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Home My WebLink About23022-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34216 Date: 03/09/10 I~{IS CERTIFIES that the building AWNING Location of Property: 27835 MAIN RD (HOUSE NO.) County TaxMap NO. 473889 Section 102 Subdivision Filed Map No. MATTITUCK (STREET) (HAMLET) Block 1 Lot 18.1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 12, 1995 pursuant to which Building Permit No. 23022-Z dated SEPTEMBER 22, 1995 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 AWNING FOR EXISTING SCHOOL AS APPLIED FOR. · ~ne certificate is issued to RC CHURCH OF SACRED HEART (OWNER) of the aforesaid building. SUFFOLK COUNTYDEPARTMENT OF HEALTH APPROVAL ELEt-rKICAL CERTIFICATE NO. CERTIFICATION DA'£~U N/A N/A / Authorized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCU This application must be filled in by typewriter or ink and submitted to the Buildir A. For new building or new use: 1. BL G. EPI. Departme~q,~ g~l~0tltOwin~,: _ 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. Commemial 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. B. 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 properly lines, streets, building and unusual natural or topographic features. 2. A properly completed application and 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 - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Cormnercial $15.00 New Construction: Location of Property: Old or Pre-existing Building: House No. Street Owner or Owners of Property: ~ ['l ~' :'C [~ (? ~.v"- ,4- Ix ~ Suffolk County Tax Map No 1000, Section / O '2.~ Subdivision Permit No. (check one) Health Dept. Approval: Hamlet Date of Permit. Lot ! ~, t Block Filed Map. Lot: q' 22' t~D" Applicant: Unde~riters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~'(~, ~O Final Certificate: V'/ (check one) Applicant Signature TOWN OF $OUTHOLD BUILDING DEPAETMENT TOWN HALL $OUTHOLD, N.Y. 23022 Z BUILDING PERMIT ~HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)/-~ ................ ......... ......................................................... ~....,../...Y..-...~ ...................................... CounlyTax Map No. 1000 Section ......... ,,.~..L~..._~. Block ...... l ............... : Lot NO..., ,~',,, .4~'..~...~.. .......... pursuant tO application doted ............. ;,~...../.....~... ......... 19...~.....~.... and approved byfne Building Inspector. E~ ~.. 1~.....~.. Rev, 6/30/80 Building Inspe~or TOWN OF SOUTHOLD BUILDING DEPARTMENT.. TOWN HALL l)isapproved a/c ........................ \ BOARD OF IIEALTII ......... 3 SETS OF PLANS ......... SURVEY .................. CIIECK ......... ~ ......... SEPTIC FORtl ............. :ATION FOR BUILDING PERMIT Date ....~.~.-..~..2. ....... 19 INSTRUCTIONS a. This application nmst be cmnpletely filled in by typewriter or in ink and submitted to the Building luspector, with 3 sets of plaus, accurate plot plan to scale. Fee accordiug to schedule. b. Plot plan showing locatidn of lot aud of buildings ou premises, relationship to adjoining premises or public sti-eets or areas, aud giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cati. ou. c. The work covered by, tJfisapp cat ol ~lay uot be commelced befo'e issuauce of Bu lding Permit :d. Upo ~ approva of ttus application, the Buildiug Inspector will i~;sued a Butldiug Permit to the applicant. Such permit shall be kept on tire premises'available for inspectiou throughout the work. e. No building shall be occupied or used in whole or in prat for auy purpose whatever until a Certificate of Occupancy shall bare beeu granted by the Building Inspector. APPLICATION IS ItEREBY MADE to the Bnilding Department for the issuauce of a Building Permit pursuaut to the Building Zone Ordinance of the Town of Southbld, Suffolk County, New York, and other applicable Laws, Ordbrauces or Regulations, for the construction of buildings, additions or alterations, or for removai or demolition, as hereirl described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized b~spectors on premises and in bt ildh~g for necessary ........... inqpe,'t · .?. ,.0: .q~. ¥. flP.? ..... .C~t c..h.o.5~+ .... .~...q: ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, geueral contractor, electrician, plumber or builder· Name of owner of premises . .~.~c.c..e.d[.. :g. ~..~r..C..