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Home My WebLink About12617-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No. Z13190 Date Feb. 5 1985 THIS CERTIFIES that the building ......... .A.c.c.g.s.s.o..fy ............................ Location of Property 19250. C.R. 48 Cutchocjue House No. Street Ham/et County Tax Map No. 1000 Section .... 0.9. 6. ..... Block ...... 0..5 .......Lot . 0 01.2 Subdivision ...... X ...Filed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore fried in this office dated Sept. 17 19..8.3pursuant to which Building Permit No..12617.Z , dated ........ S.o..p.~......17 ....... 19.8..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 ......... Accessory Barn ITractor Shed) ROBERT E. BIDWELL The certificate is issued to ..................... [o~n'e'r,~.-;;~i-dO ...................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. N6 0 74 59 ...... Building Inspector Rev. 1/81 ~O~]g[ NO. ~ TOWbi OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, bi. Y. BUILDING FERMIT ('fillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO 12617 Z Permission is hereby granted to' ,o at premises located at ....~...~...,.'~m..~..'~.......~.,..~........~...~. ........ ...~.~..t~.~.~.. County Tax Map No. 1000 Section ...... .~)...c~..~. ..... Block ........ ,~-~,. ........ Lot No ....... ~.:..~ ...... pursuant to application dated ~'"~-~(~o"~" ~).~.'0._. 19.~,..~ and approved by the Building Inspector. ~uilding inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: I. 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 "pm-existing" land uses: 1. Accurate survey of pZ'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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 //// 4.Vacant Land C.O. $5°00 // Date ...................... New Building ............. Old or Pre-existing~uilfding ............ Vacant Land ............. Locati f Prope ty on o r ................................................................... Owner or Owners of Property b County Tax Map No. 1000 Section ..... !D, ........ Block ... ,(~,. ,~- ....... Lot. .~,,o ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.t .)';.~ ! .~. .... Date of Permit ~ {,~ i~.~pp licant .................................. Health Dept. Approval .................... Labor Dept. Approval ........................ Underwriters Approval ~.~.~. ........... Planning Board Approval ...................... Reque~ for Temporary Certificate ..................... Final Certificate ..... .~ .............. Fee Submitted $ ~ ..... ~'~ ~ ............. e~e~~b gu lations. Construction on above described building and p I~¢d~d~ , Applicant ...... ~ ,~.~ ~ ................ FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N, Y. STATE ENERGY qODE 6. FINAL DATE COMMENTS THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 1~J83 THIS CERTIFIES THAT only the e[ectHcu~ equipmen~ as desc~bed beJow and ~ntroduced by t~ applicant named on the a~ve aRplication ~,~ber in the premises of in the following locatlon; ~ Basement ~ 1st FI. ~ 2nd FI. Section Block was examined on 0~ ~3 ~ ~3 and found to be in compliance with the requirements of th~8 Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE OUTLETS SWITCHES FLUORESCENT DRYERS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: E R V I C E PER ,e' OF CC, COND OF HI-LEG -- -- OF NEUTRAL ~.0, LVox 24;3 Per ~ ~ This ?rtif{cate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their crede2tials--'& ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICA~EMUSTNOT BE ALTERED IN AN~ANNER. ,.-~ TO~'N OF SOUTHOI,I~ OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /3~ -(please print) Plumber /~/S On ~fdW (please print) LIe ~ 3-'7q-P I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this q day of t~)~"~Oi'~&, Notary Public, BLDG, DEPT. 'row~ County Notary Public ,~ALTER M. COLLERAN JR, 4712906 - Saffolk Coun~ 'l'e~m Expi~e~ March 80, 19¢~1~ FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved...~.~7.. !?..., 19~..~. Permit No.. } .2~..~. ! .~, .~. Disapproved a/c ..................................... ................................. 4,'/: ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19... Date ................... 19... INSTRUCTIONS a. Tins 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 m~.ust be drawn on the diagram which is part of this appli- cation. c. The work covered by tins 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 ~hall 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 re/m~,al or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buflding~foja%_, housing co~ and reguiationsj and to admit authorized inspectors on premises and in building for necessary insp~d' ~~ · . ...... / .', _.-. ~.. · .,; .............................. (Signature of applicant, or name, 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 .... ~ g{"'~ .~.... ~'.... ,~/.~. ~ .~.'~..~..~'. ................................. (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 ...................... 1. Location of land on which proposed work will be done., ff.~..~. .... . .b~.e."/T-.... O..~.... IQ..e.~. O..r~....(..ff..~.e'~... · .... .... . ................................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ~.~(o ........Block .......~ ....... Lot .... ~.'.~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ........ ~7. ~. ~-/., ..................................................... b. Intended use and occupancy ........ : · · t~ ...................... · ........................... 10, 11. 12, 13. 14. Nature of work (check which applicable): New Building ~' Addition Alteration Repair .............. Removal ............ Demolition .............. Other Work ............... ..~.~ ~ (Description) Estimated Cost . Fee ...................... (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars . .,;~.. ~..~..O~.q',~./4... ~.~ .................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 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 ...................... Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... tteight ............... Number of Stories ........................ ~ ............................... ~aze of lot: Front ....... 7/_/...'. ........ Rear .... ~J~. ........... Depth ... ~'..20 .............. [)ate of Purchase .... ~.-7 .~.~ .................. Name of Former Owner . ~a~.'-/.... ~dt..~/l-.qZ ........ Zone or use district in which premises are situated ..... ~r. tJ.~./... ....................................... [)oas proposed construction violate any zoning law, ordinance or regulation: ....~. P. ........................ Will lot be regraded ....... ~.,r~.~ ..... :, ......... _Will excess fill be removed from premises: Yes No Name of O~vt~ebo.f premises ~.OB.{[~...~..~. ,..j~/.O.uJ[~r~ss ,~-,?./q'dO~'l'lt.o~'.~.. tO.t:Phone No, ~ .~..'..~'~. ~... Name of ~r.&~*~,,ct (~0~ .~.-~.,/~..: .~)q ./,..~ ~ . . . Address O~.4d~.~...t~...1T ...... Phone No ............. o 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. ~ STATE OF NF~"'~']ORK -." :~ ~ , COUNTY 0 .~~/~.fS.~ ^ ............. '.' ' '....~ .... being duly sworn, deposes and says that he is the applicant sig~ing contract) - above named. He is the .................. ,~,,,4'~ ....... (Contract ag t ate ff' ) or, en ,corpor o lcer, 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 manner set forth in the application filed therewith. Sworn to before me this ~y P~ubli% .,~ ./]. ',-'";T3 .... .*~,,~.~.. County