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Home My WebLink About10816-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPART, M ENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ...... .7.. fi.Q.1?? ,,. Date ....... 99.*.q~..er..1.~.: ............ ,19.. S0. THIS CERTIFIES that the building ............................................... Location of Property 2/4730 Main Road, Cutchogue, N.Y. County Tax Map No. 1000 Section .... .1.0.9. .... Block ...0..3 .......... Lot...°. 9.2.'.°.°..~ ...... Subdivision..C.o..'[1~. ~ .ry....C.~.u..l~..E.8.~..o_.'t;.e.8. .... Filed Map No..67..~.6...Lot No...~.~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...tl..L~.y...~.~. .......... 19 .~.Qpursuant to which Building Permit No... ?.O.~.~.6...Z ........... dated ....fi.14.ghl..~.t;..7. ............ 19..8.0, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is ......... ....... .a.d.d.;.~i.o.n...(D. ec.k. ). ~o...Ly.J,.~.~.i.n.¢ .D..w.e.1.]:.~..rig., ........................... The certificate is issued to .... ~jqC~IIII~t~..~B8J..V.¢¥ ~..G..17., .............................. (owner. of the aforesaid building. Suffolk County Department of Health Approval .... 1}J./.R. .................................. UNDERWRITERS CERTIFICATE NO ............ N../.R. ..................... Rev 4/79 TOWN C BUILDINQ TOWN?ALL $OUTH'OI~D, N~ BUILDING~ PERMI~ (TH S PERM T MUST BE KEPT ON THE PP, E~IS~S COMPLETION OF THE WORK AUTHORIZED) 10816 Z Per~nission is hereby gra~ted to: : UNTIL ~ULL o~rpremises located at ... ....................................... , ..................................................... ~.,U...~.,.., .......... ~,~ ................................ · ' , ~ ~Lo N ........ County Tax Map No. 1000 Sect,on ......... pursuant to application !dated ...... ~ .. i;.i..~..~....., 19.~.~.., and approved by the B~ldlng 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 featu res. 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 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date . ~.c~.o.t)¢r..2.,. 7-2.8. Q ....... New Building ............. Old or Pre-existing Building ..... J~ ...... Vacant Land ............. House No. Street Ham/et Owner or Owners of Property ~hom;~.',~ Sh.~.'LYe~, ~ J~Co . ................. County Tax Map No. 1000 Section ...~.0.~. ......... Block ...... ~,(?.~... Lot .... - .O~.~.". ....... Subdivision Cou. nty C]_ub :~stal, es .Fded Map No. 6736 .Lot No. ~, 1 Permit No. Z0816 Z Date of Permit . .Applicant S~.d ~eebe, A//C ~T' ~ V~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ¢~. ............... Fee Submitted ............................ Construction on above described building andj~ermit meets all applicable codes and regulations. Applicant; .~/. ~ .............................. COMMENTS FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING e INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ........ ~ .... . .-'~..: .....~ ...... ....../ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application Not/~/.~. ......... a. This application must be completely filled in by typewriter or 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 appli- cation. c. The work covered by this application may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this application, the Building Inspector will issue 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 Bmlding 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 buildings for necessary insj~ections. ~pplicant, or name, if a corporation) .... ............ (Mailing address of appl~cant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .................... ............................................... Name of owner of premises .,~t.r.,.~.77~ .z~.4.. ~'&'~'~'~'n' ~h'e' ~a'x' ;o',i ;; i~t;;t' ~e'd') ......................... If applicant is a corporation, s~gnature of duly authorized officer. (Name and htle of corporate officer) Builder's License No. . ./~./ ................... Plumber's License No .... ff ................. Locat,on of land on which proposeS work will be done ..... ?~.~...~ ...... .~ ......................... · ............ .... .................. House Number Street County Tax Map No. 1000 Sechon . . . [ .t?..~. ........ Block .... ~. ,fl .......... Lot. t20. ~.~. ~'.~. ~. .... SubdivisionS. ~...~~...'~..~iled Map No...~..'~..~..~ .... Lot... ~.. ~ ........ ~ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~04t~.~... ~~...~.j . .I .......................... b. Intended use and occupancy ................. ~f. ~...~ ...................... 3. Nature ofworl~ (che[k~lich applicable): New Building .......... Addition .......... Alteration .......... Repmr .............. Removal .............. Demohtmn .............. Other Work ............... /! (Description) 4. Estimated Cost ...................................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling enits ............... Number of dwelling units on each floor ................ Ifg ge berofca ara ,num rs ..... , ..................................... If business, commercial or mixed occupancy, spec/fy nature and extent of each type of use Dimensions,gl existing structures, if any: Front. ~' ..~. ......... Rear .. ,~...~. ........ Height ............... Number of Stones ................. Dimensions of same structure with alterations or additions: Front i i,~.~.' i i i i i i i i i i i Depth ~ .... ~,,. ....... ~ ........... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories 10. Date of Purchase ........... .................. Name of Former Owner ............................. 11. Zone or use district in which pr{mises are situated ..... '..' ................... ~ ......................... 12. Does proposed constru~ion violate any zoning law, ordinance or regulation: .... .~..LO ..................... ...~ 13. Will lot be regraded . ~0...,~4~, ....... /2t..t~ ..... Will exc~.ss~fil~ be removed from premises: . Yes Nfo' 14. Nmne of Owner of premises .~.. ~. Address .~ ....... Phone No..~.5/. ? u~/.~... Name of Architect a - .~. · .a ........ (]. Address ..... ~,~.. ........... Phone No ................ Name of Contractor. ~.~)..,~ ......... Address ..~ ..... Phone No. 7~.q.n 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. STATE OF NEW YO4RK, ,~ ~ COUNTY OF .~ i~'~ .......... _~../~..t~. ~.~...,~.~.~,..~.~..~. .............. being duly (Name of indffidual signing contract) above named. sworn, deposes and says that he is the applicant He is the ~ (Contractor, agent, ccrpsrat: c~ffle~r~ ~ of said owner 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 i ........ .~....~... ........ day oi...,~.~.~-,~'~..., 19..o~. N taryPubli~ ............. i.c,~-~ .....~ ...... County . /r)_ ~ , I~1VR1£[. TOLMA. ; .......... ~t ................... , ~ ~tl~y,,~tC, su,te et ~ew ¥~r~ ~ (Signature of applic~t)