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HomeMy WebLinkAbout9782-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15748 Date May 13, 1987 THIS CERTIFIES that tbe building Enclosing deck addition L ..... 1605 Pine Tree Road Cutchogue, New York ocarlon el rroperry ...................................................... House No. Street .... County Tax Map No. 1000 Section 98 ,Block I .Lot 7.7 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 14, 1978 ~ pursuant to wtfich Building Permit No. 9782z dated ....J.u.n.e.. ! .5.,.. ! .9 .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 ......... ENCLOSING DECK ADDITION WITH SCREENING TO EXISTING ONE FAMILY DWELLING bls ' A'P'PL ~[ E'Er 'FOR ................................................................ The certificate is issued to LOUIS E. & BARBARA LaGRAND ..................... ? o¥.'o), g.Xtt 'Z;t X .................... 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 FORM 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) N? 9782 Z Date Permission is hereby granted to: at premises located pursuant to application dated ~J UA/K ! ~/ /'V,~' ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $....L.?.. .............. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Buiidin9 Department Town Hall $outhold, N.Y. 11971 AP, ,-IC,~T,ON FOR CERTIFICATE Instructions A. Thls eEoiication must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor,.vi~n the following; for new buildings or new use: 1. Final survey of property with accurate location of all bui]din§s, property lines, streets, and unusual natural or tooograohic features. 2. Final enorovel of Heaim Oer~t. oi: water supply and sewerage disposai--{S-9 form or equal). 3. Aporcval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple ResMences and similar buildlng~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the buiiding. 5. Submk ,Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildincs and "pre-existing" land uses: - 1. Accurate sunley of peoperty showing all property lines, streets, buildings and unusual natural or to po,'jrapi~ ic features. 2. Sworn statement of owner or previous owner as to use, occupency and condition of buildings. 3. Date of any housing code or safeW inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. ./ 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing d~velling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building(Z) . _~._ .... _. /Vacant Land -. ........... ................................. , ...... County Tax Map No. 1000 Section ............... Brock ............... Lot ..... ~ .......... Subdivfsion ................................. Filed Map No. . ·: ....... Lot No .............. ~ ~,,. **~,o~ .... ~ ~.. .............. ~or ~;. *¢,,o,~ .~,~, ............... ,.. Request for Temporary Certificate ..................... Final Certificat~ ...~..- ......... ...................... Construction on above described building and para'ir meets all app~cabfe~co~es and regulations. Apphcant ., .... ..,.~.._... ......... ".-' ............................. Rev, 10-10.78 TOWN OF SOU~OLD OFFICE OF BUILDING INSPECTOR P.O BOX 728 TOV/N HALL SOUTHOLD, N.y. i 1971 TEL. 765-I 8(]2 Permit 1~'o. ~'~$2_' i~su-~ L-,-=~ ~qe ~o~o unaer Euzlding - - .s~=~_o,: ,,az ~ nas no~ been done. In o~der to com~!ete this file, it is necessary ~.~-cy be issued Please f~ll out the enclosed form(s) , ~-,,~ ' - r .... n same to the above office with a check for $5.00 payable to the Town of Southo!d. Plesse indicate to whom the Certificate of Occupancy is to be mazled, a~d arrange - ~ ~ ~ ~-~h this ozfice for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard ~-dminis tr~ tot VL:ec Enclcsures FOH,~ ~qOo 1 TOWN OF SOUTHOLD BUILDING DEPARTMS~NT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo ~,~o,~ ............. ~ ......... ,,, ........ ~,~ ,o...~ ............................... ................ ............... ........................ {Suildino Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Thi~ 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 of property 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 be~n 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. ..~~'""' '~ ......of :....~-~.dgor name, ......................................... if a corporation) t ress o opp icont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................................... z) i, .................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed ~m, rk, will be done. Map No.: ........................................ Lot No ......................... Street and Number~....~...~::......~....~-J-./,~....~ .................................... Munic~/lity State existing use and occupancy o~. ises a~nd_~inter~c~;u, se .~.~cu. pancy of/p~oposed constructior~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition ................... ,,Other Work ...~..~..C.~.°.~.~......~r..~...C(h-..../~./,-....~...~. ,,~... .-~ ~ ~ ~ (Description) 4. Estimated Cost ~.~ .............................................. Fee ................. X~: .......................................................... (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 ~pe 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 ................................ B. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of Jot: Front ........ Z~..~. .................................. Rear ...... ~.~.~ ....................... Depth ...~ ................ 10. Date of Purchase .~.2.~...., ................................ Name oCFormer Owner ...... ~ .............................. 1 1. Zone or use district in which premises are situated ............. ~ .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ....................................... (~o 13. Will lot be regradedpremises......~,,Z ~ ~ ~W~l exc~s fill be r~moved from pre~es;~~(, ) Ye~ ~ ........................ ~ 14. Name of Owner of .~..~....~f ~ddress 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-Wck ~imensions from prope~y lines. Give street and block number or description according to deed, and shaw street names and indicate whether interior or corner lot. STATE OF~,NEW YQ, RI~,. /~/~ ~e ¢ COUN: .......... .',~..~. ~ n~ ........ ~ ........ being (Name of individual signing contracf) duly sworn, deposes and says that he is the opplicanl above named. He is the .................... ~ ............................................................................................................................................ (Contractor, agent, corporate officer, etc.) of sold owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that oil statements contained in this application ore true to the best of his knowledge and belief; end that the work will be performg~J in the manner set forth in the o, pplication filed therewith. Sworn to before me this U '.. .....