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Home My WebLink About7627-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23684 Date JUNE 6, 1995 THIS CERTIFIES that the building ACCESSORY Location of Property 1905 STILLWATER AVENUE CUTCHO~UE NY House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 8 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 12, 1974 pursuant to which Building Permit No. 7627-Z dated NOVEMBER 12, 1974 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 ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to HELEN BRUSH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A /~uild~ng Inspector Rev. 1/81 FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7627 Z Date ............. ~.. ~,'¥re. . ~:,r 12 ~'br ............................................ 19 ........ Permission is hereby granted to: Edward L~z~u sh ............. '.q~..t.?.h.o.~.~.e. .............................................. at premises located at ..,,i¢/.;~....~.1~,,].,~,.~,.$:~. t,.V~ ....................................................... Cutchogue N .~. pursuant to application dated ........................... ~.O.V. .......... 19.~..k,., and approved by the Building Inspector. Fee ~..~..:.~..0. ............. OF SOUT.OLO BUILOING DEPAR'DIENT 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR i,k and submitted to the buildieg inspector with the following: for new building or new use: 1. Finnl survey of property with accurate location of alt buildings, property lines, streets, and mmsoal natural or topographic features. 2. Final Approval from Hehltl~ Dept. of water sapply and sewerage-disposal(s_9 form). 3. Approval o~ electric~ installation from Board of Fire 0nderwriters. Sworn statement from~plumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Commercial building, indnstrial b~ilding, multiple residence~ and similar buildings and installations,ka certificate of Code Compliance from architect or engineer responsible for th~ building. 6. Submit Planning Board Approval of completed site plan requirements. F~r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and .Pre-existing" land uses: I. Accurate survey of property showing ail property lines, streets, building aud nnusual uatural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate' of Occupancy is dealed, the Building Inspector shall state the reasons tberefor in writing to the applicant. C. Fees 1. Certificate of Occupaucy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swin,ning pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupaucy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $t5.00., Co~ercial $15.00' .... .... New Construction ........... Old Or Pre-existing Buildi~..~ ...... Location of Property ..... 'II, :.e~ ~:q .... ~ ~'i~,~ ~...~.~.g, ..... }louse No, ' Street ' Hamlet Onwer or Owners ,.,f Property.. ''']~:'' ~g~- .... 9.~ ~o~.~ ~ ,~,, .o ~00o, ~c~o. .... Z.O.]~...~,~k ..... C ......... ~o~ .................. aubd~vis~on .................................... Piled Map ............ Lot ............ ........... ....... ' -. .7..f. fApplicant ... ~.~.. Health Dept. Approval .......................... Underwriters Approval ......................... ~lanning Board Approval lequest for: Temporary Certificate ........... Final Certicate ......... ..... FORM 1~0o 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~proved ~/ /~ 19 ......Permit ~o. Disapproved a/c ...~~~ APPLICATION FOR BUILDING PERMIT 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 iocation 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 part 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 ia 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, ~ o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... f)~fr~ e,,~... ~... ~?~ ~¢¢ ,e.~. ....................... , ................................................................................... Name of owner of premises ....... :),;~.~*.:~..,[~;r/;~q.~ ................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~1~r,~fi~. ................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ..~ ................................. Lot No.....~ ............... Street and Number ..~/.~...;~.%.:~,~?~,.~',~:;.'~Z~...4~ ............ C~;~,,k~C~j'~.....~.~.~;..~ ...................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ....%Z,,% ....... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... (Description) 4. Estimated Cost ............................................................ Fee .~...'*~ .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... O ................... 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 ................................ 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 ....~6 ........................... Rear ..... ~ .................. Depth .....~6 ............... Height .................... Number of Stories ...~ ............................................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..~.&tt..~ ................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~ ......................................... 13. Will lot be regraded ..... ~Q .................. Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of premises ~ ~ · ..~d ~....~.~ ............. Address ...... C~t~o.~ue ..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...... ~}~ ............................................. Address ................................ Phone ~o ....................... PLOT DIAGRAM Locate clearly and distinctly aH 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. / / / / / / / / / / ~qA E OF NEW YOR(. /¢~ ..... ; COUNTY OF ...... ¢~;~¢[~; .........f - ....................... ¢~¢.'~2(.~...~Z~¢.~ ................................................ being duly sworn, deposes and soys that he is the ~pplicom (N~me of individual signing contract) above named. He is the ................................ o~e~..~...b.u~&¢.~.= ............................................................................................................. (Contractor, ~gent, corporate officer, etc.) o+ said owner or owners, and is duly authorized to per~orm or hove performed the s~id work ~nd to m~ke ~nd fife this ~pplic~tion; that ~1I statements contained in this ~pplicotion ore true to the best of his knowledge ~d belief; thor the work will be performed in the m~nner set ~o~h in the ~pplication filed therewith. Sworn to be+ore me this ................. ~2..~y o~,..¢...~[a}~ ...... , 19.~.. /-[, __ ¢, ~ .... .................... (Signature of applicant) Com~J~;io~ Expires March 30, 19'/~