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Home My WebLink About7873-z· FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTM]DNT Office of the Building Inspector Town Hall Southotd, N.Y. CERTIFICATE OF OCCUPANCY No Z-20866 Date JULY 20~ 1992 THIS CERTIFIES that the building. Location of Property 65 DEERFOOT PATH House No. County Tax Map No. 1000 Section 97 Subdivision ADDITION CUTCHOGUEr N.Y. Street Hamlet Block 7 Lot 23 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY ir 1975 pursuant to which Building Permit No. 7873-Z dated MAY t, 1975 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 ONE FAMILY DWK~.~NG AS APPLIED FOR. The certificate is issued to ROBERT FIS~B~R (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7873 Z Permission is hereby granted to: ..... ~,,o.~,.~.~.t....~,~.,e. ~ .......................................... ............ .c...u. ~..c.b, .q ~.....e. .......................................... at premises located at ..... ~.g.J;..~ ..... ~D.~;~.~....~.Q.'7'.~ ............................................................................ ............................................................ ~ .e..e...z:..?..o..o...~...L~.~.rt. .......... ~.c..~.o..~...e. ...................................... pursuant to application dated ........................................................ , 19 .... and approved by the Building Inspector. Fee $..~.~.,...C~.. .......... JUL I I t99 ,i Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~ ~ ~' T, ~PPLICATION FOR CERTIFICATE OF OCCUPANCY zais J'~plication 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 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. 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. 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 - $5.00 over 5 years - $I0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New Construction ........... Old Or Pre-existing Building ................. Location of Property..~.~ .... ~..~.~.~... ~ ...... ~. ~.~)..~.O..~ .............. House No. Street Hamlet Onwer or Owners of Property .... ~..~'~- ~-~-~c~'-~ .. County Tax Map No 1000, Section .... ~.7 ..... Block ...... 7 ......... Lot. Subdivision .................................... Filed Map ............ Lot ...................... Permit No...I.~..7..~..O~. .... Date Of Permit...~fZ'.2~.~.... .~.O....Applicant..~.~J~.[~....~$~..... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate..~.... Fee Submitted: $....~.5.°.~ .......... i.~ ~/~ ............... CO~~7 APPLICANT -I I (;1 IPOn, M ]q'O, ! Application No ..... . ./.~....?..~ .......... Disopproved o/~...~ INSTRUCTIONS a. Th~s application must be completely filled ~n by typewriter or in ink and submttted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premises, relahonshtp to adjoining premmes or public streets o~ areas, and giving a detailed description of layout of property must be drawn on the d~agram which m part of this application. c The work covered by this apphcat~on may not be commenced before issuance of Building Permit. d Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the apphcant 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 o 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 alterahons, or for removal or demolition, as harem described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and ir~ buildings for necessary inspections, r (Signature of applicant, or name, if a corporation) ............ "(7 ........... iX;~;ig;;;';;T 4;i;li;;;;fi'"~ ................. State whether applicant m owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ..... .............................................................................. '~';'~'~ of owner of prem,ses ~'~L. t.. . .~.f'-~...t4~ ............................................................... If opphcant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Bu,lder's License No .......... ...c~/...C.~,~...~.,.,./~.....-~.. .................. Plumber's License No ................................................. Other Trade's License No ............................................... Location of land on which proposed work will be done Map No ........ .v'-) ~...?... ............... Lot No .... ~ ............. Street and Number ..... .~..~..~.....c~...?...~.~...,...~....~k....'~... ................. C..~..~.~.~....C.~..~.~..~....~ .................................... Municipality State existing use and occupancy of premises and m.~eJzL~ed use/~nd occugancy of_proposed construction' o Exisitin,~ use ond occunano,~ ] v% ,..c~.. l c.c~ ~-~k.L ~,k.'L ~ C~c~l~' I,.L.~ ~ ~ ' ...................................... ;'"q~ ........................... ;'~1 ............................ ~: ...... 5 ...... b. Intended use and occupancy .....................;......~.. ............... ..~. .............. ~ ~.~._ _.~... 3. Nature of work (check which applicable). New Budding .................. Addit,on.....~ Alteration ,. Repair ................ Removal ................. Demoht~on .............. Other Work .Ff)Q.~....D..?..c?..~.....~.~...T].~ ........... '~" ..~'...~..~ ~ --~Z~- (Description) 4. Estimated Cost .................................................... Fee ............. (to be pa~d on flhng th~s apphcat,on) 5 If dwelling, number of dwelhng units .......... ~ ........... Number of dwelling umts on each floor .......... ~ ......... If garage, number of cars .................................................................................................................................. 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... ..-Z. ................... 7 D~mens~ons of exist,rig structures, ,f any. Front ...... Rear Depth -~ ! Height ...... ~ .......... Number of Stones ...................... ~.. ............................................................................. Dimensions of same structure with alterations or addmons' Front .......... ..-~......~.--~...I ............. Rear ........ ~ ~.~.. ...... Depth ....... :.~......27..i .............. Height ........... 5..O:. ~. ...... Number of Stones ............. ~ ............. ................... 8 D,mens,ons~/~c ent,re new construct,on' Front ~'...?...~. . Rear ........ ../ ................. Depth ................ Height ...... / ............ Number of Stories ............. f. .............................................. 9. S,ze of lot. Front ..................... /....~..-....~..~. ...................... Rear .............../..:.~....,~.. .......... i."[~'t'~"[i[[[[[[[..i.~[[.~.'[~'~[[[..~.".' 10 Date of Purchase ..................................................... Na~ of Former Owne~.~ ..................................................... 11. Zone or use district ~n wh,ch premises are s~tuated . ki(.~.~.~, ~ ¢~_'.-~ , ~ 12 Does proposed construction violate any zomng low, ordinance or regulahon ......... ~ ........................................... 13 Will lot be regraded ...... (~:.~.. ............. Will excess.fill be removed from premises: ( ) Yes (~'~No 14 Name of Owner of premises ..... .... Address .. Name of Architect ........ ¥.... ~......~.. ..................... Address ................................ ~ Phone No ...................... Nome of Contractor ......... ~4 ~ ................ Address ................................ Phone No....~,~..'-.~,.~..~.. PLOT DIAGRAM Locate clearly Qnd distinctly oil buddings, whether ex~sting or proposed, ~nd ~nd~cate all set-back dimensions fron property lines Gwe street and block number or descnpt~on occordmg to deed, and show street names and indlcat,-- whether inlenor or corner lot STATE OF NEW Y,~Zf'gK/'//.,,, //~¢ ¢ COUNTY OF ~.~'~"~ ...................................................................................... being duly sworn, deposes and says that he ~s the apphcan (Nome of indwldual signing contracf) above nome& He ~s the ................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have_performed the said work and to make and ill. this application; that all statements contained m this apphcation a~'eI true to the best q~ his I~nowledge and behef; an, tha~ the work wdl be performed in the manner set forth in the oppli~/at~on;, filed th~rewith.I ) Sworn to~re me th,s ~ //[/ ...... ....... .... ........... JUDITH T. BOKEN 14otary Pubhc, Stale c~ New York ~ Jo 52-0344963 Suffolk Coun?~ ~ qrmsston Expires March 30,