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Home My WebLink About11772-zFORM NO. 4 TOWN OF SOUTHOED BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... z.l. zj..7?.2 ....... Date ....A.u.g.u.s..t..1.2. ................. 19 .8.6. THIS CERTIFIES that the building ... ?etch add±tion & Accessp?.y' building. Location of Property 2015 Cox Lane Cutchogue, N.Y. House No. Street Hamlet County Tax Map Bio. 1000 Section ...0.9.6. ...... Block ..... 3. ......... Lot .. ?./.q. ?...2 ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J u n e 1 1 .............. ,19 8..2. pursuant to which Building Permit No .... 1. ! 7.7.2.. Z. .......... dated . .;.q ], Y..3., ................... 19. ~3 ¢, 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 ......... Porch addition & Accessory building The certificate is issued to James D, Roache (owner, x~g~exO of the aforesaid building. Suffolk County Department of Health Approval ................. ~/.~. ...................... ~/A UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 BUILDING BUILI (THIS PER/VilT MUST Bi: KEPT ON COMPLETION OF THE WORK AEITHQR!ZED) N? ~??~ z Permission is hereby granted to: i S~5 UNT L gULL tO ..~.~... at premises located at · .:.~.i ....... i ........ ~'~' i ' BIOCI~ CoB ty Tax Map No. I000 'Section .................. ~..,~,. ' ,pU~s?ant t~o application dated ....... :: ................ ;;.,.....; .......... ......... , 19 .... B~il~Jing I ~hspector. ' ; : ~ ' · ;Lot NO .......................... .., and approved by the 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 ~m I~m~m~ 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 natura~ 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 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 p~operty 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 New C on s t r uc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..................... ........... , ................... ,; C,'/,?.,t,~. ~, ..... House No. ~ *~ ~, Street /) ~-~ Ham/et Owner or Owners of Property ~~ .~.:..~...-~.~'/~.~...~...'...~.~ ........... County Tax Map No. 1000Section...~.~..~. .... L Block .... ~ ....... Lot. ,/~..~..7,t ,,~. .... Subdivision ........................... . ...... Filed Map No..., ........ Lot ~,~ ............. Permit No. (LT.f..~-~J. Date of Permit .:l.~..~....App cant.. ~ .~...~.; .~.../~.:, ./~..0..,~...~./~../~. ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ....................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Rev. 10-10-78 ,,9 0 o Ii 7GS-II802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 'sST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FIL4MING ~ ~ fINAL REMARKS: ~/ ~'~'/~ DATE Examined . .~...~. · FORM NO. i ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' SOUTHOLD, N.Y. 1/1971 TEL.: 765-1803 Disapproved a/c ..................................... .................................................. :? , 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 sere. 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 prope~y 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 Pe~it. d. Upon approval of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such pemxit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any purpose whatever until a Certificate of Occupancy shill have been granted by the Building Inspector. ~PL1CATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe~it pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~lations, for the construction of buildings, additions or flterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordnances, b~lding code, housing code, and regulations, ~d to (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general ~d~ll~6?Z~leA~kli~TE~mber or builder. ........ ............................... 9 .Yf:. ..... (as on the taxTe6fl-b~q~te~t dWetlFO 4 PM F,'~R Z' ~OLLOWING INSPECTIONS. If applicant is a corporation, signature of duly authorized officer, l. FOUNDATION - TWO RFO~ FOR POURED CONCRETF .............................................. 2. ROUGH ~ FRAMING & (Name and title of c~?orate~, officer) 3. INSULATION Builder's License No.. ,C.q<[~.,~. I. ( 4. FINAL CONSTRUr'-~, t'~N ).(~k)$!..(~A&)... BE C'~A4Pl ETE FOR C. 0 Akk CONS-~RUCTION S~ALL Plumber's LicenseNo ......................... THE REOUIRE^4ENTS OF Tbs? N STATE CONSTRUCTION & Electrician's License No ....................... CODES. NOT RESPONS BLF Other Trade's License No ...................... ~,O.,F / ,~-,.$1GN OR CONSTRUCTION ERRORS, 1. Location of land on which proposed work will be done. 30, O,~' //~7---~- · & ...................................................... House Number Street Hamlet ~ County Tax Map No. 1000 Section O .~.ffo Block ~'~ Lot ~q~L r~. Subdivision ~/ Filed Map No. Lot (Name) 2. State existing use and occupancy of premises an,d intended use and o~cupancy of proposed construction: a. Existing use and occupancy.. ~ .~/.~..~../~...'~../../~..~.../.~?/.. ~.~. .......................... b. Intended use and occupancy /z45~¢7-~ ~ ~zg/~Z AY:iT-z4 ~,e,~4 /51-~29/77,~x3 3. Nature of work (check which applicable): New Building .......... Addition ..... Alteration ......... Repair .............. Removal .............. Demolition .............. O~herWork ............... ~//~ .~ ~ , ~ Z~.L~_~/ '-- (Description) 4. Est/mated Cost .C~./.~6~ ................... Fee ~ (to be paid on filing this application) 5. If dweliing, number o f dwelling hnits ............... 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 ...~..Z-..~.~. .... Depth Height.. .............. Number of Stories ~ i i ~ .~. ~"~-~': ..... Dimensions of same structure with alterations or additions: Front . . .~.z_. ~ ...... Re r ........... 10. 11. 12. 13. 14. Depth .... ~.O. ............. i.. Height ....... ~. ~.~ .......... Number, ol~ Stories .... .z-r ............... Dimensions of entire new construction: Front... ~ ........... Rear ... f~.(.~. ...... Depth ./.Z...~..~-. ...... Height ............... Number_of Stories Size of lot: Front ...... ? ~ .,~7~. ,~ Rear ~c9 ~;r r~,,,h Date of Purchase ........ : ...... Name of Former Owne ............................ Zone Sr use district in which premises are situated ..................................................... Does proposed construeti,o~ violate any zoning law, ordinance or regulation: ..................... ~ ...... Will lot be regraded '..../t{.~../.: ....x./y.XA~ .... tWill excess fill be remov~ed frgm premises: Name of Owner of premises .~.&~. .27 /). ,. ~.c~. ~... Ar~t~s , .~. ,~, .Fr..~..~2.> .dg~. ~.d~..~e No..~..~..~.'~... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ......... : ................. Addreis ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and, indicate all 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. STATE OF NEW.~6R~/Z/2 ~_ S S O.F . · ?. ......................... ! .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigrting contract) ~ above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this/ . ............. :/. . ?. . ...... ...... , , Nfll~rV Public, $'~ate of NeW :YOt /~- ~.,//~'/~ ~/~'~'~_~ .... ' '.:---~ ..... ,~ e.,~fOIk Goun~/~' ~ .............................................. ~0, ~u~p~.'?_o~__~,'i~r.i~ ~0 1~)( ~ ~ (Signature of applicant)