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Home My WebLink About12063-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14331 Date April 2 ................................................. 19.86.. THIS CERTIFIES that the building ................... .A.c.c.e.s..s.o.r.y. .................. Location of Property ...4. 5. Q.5 ............ .D.e.l?.o.t..L..a.n.e. ........ Cutchogue House/Vo, Street Hamlet County Tax Map No. 1000 Section ...Q 9. .6 ...... Block ..... 0..5 ........Lot .... 0..0.1...2. ....... Subdivision .... X .Filed Map No ..... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...N..o.v.e.m.b..e.r....2.0 .... , 19 .8.2. pursuant to which Btfilding Permit No. 12 06.3 7. dated ..... p.e. qe..m.b?.r. .... 9 ......... 19.8. 2., 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 ......... · .~ 77.-.~ .-.-...5.c.r.%qu..~.~.u.r.?.~. .s.~.9.r.a?...%u.~.~. §.~.n~., 77.~TTT.-.~T .-.- ................ The certificate isissued to ........ CYBULSKI t THOMAS & ANDRE ............. io¥,'o;,'ai.~'~im~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ............ N/R N/R UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector · Rev. 1/81 TOWN OF TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON '~HE PP' IS UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted ~un~ TQ~ ~ep No. ]000 Sectmn ......... ;, ........ r... BI~k .~:.~..> ............... ~Lo~ No ......................... pU~ua~t to opplicotlon dot~ ..................... : .................... ,..~....~;...., 19..-d..~ ond opprov~ by the Building Ihspector. : Fee $ ........ ; ............... Rev. /30 ao FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted =,lmmmmaaa 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 featu res. 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 pZOperty showing all property lines, streets, buildings and unusual natural or topographic featu res, 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 $ ].5.00 3. Copy of certificate of occupancy $1.00 ..00 5.Updated C.O. $15.00 Date ........... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Owner or Owners of Property ............................................................ County*ax Map No. 1000 Seetion .~..¢~ ....... B~ock ...d.~..T ...... Lot .... ./.~....):>...... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo,/..~.~. ~.~. ..ZDateofPermit/~/. ~.//.~',,~pplicant ..P~?'. ~ Health Dept Approval ~ Labor Dept Approval ........... Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempo~ary Certificate ..................... Final Certificate ...../~.... ............. Fee Submitted $ :'..~,~i,~,~, ................... Construction on a~bove described building and per, nit meets alt applicable cod~ and regulations. ~~1 ....................... Rev, 10-10-78 FIELD ~NS~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDI~ONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine e .... ..... Disapproved a/c .......... '... (Building Inspector) Application No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 appli- cation. 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 issued 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 in building for ngeess'4r~ inspectiffr~s. /~ /7 /~ (Signatu~ of applicant, or name, if a o poratio ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build,er.~ ....(~.x~.. r~.~./~ ................................................................................. Name of owner of premises . ./kTf. OAfl./].-5'....~.../~. ~. Df~....~.. ~.~5.[d.L,ff.~r. 1 ............................ (as on the tax roll or latest deed) If applicant is a corporation, 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 ...................... 1. Location of land on which proposed work will be done .................................................. r Hamlet / 0 ~ House Number Street O(~& .iQ ~"~ ~ County Tax Map No. 1000 Section ..... ~ .... Block ..... ~ ........ Lot ................... Subdivision .... .~ ............................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... F/q l¢.. .~l. . . ~ U.].Z..D./tD.~ .5' .................................... b. Intended use and occupancy ...... .']~x'~g~. bq .... .~.. 7~.O.~/q.G.,~' ..................................... o 9. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .......... Addition...t(. ...... Alteration .......... Repair' Removal Demolition Other Work (Description) 0OO.' /6:., Estimated Cost .......................... Fee .... ~ ............................. (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... .... if any: Front Rear Depth Dnnenslons of existing structure~, ............................................ Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth. ................... .. Height ...................... Number of Stories ...................... Dimensions of ent,~ire new construction: Front .... a:~./. ....... Rear .... x.~, .~5 .......Depth ............... Height ....... ~ ...... I~umlber of Stories .......................................... ~ ............. Size of lot: Front . .~.0~.4/.O. ................ Rear ..... ~ 6?. ~ ./ .......... Depth . .%/.2~ ............... Date of Purchase ~ u. ~...~ l .~..7.-~ .......... Name of Former Owner/~.fu2)aV~.. ¢4.. O~...C. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation ./I/~.. ........................ ~,.. Will lot be regraded ./V. oJ..~.. ....... .~ .......... Will excess fill be removed from premises: Yes (No2> Name of Owner of premises/Iqg~./iaq...(~'Y'~UJ-.~BT./Address~14~.c... ,~/J~.. .... Phone No.~.,~.~. 7.4"~, .q.~ Name of .aa~l~-oet ~c.~ &'.D~q'...~..k'~./~'~ ~rr .t.,. Address ~.u).~o o.d..~..~ ..... Phone No. 7~.q.'~. J~ .~./o.. Name of Contractor ......... ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail! buildings, whether existing or proposed, and, indicate ail 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. lB7' / x, ,5'z'gO / %x~. STATE OF NEW }'ORK .... COUN~YOF.~ . ~'~ ---, ~ , ~.~.~.~..ff~......'~...~'~r.. ~ ~... being duly sworn, deposes and says tha~e applicanto (Name of individual si~ing cofftract) above named. ~H~the .......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this application; that ail statements contained h this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ..... ~ 7~ ........... day of .~~ ..... 19~ ,, R~SlglN¢ IN SUCFOLK coulqr~ --~~ ~~~/ (Signatur0~f ~plicant) : ' No. 5248?5900 : ~ C6mmlsde. ExpJr,s March ~0, 1~4~,