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
..._. ....... ..