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Home My WebLink About12237-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~;I-2,1.77 .......... Date ....... cTAN~JAR¥. '3 ............... 19 -83 THIS CERTIFIES that the building .. ~ISDITXQ~ .................................... Location of Property 680 ivI~SON. DR. CUTCHOGU~ House No. Street Ham/et County Tax Map Ho. 1000 Section .... 10g. .... Block ...... .7 ........ Lot ......... 2...:..~- Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ~.R.~.I:I :~.~t ......... 19 t3.2l pursuant to which Building Permit No. 12237Z dated .... A~I~tru. 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 ......... ....~.o.r...a.n..a.d..d.J..~.J:.o..n..~.9..an existi.ng one family dwelling The certificate is issued to ...CHgl~.LE S. ~ .ELI..BOY/kI~ ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO .......... N./..A ..................................... Building~fnspector ~'owN OF SOU?HOLD BUILDING DEpARTMI~NT TOWN HALL ~ $OUTHOLD; N. Y. i BUILDING F~ERMff (THIS PEP.~IT MUST BE KEPT OH THE PRE/~IS[S UNTIL i COMPLETION OF THE WORK AUTHORIZED) ~ ~ULL ; N? 12237 Z Date ~ ~ : permis$iol~. is hereby grante~:~ ~/~~ ,~~ , : .... ~o .: ............................................................... ...: ...... '~-"-:" T'"~ ..................... ...... } .................................... ~.....~...~......~....:.... ........ :s~ ......... ~....; ............. ......................... ¢ ....... " at pr,m~t~d at~...~ ............................... ~.....~.~?.~ ................. : ............. ~ ................... ............................... ~ ........ ~ ....... ~..~ ..... ~ ................. .}. ............. : .............. ....... :' ......... ~ ............................................ 7'~'"'~'"'~ ........... ::"' ~;'"';'"}~"~ .......... ""7 .................. ~un~ T~x ~p ~o. 1000 S~t~ ~.~ .......... L...,...,.,~lm~...Z .......... ~ ~t ~o.: ....................... pUt'ant io ~ppllc~on d~t~ .......... ............. ~..~, j . , ]~.: ~ , and ~pprov~ b~ th* 'Bull,~ ng I~Spector. Fee t.,.;.,..; ............... Building FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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. 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 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 occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling land use --?re-2;x±stinC C.O. ~15.00 3. Copy of certificate of occupancy $1.00 Vacant. ~.and C.O. $ 5.00 ......... New Building ............. Old or Pre-existing Building .....~'..' ...... Vacant Land ............. Location of Property .. C) .~.'.~;~.~.c'~..h~.. i~zt.~,~' .~-.¥.T~.¢.-/; /:" ........ .~..d~..~,.-~ .................. House No. Street Hamlet Owner or Owners of Property ~/-/~,~-,'~ ~J~ ~" ~- f~z_.; ,~,~, ~. ~ ~ ' .Z. .-J. County Tax Map No. 1000 Section .../. ?. ......... Block ............. Lot ............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./!~..~?.?. .~.. Date of Permit¢. ~. .... v..Apphcant ................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Request for Temporary Certificate ..................... Final Certificate..' ' '../-~....... ' ' ' ' ' ' ' . Fee Submitted $ ..... .~-,-~/....~.. ............... Construction on above described building and p~t~./t~./app~le ~odes and regulations. Applicant ..... .--; .¥~, ,~'~,,, ,~¢-~"-,~:~ ....................... Rev. 10-10-78 FIELD INSPECTION ~ ~ COMMENTS FOUNDATION (1st) FOUNDATI'ON · ROUGH FRAME & (2nd) PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: ioooT~i THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 in the follo~in~ Ioc~tlon; ~ S~sement ~ ls~ FL ~ ~nd FI. Section Bloc~ Lo~ ~0~ ~ l~ and found to be in compliance with the requiretnents of this Board, FIXTURE FIXTURES RANGES ~OOKINGDECKS OVENS DISH WASHERS EXHAUST FANS VA~. ~T. K W AMT. ~ K' W ~T K W ~T. K W. AMT. H P This certificate must not be altered m any manned return to the office of the Board d Inc~rrect. Inspectors may be~ifl~d ~hei~redenfioJs. ' MANNER. i I I .T..Z, ~,4, ~0 "W. -'r~.B4 ' NEW YORK STATE DMPk/TM~I' OF F}r~££O~'~3~ COI~$MRVATION Regulatory /,ffoirg 3ui/ding 40, SUNY Stony Brook, NY 11794 Robert F. Flacke Commissioner Re: Dear NO PERMIT NECESSARY - TIDAL WETLANDS ACT This is to inform you that we have determined that your proposal to has been reviewed and that it has been found that no permit is necessary under A,:ticle 25 (Tidal Wetlands). Assuming you have obtainad amy other applicable permit~you may procmed with your project, oat/er D~I2EL J. L~.FJ~IN Regional Perm!C Administrator FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ¥ .... Disapproved a/c ..................................... Application NO../. ,~.