The URL can be used to link to this page

Home My WebLink About12313-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ..... . .1~..?¢~.{ .~o.o.r.c.h.. ?.~.e. 3:..o.8.~.r.? .. ............. ~295 l~e qua sh Ave. Cutchogue Location of Property/~s~ bio ......................................................... · Street Hamlet County Tax Map No. 1000 Section ~ 37 . .Block 2 .Lot ~ Subdivision x ·Filed Map No. ~r .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... A. ]p?.i.1...5 ........,19~.3. pursuant to which Building Permit No ...... ! .25.~.3.Z. ......... dated ....... .YI~y..']..q .............. 1 ~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 ......... ..... Enc.lo~e..~xis.t.5~g. c.a~por, t .£or..unh~ed..li~i~ .ar~.a ................ The certificate is issued to RU~It & EILEEN CARR ..................... ...................... of the aforesaid building· Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. Rev. 1/81 12313 Z permissiori Is hereby granted to: TOW. OF ~o0'r.odl~ BUILDING ~DtPARTM!~N~ TOWN HALL SOUTHOLD, N. Y. BUILDING PERMITi (THIS PERMIT MUST BI: KEPT ON THE PRE~is!~ UNT COMPLETION OF THE woRK AUTHORIZED) ! to at pi~l~ises located at ...', ; ........................... ~ ............ ~...;.. ,,.~.~;....~ .............. ,~..~ .......... ~ .......................... co~a~ Ta~ Map Uo. lO00 Sect'on Z.~7..i: ~ B o~k~ ~ ~.~.:.:... ~Ot Uo. i,~.Z..~... pursuant to application dated .............. .~..~./.~,..; .:::,...., .Jg: and ~zpproved by the Building In?pector. .. Bj~il~li~g: I~::~eCtol~ Rev. 6/30/80 . FOAM NO. ~ TOWN OF SOUTHOLD Town Hall Southo~d, ~. ~." APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building lnspec- tot with the following; for new buildings or new use; 1. Final sum, e¥ of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograoh[c features. 2.Final approval of HeeJth Dept. of water suop y and sewerage disposal--iS-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildlngs, Industrial buildings, Multiple Residences and similar building~ and installa- tions, a certificate of Code compliance from the Architect or Enoineer responsible for the building. 5.Submi[ Planning Board approval of completed site plan requiremer~ts where appiicab e. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildinos and "pre-existing" land uses: 1. Accurate supzey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn s[atement o¢ owner or previous owner as to use, occupancy and condition of 3. Dale of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion requlred to prepare a cer[ificate. - / · C. Fees: 1. Certificate of occuoar, cv $5.00 t 2. Certificate of occu~)ancy on pre-existing dwelling c/r land use '~/~'p5.00 3. Copy of certificate' of occupancy $1 .O0 New Building Old or Pre-existingBu ~otng,~) ,~. ...... =/Vacant Land ....... County Tax Map No 1000 Section /.~. ~.. ........ Block L:~ ~-- Lot. O/~ SubDivision .Filed Map 'No...: ...Lot No. ' Health Dept. Approval ..../'~..~. ................ Labor Dept. Approval ...................... ,.. Underwriters Approval . ~.~ .. ................. Planning Board Approval .................. Request for Temporary Certificate Final" Certificate' Fee Submitted S ......... ~ ........ Construction on above described building and pern~it'mcets all apo~(cable~.cod~s and regulations. FIELD I~S?E~TION COMMENTS ,. ~, FOUNDATION (1st) F, OUNDATION 2. (2nd) ~OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~o~ FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B02 ..... Approved . f.t' ..... , 1 ... Permit No . . . Disapproved a/c ........... ::':.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...~.~.~.. ......... , 19~.~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .... (Signature of applicant, or name, if a corporation) ..... ~.~. ~...~..~...z~. ~.~...~.~.. (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.~...~..~.....~Y... ~. '.(~.-.¢5.~-.. ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ~ ' (Name and title of corpora~'officer) Builder's License No ..... /.3. ................. Plumber's License No ......................... , ~ Electrician s License No. ~.~-fi..~-.~.-~. ,~,~.~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ~$.-t...~.: .~ .... ~.//~. ........................ .... ./4-. . ?. .S: ............ . ·.~ ~ ..... : ............................... .~ ./.~..~./.-. House Number Street Hamlet County Tax Map No. 1000 Section .... /.~ y ........ Block.· .~ ............ Lot../..~ ..... ~ ..... Subdivision ........ .~.. ' 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 occupancy . ../...~.,~.../~../.~.....~../~/..~-,~../~. ~/. ................................ b. Intended use and occupancy ...~../~.. ,~..~'~..2~..~..z~....~.4~,,~.~.~...~/-~..~.Z..~.~.4/~. ~'. ............. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration 1.,<~... ..... Repair .............. Removal .............. Demolition .............. Other Work ............... ' ~ ~ ~c~_.~ (D ipti ) ' escr on 4. Estimated Cost o~...~ o. oo Fee .~2:~... "-' o.. .... : ! (to be paid on filing this application) 5. If dwelling, number of 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 .............. 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 ............... 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 pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ,/~..O ........................ 13. Will lot be regraded ....... /if...O ................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ./2~,..Z-.,~...C.,,p.~,. ,~ .... Address .../~..~..~ .~.~}f/'~..~.t/.~Phone No ................ Name of Architect .......... ................. Address ................... Phone No ................ Name of Contractor .~..'~'~.~../.~.~.,)f. ~ .J. 9.,~..-f./~/C,-Address/.~aX ~. ~ ~.. t'~,O/-f/.. ~. Phone No. ~ ~. ~ :.~.d.. ~..~.. 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 mmber or description according to deed, and show street names and indicate whether interior or corner lot. ~o STATE OF NE.~R~,/~ COUNTY OF . . .~'r~ ..... .... ,7~f..~. ~ ~ ~....,~,...,~.?,~.~-.~. .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the... ............. f~. ?../.~..Z,?.~'~,~. ........................................................... (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 ........ ,19 . ... County ' ~*~ ¥o~ (Sign?.~.~ applicant) (iF', 6CCU?A : : ~ DESI b J:~t' ON' MUST,: , .'"' E.O. ;...:f ...~, SHALL; M~I~'. ~ ,: '~ *~ iCY