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Home My WebLink About22243-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY' No Z-23221 Date SEPTEMBER 15, 1994 THIS CERTIFIES that the building ADDITION Location of Property 3125 WELLS AVENUE SOUTHOLD, NY House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 4 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially .to the Application for Building Permit heretofore filed in this office dated JULY 19, 1994 pursuant to which Building Permit No. 22243—Z dated AUGUST 9, 1994 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 AN "AS BUILT" DECK ADDITION TO A ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to MARJORIE A. SERRELL (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 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) N-0 22243 Z Date ...................... ..�.............................. , 19...',/.... Permission is hereby granted to; �� ...... ......................22,./�............... 9/�s ///s....... 141 ....................:...... ......................... y �..... ..........I......... ... to ...... -c e.{........... ......... .. .............� .rhv.'�!.............�........... �1........... °.. V-7!�.... ... -��.. . ......... ...!i�.��` G..... .. ..... ,.��....... ....... .;� ....................... ............ ................................................................................... ................................................................................................................................................... ......................................................... .............................................................................. �l/r at premises located at...................�/.,................ .......................................................................... ................................................................... J7 ............................................................ County Tax Map No. 1000 Section .....;��............ Block........!�......... Lot No. AV................. pursuant to application dated ................7/. ............................. 19...-.��.. ., and approved by the Building Inspector. J Fee ....... ................. ........ ..... ........................... Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOI,TN HALL 11 II 2 0 1994 765-1802 I BLDG.DEPT. APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OFSOUTHOLD A. 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: I. 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. 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 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. Buildinsz - $100.00 3. Copy of Certificate- of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $ii15.00,rCommercial $15.00 Date . . . .�:1 ��C.. . . . : . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . Old Or Pre-existing Building. .+! Location of Property. . . . .W U S, AV., , , , , , House No. Street Hamlet Onwer or Owners of Property �n ,��, S. �1 ..:'! 1Q I . . . . . .�.� t L. . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . County Tax Map No 1000, Section.!. . . . . . .I . . .Block. . . . . . .. . , , , , .Lot. . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . .. . . . . . .. . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . .. . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. ! L(PD . . . . . . . . . . . . . . . . . . . . APPLICANT BUILDING DE". INSPECTION [ ] FOUNDATION 15T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] i ULATION [ ] FRAMING [ FINAL REMARKSQ- ,e� / L DATE INSPECTO BUILDING DEFT. INSPECTION [ ] FOUNDATION 15T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [fij'FINAL REMARKS: Z5- DATE IN8PECT0 1 LD is:.�',. �O:_�::i j�J�,: jj :;i;':titL T: OUIIDATION ( 1st) - (� OUNDATION ( 2nd ) o ;OUCH FRAME & ' 1 •PLUMBING c `3 =IISULATION PER N . Y. • • '� 1�� . STATE ENERGY i CODE I T --�In 1000002 0- FILIAL • o ADDITIONAL COMM TS : x \ . Sl . v y y Zk - v---------------------- • ! -o y '. M l5 BOARD OF HEALTH . . . . . . . . FORM NO. 1 3 SETS OF PL.INS � TOWN OF SOUTHOLD SURVEY 2 O 1994 BUILDING DEPARTMENT CHECK . . . . . . . , . . LSOUTI J TOWN HALL SEPTIC FOR.N • . . _ . _ BLDG. DEFT. HOLD, N.Y. 11971 . - TOWN OF SOUTH LD TEL.: 765-1802 is Z Examined . . . . . . . . . . 19 CAA L`i� C� tin TO Approved . . . . . . . . . . .. 19 . Permit No. ��C-�.�r2, r!,,,� . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ng Inspector) APPLICATION FOR BUILDING PERMIT Date . $�: .�� A.:f. . . . . .. 19 . . . INSTRUCTIONS a. This 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 this 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 necessary inspections. (Sionatur o applicant, or name, if a corporation) . . . . . . I.21 . lea , (Mailing address of applicant) z� (1 State whether applicant is owner, lessee, agent, architect, engineer, general gpntractor, electrician, plumber or builder. ; . . . . ..... . ��. