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Home My WebLink About12447-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~1970 Date October 6 $..3 .................................................. 19 . THIS CERTIFIES that the building ADDITION LncatlonnfPrnn~rtv 315 Fleetwood Rd. Cutchogu9 Ho?e No. Street Ham/et County Tax Map No. 1000 Section . ...q.3.? ..... Block Oq- ..... Lot O~lq"~l ~: : Subdivision ?..Zg?.t.w..o.e.d..0..o.v? .............. Filed Map No. ~..~.~.3 .... Lot No .... ~./.? .//.2...o.~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... 0'.Lin...e...2.2 ......... 19.~. 5pursuant to which Building Permit No.. ~ ?.~.~.7.g ............. dated ...... .~.~.~... ~7 .............. 19 .~.~, 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 ......... .... ~.gr..~...d.e.e.k...a.d.d.~.t .~.o.n..~.9..~.n., .e.x~s.~..~.n~, o..n?..~.~..m.~.~y...d.~.~.~.~..~.n~ ........... The certificate is issued to F..R~DRIC FALCONER (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .......................... . ................ ' ........ Building Inspector Structure may be subject to frost action due to improper depth o£ footings 1~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, No Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12447 Z Permission is hereby granted to: ..... ~.~...c..~.......~.&.Cc?.~..~.,~ .... .~..,,....~'.. -'C~.~.~.X.~ .....~..,~: ............ . / to .......... G..~..~. ~zE..¢z.o. LE........~..~d~..../a.~.~...~.~.../..c?~......./...~DL..~-~/..u~.~,... - / ..... ~..~ .~.~..~..c7. .................................................................. ~ ........................................... at prem,ses located at ............................. ~..~.k ..~.~..~..Z~.....~..~.L~...~.. ................................. ........................................ ....~..~.~...~.._/~..~.~...~.,. ~ ~..~-z.:i..V.a~.~......C~..~...4. ......... ~L./.d...(.~ .................. d~ ...... .:?...=..~.,,e.~....do. .......... County Tox Map No. lO00 Section ..... L,~..~... ........ Block ..... {~...~,.. ....... Lot No..~.Z..,.~..:.~ .... pursuant to application dated ..... .~./~....~......rid .................... , 19Z.-~..~ and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 land use 3;/ $5.00 3. Copy of certificate of occupancy $1.00 Date '''C~ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .3J~. .... .~. }.<~...~. ~.~...~.0. ,).....C~C~ .~.~ .~., .~. ...... House No. Street Ham/et Owner or Owners of Property .~..~.~-.~. ,C~...~- i~.~...../.~.~. J.C_.O..t~..~...~. ................ County Tax Map No. 1000 Section .../..~..? ....... Block ....4~...~. ....... Lot...~.../~..'. ( ..... Subdivision...~./~¢.~..W.~.~.~... £~ .~.d .... Fi~ed Map No. /.~. ¢. ~...Lot No. ~..~. £.~.~K ?.¢ Permit No. /. ?. .~,~?.~, Date of Permit 7/0~.~'/~..~, .Applicant .~,, .¢~,, ,~,,, i?,, .~.., ?,Z?'~. ,"~,C,~. ,0~,.'. Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval .... , .................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building an~e~ll ap~icable codes and regulations. Applicant . .,L~, ....... .,~'. ,"...~. ,~,..,~T .......................... Rev. 10-10-78 ~.o.~ ~//~ ~ .z~ ~ o~¥oo ~~ FIELD ~INSP~CTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q~DE FINAL COMMENTS AL COMMENTS N~J YORK STATE DEPART~E~T AF EHVIRON~IE~)TAL CO~SERVATIO~ Regulatory Affairs Unit Building 40, SUNY Stony Brook, NY 11794 t)O PERHIT NECESSARY - TIDAL ~ETLA~DS ACT Henry G. Iiilliams Commissioner Re: A review has been made of .your prooosal to: Location: It, has been determined t. hat no permit is.necessary under ~Arti cl e ?,,S., (Tidal 4etlands). However, any ad6itfonal ~ork or mEdtficattons to the project may require a permit. It is you~ responsibility to notify this office in writing tf such additional work or ~difications are contemplated. Assuming you have obtained any other applicable permits, you may proceed with your project. Very truly yours, Daniel J. Larkin Reginal Permit Administrator DJL:RNT:ll i, t ! FORM NO. 1 - '. TOWN oF SOUT.OLD BUILDING DEPARTMENT//~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined Approved· / (Building Inspector) APPLICATION FOR BUILDING PER~IT Application No. 