HomeMy WebLinkAbout10895-zFOI~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
u~KTIFIOATE OF OCCUPANC"I'
No S-22913 Date MARCH 23, 1994
THIS CERTIFIES that the buildin~ ADDITION
Location of Property 8800 NASSAU POINT ROAD ~uTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Hap No. 1000 Section 118 Block 6 Lot 3.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 19, 1980 pursuant to which
Building Permit No. 10895-Z dated OCTOBER 1, 1980
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 NEW FODNDATIONUNDEREXISTING ONE FAMILY DWK~.ING *
The certificate is issued to H~RRY & JANET HOHN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF EEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N/A
N/A
*NOTE: THIS UPDATES CO Z-10350 DATED JANUARY 15,
/ ~
Rev. 1/81
No.
BUILDING p,ERMiT': ~
(THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETIOiN OF THE WORK AUTHORIZED) ~
~.0895 /"" Date ...... , .................... .,, ......... ..................
Permission is hereby gra~ted to~
Eye o
~'/c
'. ...................................
to ................................... ~ ............................................................. ~!F't .........................................
....................................... ~ ........................ ~._,
ot premises Ioceted et ..q ........................................................ ~...~} ................. ~ ........ .............................
...................................... ~ ............................................................ ~ .............. ? ........................................
~,~ ~ ~ ~ ,¢oo s,~,o~ ....... !..L[....;. ~,~ ;....~.~ ....... ~... [o, u0 ...... .~ ..............
' ~ ' ' ~ [ {~ '-'~ and annrov~ bv the
pursuant ¢o application dated .............................. ?/....~ ...... ~...,~,..., W....~.., ~ ,
BUilding I nspecc~.~-
...
, ' ~uuitaing~,tns~ector
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of i% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2.Certificate of Occupancy on Pre-existing Buildin~ - $100.00
3.Copy of Certificate of Occupancy - $20.00
4.Updated Certificate of Occupancy - $50.00
5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date March 23, ]994
New Construction ........... Old Or Pre-existing Building ............
Locatio of Property 8.8.0.0. NASSAU POINT ROAD CUTCHOGUE, NEW YORK
House No. Street Hamlet
HARRY & JANET HOHN
Onwer or Owners of Property .................................................. . . . . .. . . .
County Tax Map No 1000, Section ...... ii8 ...Block. 6 ..Lot.. 3 ..~...
................................. Filed Map ........... Lot ...................
Subdivision .
· 10895-Z ~0/1/~980 EDA L. KOLBE
Permit mo ................ Date Of Permit ............... Applicant .....
Health Dept. Approval ..................... ..... Underwriters Approval ...................... .. .
Planning Board Approval .......
Request for: Temporary Certificate ....
Fee Submitted: · 50.00
....... Final Certicate.. ~D~T~J)..CO
...... :
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate O[ Occupancy
No. Z10350 Date January 15, ...
.................................................. 19 81
THIS CERTIFIES that the building ................................................
Location of Property/t3ds~2o8...0 . .1}1..~s.a.U.. ?.o.i.n..~..R.O..p .d~. Cutchog~..e, N.Y.
· stre3i ......................
County Tax Map No. 1000 Section 118 .... Block 6 . .Lot 3
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...~..ep.~.~l$1p.~.r..! 9,..., 19..~.Opursuant to which Building Permit No...J..0.8.9..~..Z. ...........
dated ....... .0.q~.o..b.e.l~.. ~., ......... 19 .O..0, was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued ~s .........
New Foundation
The certificate is issued to Eda L. Kolbe
{ o w n e r /lt~~
of the aforesaid building.
Suffolk County Department of Health Approval .................................. N[R .......
UNDERWRITERS CERTIFICATE NO...~./.r-t .................................
Roy 4/79
Building Inspector
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
natura~ 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 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 $5.00
3, Copy of certificate of occupancy $1.00
Date ... X/~~'~,'~.. ./'. ,~. .". .~. '? .........
