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Home My WebLink About11956-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...7~3,~.~.3. ........ Date December 13, 1982 THIS CERTIFIES that the bnilding ................................................ Location of Property ..... 5.75..?ine Tree Roadj Cutchogue House No] .................... ....................... h~r3M County Tax Map No. 1000 Section 104 . .Block 0Z .Lot . 007 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... qc..~9.b, ffp.' .4 ........ 19.8. 2. pursuant to which Building Permit No .... 1.1. 9. ~.6.Z. ........... dated . 0.c.~ obe;c.. ? ................ 198.2.., 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 ......... .... acc.essor.y., s .g.o.~a, ge..b.q $ ~.ci.~n. g ............................................. The certificate is issued to ..... F..~¢~.tino Addonizio (owner, ............. /rt~) of the aforesaid building. Suffolk County Department of Health Approval ..... N./.6 .................................. UNDERWRITERS CERTIFICATE NO..~./g ..................... Building Inspector Rev. 1/81 BUILDING DEPARTMENT~ TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMITI! (THIS PERMIT MUST BE KEPT ON 'I~HE PEEMISES UNTIL F COMPLETION OF THE WORK AUTHORIZED) No. 11956 Z )LL Permission' is hereby granted to: ~o..~ ......... ~ ..................... ? ~ " ' i' ~' ....... !~ .......... .....'~<~... ~-../,.~ ~"' ~ ?. ~ · ............ ~. ............................................................................................. ~-~..,~....~ ........... ~ ............. ~. .......................... .... · - ........... ; ........................................... ; .................... '.'"~ .......... i""~ ........ ~'"'~"~ ........................................ county Ta~ Map No. 1000 'Section ..~..~....~.......L..+ Block .~.. .............. ~Lot No.~..7... ........... C~.,,,'.~.~....~.... ' ...... " .......... ~.~_, 'pursfuant lo application 'dated .:~ ~.;; , 1 ~' and ~pproved by the Building Ih~spector. Fee ............... Rev: 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Depertment Town Hali Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of ail 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 dr 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" [and uses: 1. Accurate survey of peoperty showing ali 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 prem/ises, 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 ............. Old or Pre-existing Building(Z) ......... : /Vacant Land .... Looat on of Proparty House No, Street Hamlet Owner or Owners of Property ........ .%.. ~-~ ! rD County Tax Map No, 1000 Section /(-Q Block P. Lot.. (3 Q ..~... Subdivision ................................. Filed Map No...; ....... Lot No. Permit No, . . Date of Permit Applicant · '~- ~ ~ Health Dept. Approval .... . .~..<lr ............. Labor Dept. Approval Underwriters Approval .... .~J~ .............. Planning Board Approval Request for Temporary Certificate ..................... Final Certificate' · / Fee Submitted $, ~ ¢o Construction on above described, building and permit~eets all a, pp~cable_~ o,des and reg, ulations. Applicant... 2 - :' "/ ........ D ............. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G~ODE FINAL ADDITIONAL COMMENTS: TOWN OF: SOUTHOLD BUILDING DEPARTMEMT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined~. '7 ...... ,19~ Appncat~on No .......... Disapproved a/c ........ .-UT.. i.. ~ .................. __ (Building Inspector) APPLICATION FOR BUILDING PERMIT OC,,'~" 4 ., 19~l~- Date ................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted.-& :~.'_._~*_'= to the Building Inspector, with 3 sets ct 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 detai/ed 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 iss'~ance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Pe~=nit 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, a~d to. admit authorized inspectors on premises and in buildings for ~',ecessary inSA~ections. ' ~ (Signatu.~.,fi f applicant, or~ ~ co~t~ra~ion~ , .. /. ,/ ............. :.,-¢,.~. ~. tH...'... ;~<~.'.~ (Mailing address of applicant) ,~,/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ...: .................... .. ....... , ..................................... ....... .. Name of owner of premises .~.~.. ?....~..~. ~.... ~.~..,~...~Cj~..~~'~ , ..... .. (as on the tax roil or latest deed) O/ 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 ~ro~sed w,0~ will be done ...... .~,] ......................................... ..... ............................... House Number Street (,,/ Hamlet County Tax Map No. 1000 Section ...ff~/..~..~... Block .../...t~.. ......... Lot ..... './'.....' ........ Subdivision ............... ~..~.)'b./?·~ ............. 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 occupancyt7 ..... (.'~.....'..~... ~[....~..~?:. ......................... ..... b. Intended use and occupmmy .......................................................... 3. Nature of work (check which applicable): New Building,,~.~/~... Addition ........... Alteratio~ . '..". ...... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ......... . ......................... .Fee ..................................... (to be paid on filing this application) 5. If dwelhng, number of dwelhng iumts ............... 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 ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... tieigh~ ............... Number of Stories ........................................................ 9~ Size of lot: Front .......... ~ ........... Rear ...................... Depth ...................... 10.}' Date of Purchase .......... : ................ .X Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................ 13. Will lot be regraded ........ 2 ................... Will%xcess fill be removed from premises: Yes 14. Name of Owner of premises .................... Address ................... 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 blocklnurriber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF,NEW )~,g)RJ~,./..~ 2 COUNTY OF,w_~(-r'd~..,S.S: ............................ ; .................. .. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................... ....................................... - ............... : (Contra~tor~ agent, corporate officer, etc.) of said ow,ncr or owners, and is duiy 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 will be performed in the manngr set forth in the application filed therewith. Sworn to b~fore me thi~f .............. .... JUDITH T, TERR ota~ Public State of New York --. ; , . ~~~~~~ - J ~o. 52.03~.963 Suffolk Cou~ ' ~ ................. , ~ Ooffimisslon EXp res Margh 30, i : I