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Home My WebLink About12087-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. g.'1.'t676 ......... Date ............. .1~. ~r..'1.? ............. 19...S3 THIS CERTIFIES that the building . ~.e.w...Die.e.g.]: '.~. IK ................................ Location of Property 36725 Main R . Cutchogue House No. Street Hamlet County Tax Map No. 1000 Section .... 0{~. .... Block ..... .0.2. ....... Lot .... 0.? .~...2. ....... Subdivision ............................... Filed Map Ho ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~.o.v.e..m.h~~ ..5 ....... ,19 ~. purs~t to w~ch B~ding Pe~t No..Z. ..... ~..2.~..7.Z ....... dated December 29 19 82, 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 ......... For a one family dwelling The cer~ficate is issued to Hilda & Antonio Jimenez (owner, lesme or t~n~nt) of the aforesaid building. Suffolk County Department of Health Approval '1 2-so-'1 5'1 UNDERWRITERS CERTIFICATE NO. N600796 Rev. 1/81 lq)ll~ No. Il TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12087 Z Date ........................................................ , 19 ....... Permission is hereby granted~/~ ~7~/~'/?~ ~ ~, · .~.~..~?;z-~.~.;~;..~.x,~.: ......... ....................... '~' ......... ~ ...... : ......... 7'"'~'?~'""'~;~'""~ ....................................... '~ ......... m p~e~ ~ ~ .......... , ..................................................... ~.~..~.....:.~...~.....~.~: .... ............................................................ ~.~ .................... .~..~. .......................... ~.~ ........ ~ T~ ~p No. I~ ~i~ ..-....' ............. ~. Bilk ..................... ~ ~o ......................... ~nt ~ a IJ ~~~ Bulld~ng 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 typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with 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 ple~l 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 peoperty 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 1r 3. Copy of certificate of occupancy $1.00 land use ~/~/$5.00 Date ....... New Building ' Old or Pre-existing Building(Z) =/Vacant Land Location of Property ....................... ..... .......... ; .,~. ..... House No. Street Ham/et Owner or Owners of Property ......... o County Tax Map No. 1000 Section ...~-~-~'. .... · . Block ......(~.~......... Lot....~l .~,.~.. . .... Subdivision1 Filed Map No - Lot No ' Permit No.'~..~.O. ?.'~... Date of Permit .Applicant .. / .,~... ~ .f ../~...~...~...Z,~. ....... /..s7./. Health Dept. Approval - ~. ·. .Labor Dept: Approval Underwriters Approval..~.."..~..0..O..'7..~./.~... i..Planning Board Approval ..... .~.. ...... ~,..~ _ Request for Temporary Certificate .................... Final Certificate ............. Fee Submitted $ .................. Construction on above described building and permit~meets all~pl~t[cable~codes and ragu ations APplicant.~~..~...~. ~/.' . ' ' . . Rev, 10-10-78 1001093 THE NEW YORK BOARD OF FIRE UNDERWRITERS Z'~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1OO;38 ~,. ~ zs, zgs3 A..,,~o.o.~o.o.~,. zozt~ N 600796 THIS CE~IFIES THAT ~ly t~ ~t~ ~nt ~ ~ ~ ~ int~ by t~ ~nt ~ on t~ a~ ~pl~at~ numar i~ ~ ~s o~ ~erami~on ~ ~. ~ andfou~to~in~mpliancewlththerequlrementsofthis~rd. HXTURE FIXTURES RAHO~S OVENS D4SH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUO~ESCIg~'T DRYERS FURNACE MOTOES TIME CLO~KS MULTI-OUTI~'T DIMMERS SYSTEMS S~RVtC~ EXSCONNECT S E R V I C OTHER APPARATUS: L,*'~:or$: 1-F 1.W,.F.C.T. z/o N.Y., 11935 This certifkate must ~ot be qltered in any manner; return to the office of the,B~;rd f ipcqrre;t. ,lps,pec~prs. nlay .I COPY FOR BUILDING mi,DINe D, EI~T. [~] FOUNDATION LST I' ~ IiOUGH PLBG. I' '] IrOUNDATION 2ND ~INSULATION ['] FRAMING [' ~] II~INAL REMARKS: ECTID~ ,. DATE COMMENTS (2nd) '~ 'LUMBING ENERGY FIELD IN 1. FOUNDATION P'OUNDATION 2. ROUGH FRAME 3. INSULATION STATE 5,( FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examinett~/~...?..