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Home My WebLink About12453-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-15251 Date February 5, 1987 THIS CERTIFIES that the building ....D .E.C.K..a. pp.?.r.?. ............................. Location of Property 1310 West Road Cutchogue, New York House No. Street Hamlet County Tax Map No. 1000 Section .... I. 1.0. .....Block ... 05 ,Lot 0 12 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J u 1 y 12, 1983 . pursuant to which Building Permit No. 12453 Z dated......................Ju 1 y 29, 1983 ...... ., 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 ......... Deck Addition to existing one family dwelling. The certificate is issued to JOHN P. FORSBERG ..................... /o¥,,'o;, )~;$Y~7~x .................... of the aforesaid building. Suffolk County Department of Health Approval N /A UNDERWRITERS CERTIFICATE NO .... N/A N/A PLUMBERS CERTIFICATION DATED: Building Inspector ........... Rev. 1/81 FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST 13E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12453 Permission is hereby granted to: ....... .......... ........ ~..O..:.....z~.~ ......... ~z~. ................. .......... ~...~.c~z~.~.~........./s(... ........................... to ....... ~.z~..~Z..~..c~.. ........ ~..~f ....... ~r~..~..~.~../..~..~....~q.....~.~ ....................... ........ at premises located at ,,,/,,~,/,,(~, ......... ,/,, t,~,.,,..~,, ,/4, ,~,,, ,,?~ ........ ~,, ,~/,. ,~,'~, ,~,(~, ~7,, ,~. :y, / County Tax Map No. 1000 Section .... //..~.. .......... Block .,..~..~.,'~.. ...... Lot No....~./4~. .......... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF BOUTHOLD Building Department FEB 3 - 1987Town I-lail Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted 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 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. For existing buildings (prior to April 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natura~ 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. C. Fees: 1. Certificate of occupancv New Dwelllng,$25.00, Accessory '$10.00 Business $50.00 2, Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 $ 50.00 Date .,~.AI~J, 5. Uodated C.O. 6. Alteration $25.00 New C OhS truc t ion Old or Pre-existing Building Vacant Land .......... ~" i ................ ~,~/et /Youse No. Street Owner or Owners of Proper . .............. , ....................... .. . . County Tax Map NO. 1000 Section .... ))0 ....... Block...-~.. ......... Lot...~..~. · ....... Subdivision Filed Map No Lot No ... .............. .............. Permit No.[~q.~..~...~,. Date of Permit .-7. ~.~ .Applicant Health Dept Approval Labor Dept Approval .... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .~..'~ Construction on above described building and permit meets all applicable codes and regulations, ............................ Rev. 10.10-78 f~, $12, oq FIELD I~IS?E~TION COMMENTS FOUNDATION ( 1st ) FOUNDATION { 2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR 1'.O, BOX 728' TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 Thls ks Co ndvlsc you Chat the job under build{rig permit no, _~2453Z issued to John Forsberq on ..7/.29~.0~l ..... for _Addition is completed and a f~i~;i! ]nspeetiotl has ( ) has not ( X ) been done. fn order to complete this file, it is necessary that a Certificate of Occupaecy be issued. Please fill out the enclosed form, return same to the above office with a cheek for $25.00 payable to the Towu of Southold. Please indicate to Whom the Certificate of Occupancy {s to be mailed, sad arrnnge with thi~ office for an inspection date Occupancy or use is unlawful without a Certificate of Occ.pnncy. l'lea~e help .s to clear up this~ matter so that action doe,,~ not haw~. to be taken. Thank you for yonr prompt attention. Vary truly Vlc~or Le~sard Executive Administrator VL:gar enc] . >/ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH' PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: FINAL DATE~' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ^ proved. I Y. Pe,m,t No. Disapproved a/c .................. ~ .............t (Buildifig Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No....//.~f..~..c)7.~. ..... 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. APPLICATI6N 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 regulations2 and to admit authorized inspectors on premises and in building for necessary insp~ , t~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ....................... ;Z ................ , ........ / ...... "i .... i ......... ..................... Namv ,~f ...... f v,,m,oe- · ....................... · ......... · :. ........ ' ....................... · '1- ~ ~ 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 .................................................. House Number [CD~ ~I, '" · : ~v' ;~ Street Hamlet County Tax Map No. 1000 Section ....... /../..~. ...... Block ...0..~.. ......... Lot...~.~ ~ ......... Subdivision ~ Filed ~ap No. ~ Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~. ~]d.~..d~~...~5 b. Intended use and occupancy . .~ .... ~.~~ .................................. 3. Nat re of work (check winch apphcable): New Building .......... Addition .......... Alteration., ......... Repair .............. Removal .............. Demolition .......... ' ....Other Work.. ~ .... ~ ~lhC~>c.3, ~ ~ ' ~ (Description) 4. Estimated Cost ....~. ................................. Fee . ..~...d~...~. ............................ (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 type of use ..................... 7. Dimensions of existing structures, if any: Front..~..~. .......... Rear .~.c~ .......... Depth ............... Height L ~[-~ ....... Number of Stories ........................................................ Dimensions of sh~he structure with alterations or additions: Front ................. Rear .................. Depth .................... .. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front . l~.c~ ,X,~nD ...... Rear .' .............. Depth ............... Height ............... Number of Stories .......................... ' .............................. 9. Size of lot: Front ........... ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... : .................. 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 ............................ Will excess fill be removed from premises: Yes No 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 block number or description according to deed, and show street names and indicate whether interior or corner lot. <~.~¢ ~ o ¢ ,s,-~{ triot o.c..... / STATE OF NE~ YORK. ~ ~ OUNTYO~ .~,~,r~. '~'~ ....... ~~'.~. '~<~¢~. .............. 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, 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 are true to the best of his knowledge and belief; and that the wbrk will be performed in the manner set forth in the application filed therewith. Sworn to before me this. /.~. --~-~ day of .............. >>" 'F ..... ~10tary PubliC, .state of New Yom ........................................... Ito..52.0344963 Suffot~ ~C~ou~n~t~,~ (Signature of applicant) O~am~tart Ext~ires Mama o~