~. 2.5..~..~.. (Building Inspector) 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.~ode, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec/t/~fif /~ ,~ (Signature of applicant, or, me, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .C..~..~..~..~ .~..,r...~-Ay. 9....~-.~.~. 7J'7 g'~ o ¥ ~. ~ ............................. (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 ...................... Location of land on which proposed work will be done .................................................. ........ ? .......... (2 r ................... House Number Street Hamlet County Tax Map No. 1000 Section . . .I..~..~. .......... Block ...7. .............. Lot..,~ ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ./~.. (~..~. !..{)..~..tr?..t..~..% ............................................. b. Intended use and occupancy . . .~..~. ~.¢..0..~.~ .~..~?..~..&. .............................................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ........ ~ ... Remoyal .............. Demolition ..... ~ ....... Other Work ............... .i c9~/ (Description) 4. Estimated Cost .... /..~.,. o e .o. ................... Fee. ~.~. ~..'~. v..O...fi?. ................ ~ (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, ommermai or mixed occupancy, specify nature and extent of each type of use .......... 7. Dimensions of existing strnctures, if any: Front....~..~. :. Rear ~.q}. '. ........ Depth i ~ i~'. i i i i i .... 'ght a .'t.' ' Hel ........... Number of Stones ...................................................... Dimensions of same structure with alterations or additions Front .~. 2. .' ......... Rear .~. 7. ' Depth ... ~"~.' ............. .. Height .... ~..~. ~. ............., Number of Stories... ~ .... ~. } .......... 8. Dimensions of entire new construction: Front .... /. ¢7. ........ Rear .. J. f..' ........ Depth ~ ............. Height .~. t Number of Stories 9. Size of lot: Front . 7.~ ;3 ¥. Rear 7.~..,.¢1.~ ............. Depth .~...~.P.°. ............... 10. Date of Purchase .... ~.~t~.'2¢'.~i i i [ i [ i ..... ii Name of Former Owner ~O'.~T.-~.~.O.~.I.<.4~ ......... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .Ho. ........................... 13. Will lot be regraded ... ~ o... i ................... Will excess fill be removed from premises: ~l~ No 14. Name of Owner of premises C~.0~ ~,.r~-,.~..t~.o.Wq-~ Address ~.,~.x'.c,t.4.o .~-~, ~ .... Phone No. '7.,t..'-/. ? f'..~, o..~... Name of Architect .......... ~ ................. Address ................... Phone No ................ Name of Contractor . ~..O.. ~ ~$.~.~. ............ Address . .d. ~.'Cq-.t.+.o. ¢-.~ .~... Phone N6.7). g.-.~.'.~..~./. .... PLOT DIAGRAM Locate clearly and distinctly all,buildings, whether existing or propose property lines. Give street and block 9umber or description according to deed interior or corner lot. ~, and, indicate all set-back dimensions from and show street names and indicate whether STATE OF NEW YORK, COUNTY OF .................. S.S ........ · ~..Iff7 .'P.r'+..u. .~':4..~. P. )t.~...~.. ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ~ .c~.. ~ ,~ ~-- . (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 work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this ......... .~.c~ ........... day of ..... ffJ.~q~ .~. ...... , 19~.~. //ft2/~f/~fl~'~ N01/~[1Y ?It~[IC, State 0[ NOw Y0~ ......... ..... ~_ ' f,~" --._., ; No. 4695650 e' qufihfled ol Suttolk County Coram~ss:ion Expires March 30, :