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HomeMy WebLinkAbout9720-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z9672 Date September 12 ., 19.7.9. THIS CERTIFIES that the building ................................................ 175 Birch Lane Cutchogge Location of Property ~ ~/'o: ....................... ~r~i ...................... . County Tax Map No. 1000 Section ..... .8.~. .... Block ...... .~ ........ Lot ...... 3.0. ........ Subdivision..B.i..vg.h..H..i.l.l.s. ................ Filed Map ~o.. ?.99.~..Lot ~o ...... !5 ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...~.a.y...a ............ ,19 .7.8. pursuant to which Building Permit No ..... 9.720Z ........... dated ... May.. $ 2 .................. 19..7.8 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 ......... ....... .,.~.~.~.~. ~..o.n..~.o...~..~...r.~..~.!¥...~. ~..~.L~.n.~ .................................... The certificate is issued to ...... .Ey...e.r..e~.~..J.t...Pq.g .h.8 .................................. (owner, of the aforesaid building. Suffolk County Department of Health Approval ........ Nf.P~ .............................. UNDERWRITERS CERTIFICATE NO ................ ~fJ~ ....... ../ .................. R~ 4~ 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 9720 Z Permission is hereby granted to: ...&.C&.!:../,.....%i ........ ......... at premises located at ........................ ~.~...~..~'~.......~./.../}..-.('-.../7-.~ ......... ,~..¢..~-/-~,~ ...................................... ~' ?'~// (? (~ ~/Z~ 1. ~9 7 i ~ ~/ /:6 t1 t'-t/ ~ /, ~* C-' L't~ r/:~'~ ~ ~~ ~1~ ~ "/ ~ D~ pursuant to ~pplic~tion d~ted ............................... ~.~..;' ......... ~, 1~ ...... , and opproved by the Building Inspector. BuiMing Inspector TOWN OF SOUTHOLD , Building Department Town Clerks Office Sou~hold, N. Y. 11971 APPLICATION FOR CER'rlI~i~ATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, end submitted in DUPLICATE to the Building Inspector 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 dispos~l--(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 installations, 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 property 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 formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ..... .8.../..2:..2../..7...g. .......................... New BLiilding ................ Addition .....~. ......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......................... £~.~...J~i~'~.~..~.~e.,.C~JcC~o~;1J~ .................................................. Owner Or Owners Of Property ...~;..v..e..~.e..~.~.....J.,;...~'?;,c.h..s. ............................................................................. Subdivision ~..~.G~..[~[~ ......................................... s Lot No...~.~. ..... Block No ............. House No......]~.7.5. . i · Permit No...9.?.20 ......... Date Of Permit ....5/,..2~/.~..9Apphcant .~::e.~,t;..~o...~..~¢b,$ .......................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate .......................................... Fee Submitted $ .................................... Construction on above described building an~_p~ermlt meets a}l apj~licable, codes end regulations. ............................................. Sworn to before me this ........... ~,~,. day of .,.~.t..1,g.l~.~. ............................ Notary Public o~.~ ....... County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............... ...... ,,proved .............. ....... .... Disapproved a/c ...........,~"'""'"'~" ,,: ............................................................... .......................................... ............. (Building Inspector) Application No. ,~,,,.Z..~.....,.~, .............. APPLICATION FOR BUILDING PERMIT 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 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 Deportment 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, os 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. G~zynne Construction Cor~.. (S'gnoture at al~plicant, or name, it a corporation) (A~RslD ~/~ Dpl~iSa ~t~ T j~lD State whether applicant is owner, lessee, agent, architect, engineer, general contractor elec~ t~r-or builder. FEE=~ ~ BY Builder ' - ~Y:~ ................... 7~5-2~60 9A~ fo 4P~ FOR REQUIR. Nome of owner of premises ....~...~.,...~.~S .............................. E~..INSP~GN~: ................................................ If applicant is a corporate, signature of duly authorized officer. ..... ........ ~ (J~gme~ an~ title of.c..orporq.te officer) _ ~.verecu d. ~ucns,vzce ~resz~enc Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. BEFORE BACKFILLING FOU~.;DA. TiON OR START F[<A;,;;NG 2. FRAMING INSP~CT~©N 3, BEFOR[! COVERING P~F'f-g CF ANY KIND 4, FINAL WHeN JO~ CO/.:PLDFED NOT RESPONSI3Li~ FOR D~5~GN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTiOn{ ~{U~T 'M~ EQUIR~EN~ .... N Y STA AN-~ ..... T~, . · TE CODE ~ TOWN H~SiNG CODE &'ZONING 1. Location of land on which proposed work will be done. Mop No.:/~90~ ............................... Lot No.t~ ..................... Street and Number ...... .~...~..~.?-,...~......].~....~..e.., ........ ,!...~..~....~...~..],.....~. ............................................. .C.u.~g..~..,o.~,.u..e' .................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... .o...q.e....~...aAt....i..1.1(...c]..w:e..1...1..i.~g ............................................................................ b. Intended use and occupancy ............... ..~..~..'~...~... .................................................................................................. 3. Nature of work (check which applicable): New BuiJdJng.. ................. Addition ...... x .......... Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... 4. Estimated Cost ..................... ~ ...................................... Fee .......................................................................................... (to be paid on filing th~s application) 5. ff dwelling, number of dwelling units ............................ ~umber o~ dwelling units on each floor ............................ ff g~rege, number of c~rs ............................................................................................................................................. 6. ff business, commercial or mixed occupancy, specify ~ture and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...~.~.~. ................... Rear ....,~.~,~. ..................... Depth .~.~ ............... Height ........................ Number of Stories 2 ............................................... Dimensions of sa~e structure with alterations or ~d~itions: Front ....................................Rear ............................ Depth ................................ Height ............................ ~umber of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ..~ ......... ~ .......................... Rear ....... ~6~ ............................. Depth .~56..&...~ ......... 10. Date of Purchase ..... .~.~.;~ ..................................... Name of Former Owner ~.~.~.~c%..~t~g~,...~Z~.~.' 11. Zone or use district in which premises are situated ...... .~.~.O.L~.'~. .................................................................. 12. 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 ~e~e.Ct..J....~uc~s ............. Address~...0,..~x...~6.~. Phone No.~g&,~0.7. .... Name of Architect ~.r,...~.~.~ ................................... Address .~.~...~.~.~..... Phon~ No. 878-9607 G~e Co~s~uctio~ Cozn .... ~pton 3ays Phone mo ....................... Nome of Contractor ........................................................ .c. ~aaress ................................,. 728-922~ PLOT DIAGRAM Locate c/early and distinctly all buildings, whether existing or proposed, and indicate aU set-~ck dimensions from prope~y lines. Give street and block number, or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ¥.PR~,.,~,- ~SS COLJNTY OF ...... ~...~..~..~...u..~...~,, .......... .................... ~..-~e.:Ee.~,.t....J.~,.,F~te~g .................. -, .................. being duly sworn, deposes end s~ys that he is the ~pplicom (Name of individual signing contract) above named. He is the ..................... ~c~..B~e,s~e.~ .......................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this application; that ali statements contained in this application are true to the best of his knowledge and belief; and tk, ar the work will be performed in the manner set fo~h in the ~pplication filed therewith. Sworn to re me thru ~ ' ~, ~ G~ne Construc~zon Corp. ~.. day o~,...J...ff~ ................. 19.7..~ ~ -- ~ .... ............. ............... k,~y//;~f~"~7/;-;~"L~'' (Signature of applicant) · x~iTZ~j~%~~~ Evere~tJ. ~uchs, Vice President BUILDER'S JOB NO. ~ TITLE NO. 1'HE EXISTENCE OF RIGHT OF WAYS AND OR/EASE/',AENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTFFD. CESSPOOL, SEPTIC TANK AND OR WATER SERVICE ,~; PET BUILDER AND C'UARANTEED i MAP NO. ~1~i:~31~ DATE 1,.//.//.- · /.~./--,~J~. LOTB /5 BLOCK ~r, ilg~',,,~.=~ .A N D SURVEYOR'~ 144 MEDFORD AVE. · PATCHOGUE. N. Y. I ~. ~. · .-.,,~-- ~..--,..--.-, ,~... .--. ~...,-- ........ · / I LIC, NO. 47401 516-475-0349 I j ,~-,-~v ~--,-.,~-,~--,'-¢~-4-~.~ ---~-"--,-~.-~--~ c--cJv Iv. ~. I I-~C-~lO.e~aJ~ ~ JSURV£¥£O:/~-,~2'-7G ~.x,~,~,~= ~*.~-/ --o~-.~:,J IeUARANT££O TO:_ ~-E,4,~/TY' ~'/r/._~ ~'C~v./,4,~. C~:>. ~ SCAL£:/,~. ",-~,-x:. ~*,~'¢V..~-/ '77 Z/.~'. - FI~-?-~-~ r,LE "0.~--~:~/7