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Home My WebLink About11472-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22625 Date SEPTEMBER 29t 1993 THIS CERTIFIES that the building ADDITION Location of Property 250 WILD cM~RRYWAY House No. Street County Tax Map No. 1000 Section 52 Block 3 Subdivision Filed Map No. GREENPORTt N.Y. Hamlet Lot 31 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER l0t 1981 pursuant to which Building Permit No. 11472-Z dated NOVE~ER 23t 1981 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 EXISTING DECK The certificate is issued to VIRGINIA OHRIKER (owner) of the aforesaid building. · SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A /~lding ±nspec~or Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 11~72 Z Permission is hereby granted to: ..... ~T~,~....-..,~¢......~.~ ..... ./~c. ~ ~ .s.~..~........~_,~....~./~4~ ~. ..... ~z,(~?~..~....~..~ ............... ~ ,o ...... ~.,~..,~.~.......~.~.~.~.~.,,,....~.. ,~~_/~.,~..~.~:,~ ............ .................... .~.A.i ....... ~~..~,....~~ ............................. , ............... ........ ........................... ..~~~:..~..~ ............................ ~~ ........................ County Tax Map No. 1000 Section ..~...~...~e ...... Block ..... ~.~. ....... Lot No...~. ......... pursuant to application dated ....~/~1~,~-~'-~ ...... ~.J~/. ...... , ISll~../..., and approved by the Building Inspector. Bulldlr~' lnq:~ector Rev. 6~30~80 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 i% 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 - $I0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..... ~.ebr u~J~. 2~. 19~3 ............... New Construction ........... Old Or Pre-existing Building ..... Preexisting Location of Property..~Q.W~%~.C~rY..~Y ......................... ~PO~ ............ House No. Street Hamlet Ohriker Onwer or Owners of Property.....................Virginia ........................................... . . County Tax Map No 1000, Section .... ~ ........ Block .... ~ ........... Lot .... ~.% ............... Subdivision Filed Map ........ Lot ......... Permit No /./.~../..=~. ~. Date Of Permit . Applica Health Dept Approval Underwriters Approval . . Planning Board Approval .... Request for: Temporary Certificate ........... Final Certicate .... ~ ..... APPLICANT IN ~ DA~fE COMMENTS (1st) (2nd) ING ADDITIONAL COMMENTS: FIELD INSPECTION 1. FOUNDATION FOUNDATION 2. ROUGH FRAME & FLUM 3. INSULATION PER STATE ENERGY qODE FINAL IFORM NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ..... .......... , Approved ..~.......~....~.. .......... , I .~../..... Permit No../.../.....~..../...~........?... ..... Application No.//...C/../Z. .............. Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 19.. '~./.._. ........... -~:~'.~:.,...x--~;. ................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue 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 buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... .................................................................................................................. Name of owner of premises .............. .~. '.~.~...~...~./..~./.'~.. ...... ~ ......... ..~....//..~.../../~...~e/...C; .................................................................. If applicant is a corporate, signature of duly authorized officer. ~c~' title of co~-I~'~';~'~"~;i~'~'~i ......... Builder's License No. ~..~.~....~..:'.~......~...~..:~.C: ..... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ..... ..~'....S..'~.~ ...................... Lot No..../..~ ................ Street and Number Municipali~ State existing use and occupancy of premises and intended use and occupancy of pr~osed construction: a. Exisiting use and ~cupancy ......................................... F. .................................................................... Intended use and ~cupancy ............................ -~/~ ...... ~..~.... ~ ~.Cd ~... ~..~ ~.Z .......... b. 3. Nature of work (check which applicable): New Building.. ................. Addition ...... ~ ........ Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 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, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........ ;~...~.....~ ......... Rear ......... .~..~....z. ............ Depth .~,~,../. ........ Height ..... ./....~..../. ....... Number of Stories ............. ~../..~./~. ....................................................................................... Dimensions of same structure with alterations or additions: Front ...... .~....~.. ...................... Rear ..... ~...~....". ............ Depth ........ ,~.~,~../. .............. Height ..... ,:,.z..~... .............. Number of Stories ..... ~....../~'....~... .............. 8. Dimensions of entire new construction: Front ....... ~ ................. Rear ....~.-- .............. Depth ....~.~.. .......... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............ ~.~...5~.. ............................... Rear ......... ~...~...~. .................... Depth ....... ~..'~...~.. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....... .~....JL.....z2,~.I.?,J.I,~.,,.~.)~ .......... Address ....~)..~...~..../~/.~... ......... Phone No~.'..~.~..~...~...~...~.~ Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ...... .?.~ .Z~......~-.,/-~r..~. -~.....-~-..~Z...~....~.. Address ...... ~.A..~.u...~.~.~..~?.... Phone No..~..~.7...5..~..R..~.... 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 N.EW(~RK.,~ . J~ !¢~ ........ ~...:.. _..~.:.~.~.~r ~ ~. ........ :. .................. being (~lome of individual signing contract) above named. duly sworn, deposes and says that he is the applicam He is the .................................... ~ ....... ~ ................................................................................................................ ~ ~ (Contractor,X)agent, corporate officer, etc.) of said owner or owners, and(is duly~4~zad-~ 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 ti.ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,~/) ~ /'~ ..... ELIZABETH ANN NE¥1LL~ L/ J~JTAI~Y PUBLIC, State of r~w J~). ~2.8lz5850, Suffolk C0urj~j~ J'elat F.~ires March 30, x, ,5¢,9&H : 60'~ Sun 4rk ¢onsfrucf[on, 333A Calverton-Westhampton Road Calve~ton, New Yo~k 11933 THE WA SYSTEM CONFOI; SUFFOL IS). S, UFFOL SERVI CONSTF DATE:: H.S. RE APPRO~ SUFF DIST lO0~ OWNER: )EED:'I TEST