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Home My WebLink About10023-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ 5/4~ Beaohwood Iioad Cutchogue · l~,Y.Hamlet Location of Property House No. Street County Tax Map No. 1000 S~ction 1 6 ..... Block Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....0.q~. 9.b.off.' .2.2 ...... , 19 .T.~. pursuant to which Building Permit No ....... 1. 0. .O .~.~.Z. ........ dated .... .~.o.y.e.m.b.e.V..1 .?. ..........19.7.~. , 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 ......... Garage The certificate is issued to Virginia m-zd Paul Sutel~ .................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ........... .~?.R. UNDERWRITERS CERTIFICATE NO. N/It Building Inspector Rev 4179 FOR~I NO. ~ TOWN OF $OUTNOLD 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) N°. 10023 Z Permission is hereby granted to: ~.~J.~:~.. ........... Z:;/.-..~.Z.~.:?L/. ...... .~?.?~.!i.!/. .... z~i'c_ · ...~£ ....... ~/..,....~:..,:..~./. :. ~ ............ !.~. ......... :~!./..7..~./~ pursuant to application dated ......................... ~.~....f~. ........ ~.,~....., 1~....~..., and approved by the Building Inspector. .................. ¢ ;(.~ ,~,~z.....~.~.i ........ Building 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 typewriter 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 disposel-(S-9 form or equal). 3. Approval of electrica~ 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, 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 , $5.00 New Building ..... ~v~ ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ............... · .... House No. Street Hamlet Owner or Owners of Property ...... 4m ........................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../.~..~.~. :~. ~-. Date of Permit/.~..f.//.7.~ .Applicant .......... ¢~/¢ .................. Health Dept. Approval .... .,,M.I~ ............... Labor Dept. Approval ....................... Underwriters Approval ..... '.~t.~.~.~ .............. Planning Board Approval . .. ~r',/~ ............... Request for Temporary Certificate ..................... Final Certificate . ~ .............. Fee Submitted $...,,~.~. · ................... Construction on above described building and permit meets all applicable codes and regulations. ,.,o.,o., August 11 , 1980 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 John Bertani Builder Inc. Colonial Road Southold, New York Dear Sir: This is to advise you that the job under Building Permit No. 10023Z issued to V.W. Surer on . Nov. 17, 1978 for ~rage appears to be completed as of our la~ inspection. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention. Very truly yours, GEORGE H. FiSHeR Sr. Building Inspector encl. TEL. TOWN OF SDUTHOLD OFFICE OF BUILDINE~ INmPEI'~-TO~ TrlWN I'~.LERK'S OFFICE c~OUTHOLD, N. Y. TOWN OF SOUTHOLD Building inspector's Office Town Clerk Building Southol.d, N, Y, 765-2660 TOWN OF $OUTHOLD ~' BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined, ~ / ( 7 19 .~...~ Application No. /'a pro,ed .............. ,o. Disapproved a/c .......... ~~ ............................................................ ........................... (Building ~nsp~tor) 9~ ~ ~aa6 ~ ~e~V~PLIGATION FOR BUILBING PE~IT 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets m 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 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 ir~ buildings for necessary inspections. (Signature of applicant, 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 If applicgnt is a corporate, signature of duly authorized officer. (~ome ond title of corporoto officor) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on which proposed work will be done. Map No.~CFR~'.../~:..../~¢/<'.....:...~.i.... Lot No..~.g.~ ........ Street and Number ~<~(1~-~is:~ ~2 ((~' of~- ~~ . Municipali~ State existing use and occupancy o~ premises and in~ended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... ~ ................................................................................................. ........ ................................................................................ b. Intended and 3. Nature of work (check which applicable): New Building.......~.. ......... Addition .................. Alteration ..... ~.~ ......... Repair .................. Removal .................. Demolition .................... Other Work, .............................................. (Description) 4. Estimated Cost ........ .'~..~...~. .......................................... Fee .......................................................................................... ! (to be paid on filing this application) 5~]?lf 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 ....................................Rear ............................ Depth ................................ Height ............................ ~,-~. ~N~umber of Stories .................... 8. Dimensions/L.of,entire new construction: Front .~?. '.~....¥... ................... Rear ........ ~.¥.. ......... Depth ...~...~.....i ....... Height .....~'.~. .......... Number of Stories ..... ~...r.~-..~'.. .................................................................................................... 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 ........................................................... ~.7~ .................................. ]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ...... .¥~.~ ............. Will excess fill be removed from premises: ( ) Yes (~ No 14. Name of Owner of premises .~.~.-%..,V. LS.?.~.~3z~..~.....~...'.q..-C.~.~. Address ................................ Phone Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor [~..J.~.....?'~.'~.~.l,......~:;kq.¢.'..~..~..!.~..... Address ....~..0..~.~f7..¢~, ~..(~.. Phone No. ~'..~...'T.(..$~.~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property Hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW yJDRK,, ~, /2~lSS COUNTY Of .~.....~..~.f ' ......... ,~.. ~ &..-~J~Z~#~,£,. ............. ; .................. being duly sworn, deposes and says that he is the applicon, (Name of individual signing contract) above nome& (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that off statements contained in this application ore true fo the best of his knowledge and belief; and that the work will be performed in the manner set fodh in the application flied therewith. Sworn to before me this ......... ....... o, ............ .... cou, ............... ..................................... ..... ~--~--~ .............. ~ ~ (Signature of app icant)