~.--, 19 .,~" Approved ,-~ .¢..C-......'~. ~..., 197..2~'Permit No..[ ?:.O..~.~...fff~ Disapproved a/c ................ L ........ i/ii~ ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No../.' .~.~ .(J. ?. Z ....... Date . ./Y.o.v..e~e.~..q ........19.82 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 ;hall 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 of'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. (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 . .ff.'.z.~d..a. ff.'.~.~..e~.e~. ............................................................ (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 ..... .'2'0.~. ...... Plumber's License No .... q?Y?.t.~ ·h ..... Electrician's License No.. ff.~..~.a. ! .~-5 ...... Other Trade's License No ...................... Locat~m of land on Much proposed work will be done. (bt). ~/.fl./~ax~ l ora~. P~ao,~. ~ff... ]1~5~. ............ ' '"" .............. ................ House Number B~,7~ ~ Street Hamlet ~'~ ~ ~ ,. County Tax Map No. 1000 Section ......... - ......... Block ......... ~ ...... Lot ............... .... Subdivision ....... ' Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' Existing use an, t.~.'u?z2'~cy ......... :~ .~ .c~..,): ............................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~, / ~ (Description) 4. Estimated Cost ....... ZZf .~.O../.fi.)..O..~. ................... Fee ';~,.~.'.¥..~-' /~' ~ .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ] ........ 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 .:. f.~6. (~..o~.n4'.zy .~.~. .... 7. Dimensions of existing structures, if any: Front ....... --"v. ....... 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 ~ C Rear C~ t, r~,,,h 3¥ ...... Height .... ! .~. ........ Number of Stories 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. l 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... /Ot~ ......................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ 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. ~TATE OF NEW(~Y~K~ __ _ _ ~OUNTY OF . .'~_a_a_a_a_a_a_a.~~~..., 5.5 ~~ ' being and that~e is the (Name of in ivi ic'ti .......... duly sworn, deposes says tbove named. applicant te is the ............. ~ ................................. (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this .pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this .......... ~- ~ .... day of...~.._.]~:.~.!.<~.~'2., 19 ~.~ ,, ~., .... \ ,- (Signature of applicant) "It sh4uld I~ noted that~slnce this propert~ is Ioc?.t.e.d in area, STATEMENT OF THE WATER SUPPLY AND ? SYSTEMS FOR THiS F CONFORM TO THE STAt SUFFOI~{~ CO DEPT O~NI APPLICANT SUFFOLK COUNTY DEF SERVICES - FOR CONSTRUCTION ONLY DATE'..~- APPROVED ..... ~.~ SUrFOL~ C.O TAX D~ST. SECT. ~9o9 85 OWNERS ADDR£S~: DEED: L TEST HOLE distributing n; piping shall be tYPes ~ OCCUP/~HC¥ OR USE IS [~LAWFUL ~i1HG~T C[RT[FICAT£ ~F OCCU?~,HC¥ ¢OP~3er tubing is used water distributing ~¥ste~ piping shall be d ,~/p~s K or L on~ AP?~C':£D AS NOTED FOLLOWING IbP?ECTIONS. 3. INSULAT~Ok~ THE REQU{REMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY ~DES. NOT RESPONSrBLE FOR DESIGN OR CONSTRUCTION ERR~S. , T -I L I /2. 'Z