New Building ............. Old or Pre-existing Building f Vacant Land
Location of Property .
House No. Srree~' .......... ' Ham/er
Owner or Owners of Property . :-~'.~..1~. ,/,, ,J~',t-:~-"'~-t-~-h:~ ,/~..~, (..,~'..z-~- ..................
County Tax Map No. 1000 Section ..././..~' ........ Block ..... ~. ........ Lot... ,c?. ..........
Subdivision ................................ Fded Map No ........... Lot No ..............
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .. Z ....................
Fee Submitted $., . 5...Q0 .....................
Construction on above described building and permit meets all applicable codes and regulations. Applicant, A.¢~, .~..~¢~L..~., 'Z .¢~. 7//¢' '~' '" .................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined 19...
Approved ' . !/.'9'/~ ii19 . .~.~ermitNo. .........../~?Z9/)- ~---
(Building Inspector)
Application No ..................
APPLICATION FOR BUILDING PERMIT
Date ........ .6.?.-'...~/.., 19 .~?.'
INSTRUCTIONS
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 issuance of Building 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 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 ali applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections·
· .~..~-~.i.~ 34..T.~..~ ..... ;';;'i ';~ ....
(Signature bf applicant, or n~ame, if a co p at'o )
· f .x. a v.Y. l
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder·
,(h. ~. ~.o..~ . .e~.x~-lT. ~.'.ac.,~... ~ ........... ~ ............................
L- /4 0L. 'Bt:-
Name
of
owner of premises .. ~.-- ,- .i.d} ~.nt.t-~e.-~a.x roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.....,~.~:... ~ ..........
Pluinber's License No .........................
Electrician's License No .......................
Other Trade's License No..~: .~. t~J.~../~.,. ], .....
'~/a ~ ~'..q" ne >.. &...~...6~...~.~.
1. Location of land on ~vhich proposed work will be do . .'~rd-~-~l-x(. l_...~/~-, Z~. .~.~. ......
.......... ................. . ........................
House Number Street Hamlet
County Tax Map No. 1000 Section /.}..~ .............. Block . .~ ............. Lot...~. ..............
Subdivision ................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ~.*~ S., .~ ~.~, .~. ................................................
h. Intended ~se and om, pan~y ... g..~ ~-.~,. 4 .~. ,~.'t- .................................................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
/ (Description)
4. Estimated Cost..~..~.~'~. :.~.. ! ........................ Fee .............. [.7 .......................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... /. ........ Number of dwelling units on each floor...7. ...........
If garage, number of cars ........................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front .... '7.0 ./. ...... Rear ...~.~. ........ Depth.. ~.~ ..........
Height ............... Number of Stories ....... / ................................................
Dimensions of same structure with alterations or additions: Front ...'7.~ ........... Rear .. '~ .O. ............
Depth ..... '-~.d .............. Height ...................... Number of Stories.../. .................
8. Dimensions of entire new constmctinn: Front ..... 7.t~ ....... Rear .... ~.~0 ......... Depth . .3. ~ .........
Height ............... Number of Stories ....... /. .................................................
9. Size of lot: Front ...................... Rear ...................... Depth ......................
10. Date of Purchase ........... : ................. Name of Former Owner .............................
1 1. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded . , Will excess fill be removed from premises:.~i.. Yes .,No
14. Name of Owner of premises ~} .~..If7. ~qun.,q.~. Address ~ .... Phone No.~
Name of Architect .......... . ................. Address ................... Phone No ................
Name of Contractor ......... ! ................. Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block umber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK, . '
COUNTY OF. ~.~'~. Z~. ~, .d"/.
........ ,~.t-~ ~.~.~,/.¢:...~..?/..o.~ ............ being dui~ swo~, deposes and
(Name of individual signing contract)
above named.
t
says~that he is th~japplicant
He is the ........................ .~ ................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dui}, authorized to perform or have performed the said work and to make and file this
applic ~tion; 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 ...... ~'
................
Corem,ss,on ~xg'[o~';;'~O~" ~' (~ignature of applicant)