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . 1.6\ �.� ! ►=. . °. . .� �'��, ,L-- . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed)APPROVED AS TOTED If applicant is a corporation, signature of duly authorized officer. �j IRATE• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FEE: (Name and title of corporate officer) NOTIFY OR NOTIFY BUILDING DEPARTMENT AT 765.1802 9 AM TO 4 PM FOR THE Builder's License No. . . . . . . . . . . . . . . . . USE. IS UNLAWFUL 1. FOUNDA. FOLLOWINGT ON - TWO REQUIRED Plumber's License No. WITHOUT CERTIFICATE: FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING Electrician's License No. . . . . . . , • . . . . . OF OCCUPANCY •3. INSULATION �. FINAL. - C::=':^.; ;;; oil_- I'll Other Trade's License No. i . . H .« ,r. , . . . . . . . . . . . . . . ,.t.l_ C'. r? l. Location of land on which proposed work will be done. . . . . ?�S : . V�J1-•,! . . ' wad \�;1 . ..,s House Number Street Hamlet �D r. County Tax Mar No. 1 000 Section - .- . . Block . . . . . . - , , . . . . Lot . . . . . . . . . . . . . . Subdivision . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. � �.�``. . . 1� I►t . . .. V.�(...�.J. ... . . . . . . . . . . . . . . . . . ... Iq b. Intended use and occupancy !: .r.� ��r . . � v! %/ . . . . . : . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . •3. Nature of work (check which applicable): New Building Addition Repair . . . . . . . . . . . . Removal . . . . . . . . . . . . '.:: : :: Iteration . - - • • • • . • • • • • . . Demolition . . . . . . . . . . . . . . Other.Work . . . . . . . . 4. . Estimated Cost . . . . . . (Description) . L. . . .. Fee . . .. . . . ... . .. . . . . . . . . . . . 5. If dwelling (to be paid on-fiiing"this.appli'cation) b,number of dwelling units . . • . • • • • • Number of dwelling units on each 17oor . . • . • - If garage, number of cars • . . . 6. If business, commercial or mixed occupancy,• • ecif -• • • • . • • • • . • • . . • ' ' ' ' ' ' 7. Dimensions of existingstructures specify nat re and extent of•eacli type of use . . . . Height , if any: Front . . .(. 9 .�.. , • , • • . . Rear •`" 'Number of Stories • • • • • • • • • • Depth Dimensions of same structure with • • • " " " • • • • • • • • • • • • - • .alterations or additions: Front 'I Depth . . . . Height _ Rear . . . . . . . . . 8. Dimensions of entire new construction: • • • • . . • • ' ' ' ' ' • • .. • • Number of Stories . . . . . . • • •�• .Height Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Dc th. . . . . . . . . . . . . . . . 9. Size of to Number of Stories . . . . . . . t . _ . . . . : . . . . . . . . P . : : . . e t: Front . . .I ., . . . . . . .I. 10. Date of P Rear. . . .''.: . . . . . . . . . . . . . •p •I• . . Purchase , , , . • F •lq"`� �' Depth . . use district in which • • • • • • • Name of Former Owner 11. Zone or u f�¢j Lid, • ,(? 'FF�• . .. premises are situated . _ - 12. Does proposed construction violate an . • • • • • • • • • - • • • . • • • • 1 13. Will lot be regraded . , , • y zoning law, ordinance or regulation: . . f?. . , , • , • • , , • • • • • " . . . • • . . • . • • • • • • • • • • . Will excess fill be removed from premises: •Yes • . • • • 14. Name of Owner of premises . . . . . No Name of Architect . . . , • ' ' ' ' ' ' ' ' • . • • Address . . . . . . .. . . . . . . . . . . . Phone No. Name of Contractor . . . . • • • • • • • • . • • • • ' " " ' • • •Address : . . . . . . :. . . . . . . Phone No. . . 15. • Is t is propertywithin " ' ' • • • • •Address . . . . , , , , , • • , , , , , , Phone No. 300 feet of a tidal wetland? eyes-✓.. " • • • • • • • • ' ' • • .*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 lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. . :.1 "�: :b .'`'1'.i•':! .',b C' :i% .�" +F .FY, .. 'Qt S,J;% {.'"N, STATE OF NEW , �• °t :v� - --OUNTY OF � .S.S � r t k i ,, , • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named. le is the . ... . . . . . . . . . . . . . . . . .Q.W.►J (Contractor, agent, corporate officer, etc.) • • • • • • • • • ' ' ' ' ' ' ' f said owner or owners, and is duly authorized to perform or have performed the said work and to ma ke and fi )Placation; that all statements contained in this application are true to the best of his knowledge and belief;and le this ork will be performed in the manner set forth ill, the application filed therewith. at the worn to before me this � . . . . . . . . . . . b T . . .day of. . . . . .�. . . . . . . . . . . ., l 9 . . .� Mary Public, . . County ELI2ABET ANN NEVILLE • . . . . . . . . . :. . NO,ta"y Public,State of N Wwr York � (Signature ofapplicant) o. 2--P3125550,Suffolk Co ti October 31, 19X ----------------- ---------------------------- —� .. 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