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Home My WebLink About12193-z FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of ~he Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy z151.3.9 D December 29 19 8.6 No ......... ate .......................... , THIS CERTIFIES that the building ... ~.d.d.i.t.ip.n .................................... :. 1.3..6.0 BROADWATERS ROAD CUTCHOGUE Location of Property .. ........................................................... I~ouse Ivo. Street Hamle~ County Tax Map No. 1000 Section . .1.0.4 ........ Block .... .0P ......... Lot... PP~ ........... Subdivision. ~....P.~....CL~. ~'~OJ~ ............ Flied Map No..],5.6 ..... Lot No .... 2~§ ....... conforms substantially to the Application for Building Permit heretofore Fried in this office dated Feb. 22 198.3. pursuant to which Building Permit No 12193Z dated Mar. 16 198.3.., 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 ......... ConstruC. t addi. tion to existing dwelll.n.g. . The certificate is issued to ..... T.i.l.l.i.e..van.......DOVE.R. ....................... . ....... ....... (owner, of the aforesaid building. Suffolk County Department of Health Approval ..... i,I./~; ................................. UNDERWRITERS CERTIFICATE NO .............. .P.EZq.D.I_.N.G. .1.2./.13./.8.6 ................... . Rev. 1/81 TOW. BUILDING D£PARTM TOWN~ HALL sOUTHo~D, H. Y (THIS PERMIT MUST BE KEPT ON THE COMPLETIC~N OF THE WORK AUTJ'j6R~Z£C/) peri'nissior~ is hereby granted ~to:, UNTIL ~ULL ,7, FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions TOWN of SOUTHOLD Jal OFFICE OF BU LD NG INSPECTOR Receipt No.31 O] 4 Town Hall Southold, New York 11971 la- Da,e..../>.../.~.~.Z~. ................... :. ~ceived of ....~ .................................................................................................................. ~ 8~ ~ /100 Dollars Fee for Fee for Fee for Fee for r__v(~tificate Yard Sale [] [] [] H.t.C, [] Building Permit ~ of Occupancy [] Misc. ck ........ ...... ................. . .~...~....~...~.. .................. Building J .spe~,Or ~ i · ounamg ............... Ula'or I~re existing Building '/ Vacant Land ~ocat,on o,~roper~ .t.~.~ ~..~:..~ ................. &>..~..~ ~.. h . fi~.~ ~ner or ~ners of Proner~ ~ U~~ i County Tax Map No. 1000 Section ......... c ............. et ............. SubdiviSion~~. ~~ ...... Filed Map No.../..~ .... Lot NO..~. ~. ..... Health ~opt. ~p~rova~ ........................ kabor ~opt. ~ppmval ................... ~ ..... Unde~rltors ~pproval ........................ Plannin~ ~oar~ ~p~roval ...................... ~equo~t for Tompora~ Cortifieato ..................... Final ~ortiflcat~ ....................... Fee Submitted $ ................ Construction on above described building and permit meets aJ,I aDplieable~odes and regulations. Rev. 10-10.78 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL PLEASEbTAKE NOTICE that your application dated ..... for permit to construct.. ~'/~ .......................................... at ....... County tax Map No 1000Section Z~..---~. .Block ....O..,~. ....... Lot ..~'~(~..~..~.~'.... Subd,visio~ ~. .... Filed Map No ...... /...~..'..~t~. ..... Lot No .... c~.~. ........ is returned herewith and disapproved on the following grounds...~.~~. Building Inspector RV 1/80 FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUME INSULATION PER STATE ENE~ CgD~ 76S~1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH tPI..BG. FOUNDATION 2ND [ ] INSULA~iON FRAMING ~ [~FINAL ! ~REMARKS: DATE, ~0 m 0 ~-i- r- Z.~ m ~ C~ mO 0 ,-./- Z ~ -4 ~C) -40~ZO~ z~-~_> ;;o m Z m -- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved .......... , Permit / (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 buildhlgs 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 pumuant 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 inspections~ '3/~' ./~ .......... &,r,.ce<&,~.. ~....a~.....~..~ .... (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............. x.~.F~. '.t~-~..~...~.~ .................................. (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 .... d~..~.~. ~. ................................. , .... ......... County Tax Map No. 1000 Section .... 1.~..t.~... ....... Block ..... O..~. ......... Lot... ~.¥ ....... Subdivision ....~.0. $ ~.a24~...~..~.i~q.?~e~). ~9.~..o..~.;, ...... Filed Map No ..... ] .~..(..0. .... Lot... ~ .~.~ ...... 2. State existing use and occupancy of premises arid intended use and occupancy of proposed construction: b. Intended use and occupancy . property lines. Give street and block humber interior or corner lot. 3. Nature of work (check which a~plicable): New Building .......... Addition ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... tV' , .~..~i ~.. (Description) 4. Estimated Cost ..... ~fl.. ~ ~' ..... "....'.. ....... Fee...?. .......................... / i (to be paid on filing this application) 5 If dwelling number of dwelling Bnits 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/~ygp-of use .......... 4. · · · ...... 7. Dimensions of existing structures, if any: Front...~.J .,~.. ...... Rear .. t.g~/4~ ...... Depth. ~ ~ ....... Height .... [ ~0(.~... .... : Numbar of Stories ..... [.~ ............... ¥.... ..... ~ .......... Dimensions o.f same structure wffh'-//R~htions..or, additions Front ................. Rear .................. r)epth ' Height ~ Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ................ Number of Stories ............................................ 10. DateofPurchase ..., ....... ~.~./.~./~.~,. ..... Name ~f Former Owner ....~vo,,c.C~ ............ 11. Zone or use diitrict in which l~mises are situated ....... : ~. . ......... · ....... 12. Does pr6~)osed construction violate any zonifig law, ordinance or regulation: 13. Will lot be regrade, d ....... ~ .~.,~....,,~.: ....... Will ex,qess fill b~ r~,moved .......................... from I~es: ~Yes g'7' .... No 14. Name of Own'er of premisesXT~....qf(q,~-,~f.... Address~~..o?A~-~...~t~)ne No. ff./'.(.. Name of Architect .; ....... , :i.. ~ .............. Address . Phone No. Name ofContractor...)~r~~ ...... Address :: ~ .~.':. Phone No. ~i~..~.~ PLOT DIAGRAM Locate clearly and distinctly allI buildings, whether existing or proposed, and, indicate all set-back dimensions from or description according to deed, and show street names and indicate whether STATE OF NE~E~Y~RI~.///J. ° S ' · .. ~.~ ;.'..~. 4v~'...~. being duly sworn, deposes and says that he is the applicant (Name of individual sign!ny contract) C/ above named. J~e is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui application; that all statements cont~ work will be, performed in the manne Sworn to before me this ........... ~tOIq[RY PUBLE, State of No, 52.8125850, SilflOlk ?~rm E~ires March 30. authorized to perform or have performed the said work and to make and file this ined in this application are true to the best of his knowledge and belief; and that the set forth in the application filed therewith. (Signature of applicant)