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, housi.~c_ode, and regulations, and to admit authorized inspectors on premises and in building' for necessaryxi~l~pections. , ._~...~/ ................. ~ __ (~ailin. g address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene~'al'~ontract~ e'Ie'ctr, fcian,~ "oe o b ilder. ......... .Own ............................................................................ Name ofownerofpremises .~.~d.~[.~lC-.~...~..OJ~olcl.~:..l~. .......................................... (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 LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Loc~tion of land on which proposed work will be done .................................................. · .... ......... Cu ...... qe.*..., N. ....................... House Sumber Street Hamleff [ ¢ / _ ~ 2, State existing use and occupancy of premises and intended use and occupancy of proposed constrhction: a. Uxi~tin~.se and occ.p~no~ ...~¢.~ ~P ~.rt 6.¢. ............................................... b. Intended use and occupancy ... OD.~,¢O,~ ...... ~ .......................................... 3. 'Nature of work (check which applicable): New Building .......... Addition...~.. .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~. ~ ~ :~.o. (Description) 4. Estimated Cost ...................... Fee .................. ~ (to be paid on filing this application) 5. If dwelhng, number of dwelhn~ umts ....~ ........ Number of dwelling u[.~ts ?n each floor... ~/~.~.... If garage, number of cars .... l ........... [~t./~. .......................................... ' ..... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .... ,~.~ J. Rear .,~.*... Depth ...~.0). Height .... [5 ......... Number of Stories ...... 1. '.]. 'P. .................... : ................ , ........ Dimensions of same structure With alterations or additions: Front ..... -~.la L.: .SA/AK. Rear ... ,.~A~'6~ ........ ! Depth ...... Of~..~ .......... i... Height ... ~,$) .... ~kmber of,.~kories ~A~.. . 8. D~men~s° of ent,~exne~w~ construchon, Front~..,~/~ ~elgn~'.,. ~. Iw.. Number oi ~torleS ~ .................................................. 9. Sizeoflot Front .'I~! i . . Rea/. 10. Date of urchase . ./Y~h.~ '1'¥i* '~'~'[8' ............ Name. 0fFo ,nner Owner .~. C~.~,...'~.....V.c~,~.I~N .~ ..... 1 1. Zone or use district in whfch premises are situated... [2~ ~, ~ ~-r.~ ~,.~-, ......... 12. Does proposed constructinn vi61ate any zoning law, ordinance or regulation: ..~.~ ................. 13. Will lot be regradea . ~ ~ ._..: ........ ; ........... Will excess fill .b.e remov .d fro . ' · ~,~Y,,s kNoJ 14. Name of Owner of premises~/r{d¢¢t~,k~ ;~¢~, . Address ~ .-~x~,~..'I-.h: .~..~6 ...g. . ~.ISZ~; 9..-~..~.~.~.. .... Name of Architect ' Address Phone No Name of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly al1 buildings, 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 ~O,,R!~,~ COUNTY OF...¢.~..."Y~C...'~Z..~-... :S.S · · ~~. · · ~fi~99 ...................... being duly'sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dulY authorized to perfo~ or have perfo~ed the said work and to m~e ~d file ~s application; that ~1 statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ne~ set forth in the application filed thorewith. Swomto before me this Nota~ Public,. ~. · ~ ~~ County ~ ~IARY PUBLIC, State ~ No. ~0-6357412 qualified in Nassau CounW ~ (Signature Of applicant) ~mmlsslon Expires