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Home My WebLink About10401-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. ~ Certificate Of Occupancy No...~q..0.'1.8.9. ........ Date 0¢tob,er 8 19 80 THIS CERTIFIES that the building ................................................ ~' ' 495 Glenwood Road, Cutchogue, N.Y. Location of Property ............................................................... House No Street Hamlet County Tax Map No. 1000 Section ....'1 .~ ..... Block .... .0.~ ......... Lot...0.? .~ ........... Subdivision...R..8.~.a.~.O..rl.e..R..o.a?...~...~.o..r~.:,..Filed Map No ......... Lot No....I./45 ..&..1.~... conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated .. ~.o.~..~.e.m.b.e..r..'Itl. .... , 19 ?.?pursuant to which Building Permit No .... .~.0.~0. ~. ~. ......... dated . . . ~.e~..~.e.m.'q.e.r...'1.2. .......... 19 .7.9. , 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 Building Rear Yard James and Rose McKillop The certificate is issued to ..................... [o~n'o'r, ~i,~;d~:~ .................... of the aforesaid building. Suffolk County Department of Health Approval .... N../.R. .................................. UNDERWRITERS CERTIFICATE NO .... I7/R Building Inspector Rev 4/79 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 10401 Z Permission is hereby granted to: · ............. '~'..~. ~o ........ ~~....~....~q..~.~.::~:~ .......... ............. c~~...:~~...~....~...~ ............... at premises I~ated at ..... ~~'"~Z ....... ~ ............ ..... ~ ........... ~ ........... ~ ...... ~~ ....... ~~~...~ ............. ~~,~.~ ..... pursuant to application dated .... ~~~...~ ........ , 19.~, and approved by the Building Inspector. Fee $..../.~.. ............. Budding Inspector · - G oF L. AND FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Btiilding Inspec- tor with the fo~iowing; 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. For existing buildings (prior to Aprd 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 featu res. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5,00 //~?d~}, Date . .~.?. ................ New Building ............. or Pre-existin uilding ............ Vacant Land ............. House No, ., ~, ff~rreet ~ '/ Hamlet County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision .............................. //''~'FiledMapN° ........... LotNo .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate , . ,/,,'~..... .............. Fee Submitted $. ~ ........................ Construction on above described building a~ndj~erBai.t~neets all q~ticabl~odes and regulations. August 11, 1980 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 William J. Jacobs Depot Lane Cutchogue, N.Y. Dear Sir: : This is to advise you that the job under Building Permit No. 10401Z issued to J. & R. MqKillop on Sept,.. 12, 1979 for_ ac~"y bl~g, appears to be completed as of our last inspection. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention. Very truly yours, /~/ GEORGE H. FISHER Sr. Building Inspector encl. Al) DITIL-~tdAL G L E NWO0 I:::) Exa mined ~w~ ..~,~.~....L · ~X ............. , Approve ...... /. .................. , Disapproved a/c ...... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No../~.~... Application No./d...~.....(.?~/ .............. (Bull ting Inspector) APPLICATION FOR BUILDING PERMIT Date ........ .Y..:.:...</...Z. ..................... , .... INSTRUCTIONS a. This application must be completely filled in by typewriter ox in ink and submitted in triplicate 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 application. 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 issue o Building Permit to the apphcant. 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 o 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 alter,arians, or for removal or demolition, as here n descr bed The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, end regular ohs, and to admit authorized inspectors on premises and in buildings for. necessar~ irbpections. (Signature of ap~a~,~r name, if a corporation) .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,' ............................................. ................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... ~...~....... .......... Plumber's License No ................. "I ........................... / Electrician's License No ............ ) ............................... Other Trade's License No ............................................... ~ /9 ,-~'* .,, 1. Locot on of and on which o oseckwork will be d~ne Ma No,' I'(*~"~~'~'~'7 ~Z.. Lot No /.~... cn~p% p · P ~ ............. ~ ....... ~,.~ ........... ;, .......................... Street and Number .....~/~.~....l~....~.~//ff..i~..~...'~/.,.....L.' .~.....~.~..¢....~......t../.'.~....4z.~ ............... ~.:. ...... ~?,//,h/~- Municipality 2. State exishng use and occupancy of premises and intended'use gnd ocdupancy of proposed construction: a Ex s t ng use and occupancy ...... ~ ................................................. ;..., ........................... '~ .................. .~.~.( ...... 3. Nature of work (check which applicable): New Building .. Addition .................. Alteration .............. Repair .................. Removal~ .................. Demolition .................... Other Work ................................................... 4. Estimated Cost 3 ~. Fee .............. ~......~..(~.~ ............................................... : (to be paid on filing this application) 5. If dwelling, number of dwelllng units ............................ Number of,dwelling units on each floor .., .......................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. D~mensions of same structur? with alterations or additions'. Front .................................... Rear ............................ Depth ................................ Height .................. ~. ........ 'Number of Stories ................................ 8. Dimensions~of entire new construction: Front ....... :,~.~.,,,,~, ............... Rear ....~...~ ...........Depth ......'~..~ ......... Height .....~,.~.~ ...... Number of Stories ........... v~.....~.,~.. .............................................................. ,.:..~. ..................... 9. Size of lot: Front ..~.: ......................................... ~ear ....~.: ........................... Depth .../~.~....-.~,~ ld. Date of Purchase ..............~.4 ....................................... Name of Former Owner ........................................................ 1 I. Zone or use district in which[premises are situated ........................................................ ~..7~ .................................... 12 Does proposed construction v~[olate any zoning Iow, ordinance or regulation: ......... .~..~....., 7 13. Will lot be regraded ...,......./~...~..['/~ ........... Will excess fill b~,removed from premises: ( ) Yes (V) No Name of Architect .............................................................. Address ................................ Phon~ No ....................... PLOT DIAGRAM Locate clearly and distinctly a'll buildings, whether existin~ or nror~osed and indicate all set-back dimensions frorn property hnes. G~ve street and block numl,er or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~Y~O~/~_ ~ S S A,~ ~. ,, ~ COLJtN~rY~OF,;~.:,a~r'-~,/~i....~.....~' '~ ~1~ /~ ¢~ ~ ..... · ~.~..'~ ....... d....~.~,.,,~,,.,', ............ ~ .......... ~eing duJy sworn,, deposes and says thee is the applicam ~ of individual si~ning contracf) ' ', ' ' ~ above named. ~He is the "~ ..... ~'--' (Contractor, agent, corporgte officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and fire this application; that all statemen(s contained in this application are true to the best of ~owledge and belief; and tha~ the work will be performed in ~he manner set fo~ in the applicafi'on file~e~e~ith, ~ ~ Sworn to before me this ' ; ' ~~J~4 ~ ~ ' ~ ....... o, ........ ....... , ............. ........ co,, ..... ........................ NOTARY FUeLIC, Stlte of N~ Y~ No. 52-8125850, Suffolk C~ Term E~plres March 30, 1~