%¢~ ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No .......................... ['lumber's License No ......................... Electrician's Liceuse No ....................... Other Trade's License No ...................... 1. Location of land on wi,ich proposed work will be done..IQ.~..~..~.d .c/..C9.. ~...~.~.q~.C.~..'~.5;.o~ ./{.~...-~..~.O.o.~ ..... .:/2 ................ ............. ¢. % ................................. llousc Number Street ttamlet County Tax Map No. 1000 Section ... :t.O.&. .......... Block .... t ' Lot...].~.,.t ............ Subdivision ' Filed Map No ............... Lot ............... (Name) 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisliug use and occupaucy.....-~:..C.o.d./c-. ................. ' ..................... b. Iutended use and occupancy .................... · .......................... .~. ~atmc m ~oik (check which applicable): New Building .......... Addition .......... Alteration . . Repair .............. R~moval .............. Demolition .. : ......... Other Work ~co ~ l ~ ' ' ' ' (Description) 4. Estimated Cost ............. :' · ............... Fee (to be paid on filing this application) 5. l[ dwelling, number of dwelling units l[ garage, number of cars ............... Number Of dwelling units on each floor 6. If business, commercial or mt.xed occupancy, specify nature and extent of.each type of use . 7. Dimeusions of existing structures, if any: Front .................... ............... Rear ...... Depth lleight ............... Number of Stories ............... .... '... ii ..... : ............... Dimensious of shine structure with alterations or additions: Front ............. ' ' ' Rear ,D..ep th .. ...................... llejght ........... . - Num' - · 8. Dimensions of entire new construction. Frnnt '2.-- 1 ........ ; uer of :Stones ........... i ......... Height ............... Nu,nber of'S;;~i;; iiii-iiii ...... ; Rear ............... Depth . .4Z..e ........ 9. Szeof 0t Front ......... l.. Rear ............. , ........ Depth ...................... 10. Date of Purchase ............... ' ................... : ..... I I. ' ................... ' ......... Name of Former Owner ................ Zone or use district in wliich premises are situated .............. .................................. 12. Does proposed construction violate any zoning law, ordina ............. 13. Will 10t n .... be regraded ce or regulation: ................................ ............................ Will excess fill be removed from premises: Yes 14. Nalne of Owner of premises No Nanle of Architbct ....... i ................... Address ................... Phone No ............ ;... Nmne of Contractor ........ ' .............. Address ................... Phone No ................. .................. Address ............. · ...... Phone No ................ 15. I.s this property within 300 feet of a tidal wetland? *Yes . · If yes, Southold Town Trustees Permit may be required. No ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property liues. Give street aud block number or description according to deed, and show street nmnes and indicate whether interior or comer lot. VOTED ~M FOR THE IS: )REOUIRED rE PLUM;lING om : ?/2I NOTIFY BUILDIN~ ~ 765-1802 9 AM ~ 4 FOLLOWING INSPECTIO ~. F~DATiON FOR POURED CONCR 2. ROUGH . FRAMING, ~. IhSU~TION 4, FINAL CONSTRU TION MUST BE COMPLETE FOR C,( ALL CONSTRUCTION SI ~ ME~ THE REQUIREMENTS O, THE N.~ STATE CONSTRU~ION ' i ENERGY CO~ES. NOT RESPON 8~ FOR DEIGN OR CONrail N CTATE OF NEW YORK, 2OUNTy OF S.S *'~'"~ . ./~.~./~...~'~'//~'.~.~ t ...... being duly sworn deposes and says that lie is tile applicanl (Name of individual signing contract) bore named. le is the ..... ....... (Contractor, agent, corporate officer, etc.) " .............. f said owner or owuers, and is duly authorized to perform or bare performed the said work and to make and file this pplication; that all state~nents contained in this application are true tO the best of his knowledge and belief; and that the ,ork will be performed in the retainer set forth in the application filed tlierewith. worn to before me this ....... ~. · · .f .'. · .day of .... ~.~.t .//4."~/... · .... '., 1 9 ~.,r4~ AN M. HULSE ' ' ' . ................... // ~,~'l[~[[a~/Pu.b, lic, State of New Yo~ . ' ' (Signature of applicant) -- No. 4720407 . · -~,~ {~l~alified in Suffolk CountyI * ~-oellmission Ex, ires Auo. 310 ~(..L.7 ~o