HomeMy WebLinkAbout10017-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z..1.2.8.1..3 ......... Date Sept. 27 19 84
THIS CERTIFIES that the building .?¥9.. (2. I..CAr...G.a.r.a.g.e ..........................
Location of Property 1640 Sterlinc3 Rd. Cutchogue
h~J,s~ 'dd ...................... 'S'de~i ...........................
Ham/et
County Tax Map No. 1000 Section . .1.0.4. ....... Block ..... 0.4. ........ Lot ..... 0.1..5 .........
Subdivision ....X ................. Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fried in this office dated
.... I~lgy. ........8 ..... ,1978. pursuant to which Building Permit No .... 1.0..0.1.7.Z. ...........
dated ...... N~>.v. ......~ 7 .......... 19. ? 8, was issued, and conforms to all o f the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
Two (2) Car Garage Addition(to existing dwelling)&Deck Addition
The certificate is issued to GEORGE THOMAS SCHNEIDER
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDERWRITERS CERTIFICATE NO. N/A
Building Inspector
Rev. 1/81
FOEM NO. ~
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)
Ne ~0017 Z
Permission is hereby granted to:
.~./~.r~.....~....x~.~x~L"'"
pursuant to application dated ..... :~....~... .......................... , 197.~..., and approved by the
Building Inspector.
~'"~Bt~il~ino Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in Wpewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3.Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5.Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing"_
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusua~ natural or
topographic features.
2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling / land
use
3. Copy of certificate of occupancy $1.00
/
--Pre-Existing C.O. $15.00
Vacant land C.O. $ 5.00
New Building ........... Old or Pre-existing Building .......... Vacant Land ..
Location of Ptope .. 1640 sterling oad, Cutchogue,
Hou~a NO, Street Ham/et
rty George .T. homas Schneider
Owner or Owners of Prope ........................................................ ~..
County Tax Map No. 1000 Section 104 4 1.5
.............. Block . Lot .......
Subdivision N/A , N/A N/A
................................. Filed Map No ........... Lot No ..............
11/17/7 . George Thomas Schneider
Permit No..1. gp.l.7. Z... Date of Permit ......... .8App ,cant ........
Health Dept. Approval ..... .N./.A. ............... Labor Dept. Approval . .~./.A. ...................
U nderwriters Approval N/A .N/A
....................... Planning Board Approval ....................
Request for Temporary Certificate....................., Final Certificate X
Fee Submitted $ .5., QQ ........................
~L0~--~C~q 2- ~2-C°nstructi°n on above described building an~i~;mee~p~odes and regulations.
C-4) ;~ l'~q~ I ~ Applicant . ~4"~. '~'~ .~-. · .~/~7. ·x ~ . x/ /~/~//x ~. ~ ............................
C? .=~-CS't~ Richard F. Lark, as attorney for
R.~. ~0-~0.;a George Thomas Schneider
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hail
Southold, N.¥. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or tooograohic features.
2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to usa, occupancy and condition of buildings.
3. Data of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate. /
C. Fees:
1. Certificate of occupancy $5.00 /
2. Certificate of occupancy on pre-existing dwelling tr Iand use '2, 5~ $5.00
3. Copy of certificate of occupancy $1.00
County Tax Map No..1000 Section ............... Brock ............... Lot ..... ~ ..........
Subdivision '~~ ~'~¢ F ed Map No //~ ~ Lot No ¢ / ~O
~ , DO ' . .................. ' .... q'" ' ~ ........
Health Dept. Approval ........................ Labor Dept. Approval ...................... ,..
Undepzzriters Approval ........................ Planning Board Approval ..................
Request for Temporary Certificate ..................... Final Cerdficat~ ........
Fee Submitted S ......................
Construction a ova described budding and permirmee~
on all apP~abl~ode~ and regulations,b ' ' '
TOWN OF SOUTHOLD
BUILDING DEPAliTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ...... ~ ~..~.. ~: ..............19.~.~
~ 00/7
~prov~ ...... ~?.(Z ~:L...C..Z ........... 19.2~ Permit ......... ~ ............................
D,=~ro~ed ~/~ ................................ ~ ..........................// .5~j ..............
......................................................................... :~/ ........... ~z~....~ ....................
Application No ...................
APPLICATION FOR BUILDING pERMIT
Date.../.~/.~..'//. ~...~...~......?.. .............. ,
INSTRUCTIONS
o. This application must be completely filled in by typewriter o~. 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 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 in whole or in port 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 applicab e laws, ordinances, bui ding code, housing code, and regu arians, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
//(Signature of ap_,pl,i~ont, 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 .. ~.~ ~,~:,~. `~.~```~.:~;`~(;~:`:~..~/``~`.~.~.m..`Z:;:~`~`/~;.~...~:.Z~/~`~.:./.¢~.~!:~ ........
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No..~..(.~..,~...,¢<.~..4'.:.:.~... .........................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Mop No.: .../~.....Z.TZ ....................... Lot No. >/,..:J. .......
Street and Number .~..~....~.~Z~ZZ~f....~.~ ........ ~.~Z~f.~.CT ...........
Municipali~
2. State existing use and occupancy of prem~s and in~ended use and occupancy of proposed construction:
a. Exisiting use andoccupa cy ....... ~ZZ..: ..........-..: ........... ';.~.~..7 ......... :.~ ..... :.:'. ...... ~: ...... ~ .........
3. Nature of work (check which applicable): New Building.. ................. Addition ~'~ Alteration ..............
Repair .................. Removal .................. Demolition .................... Other Work .....................................................
~' //. ~'~.~/ -- _ ~,~ ~ ~- ~--~ ,J ~ (Description)
4. Estimated Cost ..~......~/..,4~.~..~.'..:.~..... ............................. Fee ....... .~.....Z'..?....~ ..........................................................
-/
(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 ................................ Depth ....................
Height ........................ Number of Stories ............................................... ,..~.~ ..................................... .~..~ ..................
Dimensions of same structure with alterations or additions: Front ...... ~..Z...~...,~..~..~.. ........ Rear ....~...~.. .................
Depth ............... .~...~.. .......... Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories ................................................ , ................................................ .~....,. ................
9. Size of lot: Front .................... ./...~...~. ........................... Rear ...... ../....~.../.. .................. .~ ..... Depth ..... /~....?. ................
10. Date of Purchase .~,......:~'...T..../..~... ........................... Nom,_of Former Owner/Z~/%~,'7~,.~..:...¢....~..'./..~..'.?..'/,'..~.~..~. ..............
11. Zone or use district in which premises are situated ......... ~.'~..~...°'./~..~..r(~....'~./?...~.. ........... ~ ..............................................
12. Does proposed construction/violate any zoning law, ordinance or regulation: ............ ...~..~ .....................................
13. Will lot be regraded .....~/.~..:l,~,~ ~.,~__ --Will exce?s fill be removed from premises:~ ~,( ) Yes (~)"No
14. Name of Owner of premises ~. '~,.~'~'...~./'~'~ ....... Address~?z~.'~..','~./?.//.~.s,~.----~..'Phone No.
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone 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.
STATE OF NE~'~'QI~<I , /~ ,J/ ~SS
coum. Y
...... --~~.~_~~~ ................... being duly sworn, deposes and says that he is the applicon,
(Name of individual signing contrac~
above named.
~e is the .........~.~.~ ....... ~ ...................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to 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
that the work wi[I be performed in the manner set fo~h in thp application filed therewith.
Sworn to before me this ~ __ ~//
......... ......... ' ...... .............. . ,
oto. __ . // ....... ............