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Home My WebLink About28442-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29180 Date: 01/08/03 T~IS CERTIFIES that the building ACCESSORY Location of Property: 1155 LIGHT HOUSE RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 50 Block 6 Lot 5.10 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 4, 2002 pursuant to which Building Permit No. 28442-Z dated JUNE 5, 2002 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 ACCESSORY 12' X 16' STORAGE STURCTURE IN REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to FRED & LAURA KETTENBEIL (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF t{EALTt{ APPROVAL ELEL-I'~ICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'r~ Rev. 1/81 N/A N/A N/A - Auth;ri~ed S[gnatu~ FORM NO. 3 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) PERMIT NO. 28442 Z Date JUNE 5, 2002 Permission is hereby granted to: FRED & LAURA KETTENBEIL PO BOX 165 PECONIC,NY 11958 for : NEW CONSTRUCTION OF A 12' X 16' ACCESSORY SRUCTURE IN REAR YARD AS APPLIED FOR. at premises located at County Tax Map No. 473889 Section 050 pursuant to application dated JUNE Building Inspector to expire on DECEMBER 1155 LIGHT HOUSE RD SOUTHOLD Block 0006 Lot No. 005.010 4, 2002 and approved by the 5, 2003. Fee $ 75.00 Rev. 5/8/02 COPY 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 Departm~,!_~i!h the following: A. 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 t~om 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) hon-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 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 - $25.00 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision " PermitNo. ~-*~'~'-~-'~. -2_ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 2. Old or Pre-existing Building: Street Date. (check one), Hamlet Block O Filed Map. Date of Permit. ~ I r~ Underwriters Approval: ,-o I,~ Lot Lot: Final Certificate: ~ (check one) Applicant Signature BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] INFLATION [ ] FRAMING ~'FINAL [ ] FIREPLACI~ & CHIMNEY DATE FOUNDATION (1ST) FOUNDATION (21'q)) ROUG~ F~G & " ~S~TION PER N. STALE E~RGY CODE 'F' TOWN OF SOUTHOLD BUILDING DEPART1VH TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 76S-1802 FAX: (631) 765-9502 PERMIT NO. Examined 0 ~;,/~' ..... 20~.2 Approved o 6/O ~' ,20 0,2-. Disapproved a/c Expiration ,20 BUll.DING PERMIT APPLICATION ~I-IECKLIS Do you lmw or n~:l the following, before applyinl Bo~I of Heakh 3 ~ of Buildlng Plans . plm...:.g Board approval S~do Form N.Y.S.D~E;C. Cont.'t: Buff mg~r APPLICATION FOR BUILDING PERMIT INSTRUCTIONS D~te 0 6/o'~ ,20 eft.. a. Tiffs application MUST be completely filled in by typewriter or in ink and suhmit~ W the Builaing Inspector w/th 3 sets of plans, accurate plot plan to scale. Fee acoording to b. Plot plan showing location of lot and of buildings on premises, relationnhip to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not bc oomm~w, ed befOr~ is~amnv~ of Buildlng Permit. d. Upon approval of this application, the Building Inspector will issue a Building Pe~uit to the applicant. Such a permit shall be kept on the prem/ses available for inspection throughout the work e. No building shall be oocupied or used in whole or in part for any purpose what .~o ever uzgdl the Building Inspector issues a Certificate of Occupancy, f. Every building permit .qhM! e0rpire it' tho work authorized has not ~ within 12 months after the date Of issuance or has not been completed wliJkin 1 g montI~ from sueda date. If no zolflag amealdmlm~ or other regulations affecting the property have been enacted in the interim, the Building lnspeator may authorize, in wriOn~ tho emlen.qion of the pormit for an addition six months. Thereafter, a now pea'mit ~ha!! be APPLICATION IS H:EpRR¥ MADE to the Bnil._ding Department fort~ iss'uano, of a Building Permit pursuant to the ~uil ,d?.g zo~ o~.~a~ce of me town of Southoid, Suffom County, New ¥or~ ana.ot~ apVnc~ble Laws O~-~o~s o~ .emat o s, oo=t ctio ofb , or applicant agrees to comply with all applicable laws, ordl-a,,~, building code,, ho,,.~-g oodo, ~ regulations, and to admit authorized inspectors on premises and in building for n~oessary insp~io~. ($igmtnm of ~tlflimm or ~ame, if a corporation) ' ~.4a,-~ of at'PhcanO State whether ap~li, cant is owner, t~ssee, agent, arohite.~ en_~ne~r, general contraotor, electrician, plumber or builder Name of owner of premises (As on the tax roll' or latem &~l) If applicant is a corporation, s/smatare of duly authorized officer (Name and title of corporate officer) Builders License No. hO Plumbers License No. Electricians License No. to Other Trade's License No. to Location of iand on which proposed work will be done: House N~b~ S~ County Tax Map No. 1000 Section Subd/vision ~ i ~. offo Block Ffl~t Map No.' zot 5', to Lot ~J! tq FEE. NC)Ti FOLL 2~ R~ 3. I1~ 4, F B ALL THE STA CO[ DES :y BULL~ING DEPARTF~IENT Kr 9q2 ~ /~;,~ TO 4 PM FOR THE :)W~;~ iNSPECTIONS: )UNDATION - TWO REQUIRED )R PO~ RED CONCRETE )UGH,- FRAMING & PLUMBING SbLATIO~ NAL - CONSTRUCTION MUST ~ COMPLETE' FOR C.O. CONS'rEucTION SHALL MEET REQUIREMENTS OF THE N.Y. 'E CONSTRUCTION & ENERGY ~ES. NOT RESPONSIBLE FOR IGN OR CONSTRU~ION ERRORS q N.~.B 5S ~0 E. ~ "~ 'w/ELL MAP.AMEN P~D- JULY 8,_1996 SCALE ~ ,F~ PE C'MgOL ~ SUFFOLK ¢O. HEALTH DEPT. APPROVAL H.S. NO. SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. DRESS: P.o. ~Ox PE¢ONIC .,L~ ._Y_, .DEED: L. STAMP SEAL