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HomeMy WebLinkAbout12726-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17522 Date NOVEMBER 18, 1988 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 1315 GOOSE CREEK LANE EXTENTION SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Sec%ion 77 Block 03 Lot 19 Subdivision Filed Map NO. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 3~ 1983 pursuant to which Building Permit No. 12726-Z dated OCTOBER 17~ 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 ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ROBERT & JOYCEWESTERBEKE (owner, - - ) of the aforesaid building. SUFFOLK COUN~K DEPARTMENT OF HEALTH APPROVAL 13-SO-148-NOV. 1, 1988 UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-667224 NOVEMBER 8, 1984 9/12/88-THOMAS A. TAGGART Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT El'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12726 hereby Permission is granted to: __ . . v.,.~.~..,~...~.. ~.~~ ..................... ...~.~...~..~..~ ...................................... ~ .................................................................................. at premises located at J...~...~.:.~....ZY...;......~.~....,...~.....~........~..~,....~....:...~.....,'~..I..~.~..O........~.~.,..~-- County Tax Map No. 1000 Section ....... C)..~..i.~ ....... Block ...... .~...~. ....... Lot No .....)..~:...b....b. ..... pursuant to application doted ..~..~ ...... )....~. .................. , 19.~.~.., and approved by the Building Inspector. Fee $..I.~J..~ ......... Building Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 BLDG. DEPT. ~_ TOWN Ot=,,$OtlTHOLD,, APPLICATION FOR CERTIFICATE OF OCCUPANCy Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor wkh 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 property 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: Additions $25.O0 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$~0.00 Business $50,00 2. Certificate of occupancy on pre-existing dwelling $100.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 . Date .................... · .~. Old or Pre NewC°nstructi°n.. -existing Building ............ Vacant Land ..... ...... .. Location of Property ...................... . .,.. . ....... .............. House No. Street Hamlet Owner or Owners of Property . CD. ~.w .'~..~..~..q ¥.~-. ?~. .... [~ ¢-..-~ ~.q .~..~ .~.~ ..... County Tax Map No. 1000 Section . .] ............. Block . .~ Subdivision. Filed Map No Lot No Permit No..I.'~.~.. Date of Permit I./7.~.7.~.~..Applicant ~.~ Health Dept. Approval /.c~- ~-O -/z~ ........................ Labor Dept. Approval ........................ Underwriters Approval{,/.¢ ~,~ ~7...oq. ~ .~.. .......... Planning Board royal ................ App ...... Request for Temporary Certificate ..................... Final Certificate ...................... . Fee Submitted $... ,~.. ,~,.. ~..~. ............... Construction on above described building and permit meets all app~lations' Applicant.,..~a~.. ~ .~..~..~ ............... Rev. 10-10-78 3c r,-7 TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD., N.Y. 11971 CERTIFICATION TEL. 765-1802 Building Permit No. / Owner ?o~c~ ~ (please print) '('please prxnt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Swo;~to before me this A~ day of ~, - 19~ · Notary Public,.~(J~-()/~' County, N~tary ~Publ ~ PAUL G, CUDDY Notary Pubhc State of N~ No. 4936936 Q~ahfied in Suffolk dommission expires July 5, [9 FOUNDATION ( 1st) FOUNDATION 2. ROUGH FRAME & PLUMBING $. INSULATION PER N. STATE ENERGY (2nd) .- qOOE FINAL 76S-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST I' ]-ROUGH PLBG. ]'FOUNDATION ZND £ ] INSULATION [ ] FRAMING [//]/FINAL REMARKS: DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined..~.~..~.., 19~.~. Approved .k).~..~.., 19~. '~ Permit No. ~ .~.~ .~.[f ..~ Disapproved a/c ..................................... (Build~ng inspector) .... APPLICATION FOR BUILDING PERMIT Date /0-/?'- ~ 19. 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 qommenced 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 p. remises 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 shail 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 building for necessary inspecfions.~, , a ~ ... ........ (Signature of ~l~ant, or name, if a corporationt~ · fl o. .t .h p..(4/. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· (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 ....... ...... Plumber's License No...~.'..r*. ~.~?.~...~..v.~.~. Electrician's License No....~..~.."~.. Other Trade's License No ...................... House Number Street Hamlet County Tax Map No. 1000 Section . ~ ~ 7 Block ~ ~ - ~ ~ Lof .~.~.~.~. O ~ Subdivision ................................ : .... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of pre~ises and intended use and occupancy of proposed construction: Existing b. Intended use and occupancy ..... ~ ~.,. [~ .... ~.~. ~ ~.. '~~[~ .~ ....... Nature of work (check which applicable): New Building ...~ .... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... : ~ (Description) 4. Estimated Cost ..... ¥.0, 0~'0 Fee .] d..~,./ D ~ ~ / (to be paid on filing this application) 5. If dwelling, number of dwellin~ Units ............... Number of dwelling units on each floor ..... .-x ......... If garage, number of cars ...ut ..... ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ....... ; ....... Rear .............. Depth ............... Height: ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ...... ;Zq,'. .... Rear . .2.~. i ......... Depth .... ,3.~ ........ Height ............... Number of Stories.. O. .................................................... 9. Size of lot: Front ..... 3e.q:)... ........... Rear ...... & .e~ ............ Depth .... /..~. q:~ ,. ~. Date of Purchase ....-~. ~¥~.~.,:...~-~.. ,/~.l~.~ ..Nd. me of Former Owner . i~.~..~--.~..~,-~..'~ i. ~4[.~¢~.~ .~ i i Zone or use district in which pr6mises are s~tuated..[5,-...~.7. / ~ c?.o. ...... ' ............. 12. D6es Proposed construction viol,ate any zoning law, ordinance or regulation: .... q .?-' ....................... 13. Will lot be regraded ...... ;~..[ ................... Will excess fill be remov~d,f/'om premises: Yes C~ 14. Name of Owner of premises [Vp. 19g.~ .~..~.."~*..v~..~.,~. Address $~.,o~t ~..~.~'~.11. Phone No.V~e~..~ t'~ Name of Architect to, ~, ..e, ,- ua~O_ Address ......... Pho~l~o.~.__:.~. ?.'5r "' Name of Contractor ......... i ................. 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 inumbe, r ~r description according to deed, and show street names and indicate whether interior or corner lot. t/~ o ~ /f ............. ~' ~. ............... ~. .............. being duly sworn, deposes and says that he is the applicant (Name of individual sig9ing contract) above named. co -- o co He is the (Contractor, agent, corporate officer, et~.) ~f aald-"o~nor-~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 : .. /. 7 ZS~ da 6f F'R ,.'-R'72P ,, ~ , .................... y , ........ Notary Public .............. County ..._. ....... ..