 9, 1957.
If a Certificate of Occupancy is denied,'the Building Inspector shall state the
reasons therefor in ~rriting to the appllcaut.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
]. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of the entire 10t prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Building Inspector
shall state the reasons therefor in writing to the applicant.
O. FEES:
1. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling~
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory buildin~g-~.O0
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Certificate of Occupancy - $20.00
5. Dpdated Certificate of Occupancy - $50.00
6. Temporary Certificate of Occupancy - $25.00 Residential
$50.00 Com~ercial
rev. 10/14/88
FIELD INSFECTION COMMENTS
FOUNDATION__~(15t)_
FOUNDATION
2.
(2nd)
ROUGH FRAME &
?LUMBING
£NSULATION FER N. Y.
STATE ENERGY
CODE
Z
ADDITIONAL COMMENTS:
Examined ~./.~. ·
^pproved .....
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
19 7 .~PPermit No
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date.. 6 I~.
INSTRUCTIONS
a. Tins 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 tins 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 inspectors on premises and in building for necessa~S.%r¥~ ~
(Signature~of applic~or nlgfie, ifa corporation)
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 corporate office.r)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ................. . ~.
1. Location of land on which Proposed work will be crone. · ~-~Ol5 ~-/~/
...... 7,5. .................. .... ..... .........
House Number Street Hamlet
County TaxMap No. 1000 Section .... [ ~.~. ........ Block ...(:2~ ............. Lot ........
Subdivision .]6 ~5 C~'~' ' '~' · '~' '/~e~ ' ' · Filed Map No ............... Lot.. ·
(Name)
2. State existing use and occupancy of premises and intended use a~d occupancy of prop°sed c°n~structi°n:
a' Existinguse and °ccupancy · '~' [~' '~' '. '"' '.~...~..~x .{...~..~..71 ?-~ h'2~ ./Y..?. · .~.~_~ ~_~ (~ '~'~
-- "'
b. Intended use and occupancy ..................... ~ .~ · ,~-~.~
3. Nature of work (check which applicable): New Building . ' .... Addition .~........ Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
10.
11.
12.
13.
14.
4. Estimated
Cos ). O. 00 .......................... Fee ...................................
*~ (to be paid on filing this application)
5. If dwelling, number of dwellin[ units .... .~. ~O01Ul .~... Number of dwelling units on each floor 5.': ~-.7. .......
If garage, number of cars ... ~ .................................................................
6. If business, commerciai or mixed occupancy, specify na~ure and extent ofeachtypeofuse .....--'7 ...............
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 . [2, ...........
lq;lmher nf' ~Itnrlaq
Date of Purchase ./.~,,/./. 57. t/.~.O .............. Name of Former Owner . [.~l. Cz~.~_J~¢ ~.~..
Zone or use district in which premises are situated .....................................................
Does proposed construction violate any zoning law, ordinance or regulation: .... tm~.O. ...................
Will lot be regraded ........ ~ .......... ,~ ...... .~JJ.[excess fill be removed fro~ premises: Yes
Name of Owner of premises f'~t~./4~. ~. ~f~d'~- ~-¢.u./..c(-~.,~/--qAo~_~.f~.~one No~:-..-. ~o~ .~,~,~
Name of Architect ....................... Address ......... .~:~.7.t.~.t.~..C~ne No..'~'. ? .~.-.~..~.-..
Name of Contractor .... ~*,~i..~f~S. i/~ P~. Address .... .~ ~. ~,~5': ..... 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 block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
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 ~e this
application; that ail statements contained in this application are true to tke 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 t~fore me this ~.~ . ~
.............. A--'; day of... r~t,~.~. ........... 19 .~...3~-
Notary Public,..~-'' .~.:..~...Cf~ '/..~..~-~.. ..... County \ .~_ ~ ' ,~
'N N0. 4707878, Sa{f0tk Count~i~ ~ X k~ I ($itnature of applicant)
t
~ 'WATER SUPPL¥
SYSTEMS FOR Ti
CONFORM TO 'I HE
SUFFOLK CO. DEPT
($) APPLICANT
SUFFOLK COUNTY
~~:~N ONL~
CO. TAX r.
DI~T,: SgCT.