HomeMy WebLinkAbout10927-zFORM NO. 4
TOWN OF SOUTBOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z17593 Date DEC. 13~ 1988
THIS CERTIFIES that the building ADDITION
Location of Property 70 STROBSON ROAD & 3785 LITTLE NECK RD. CUTCHOGUE
House No. Street H~/nlet
County Tax Map No. 1000 Section 103 Block 10 Lot 016
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCT. 14¢ 1980 pursuant to which
Building Permit No. 10927Z dated OCT. 20, 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 ms ADDITION TO EXISTING DWELLING% TN¢T.n~T~ SHN R~M
The certificate ~s issued to
HERBERT SANDERS ~ PATRICIA MINORE
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N576722 SEPT.
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
17, 1982
Building Inspector
~o~ ~o. ~
TOWN
BUILDING
TowN~ HALL
SOUTH'OLD, Ns
eU'L.,N~i P,E~'T
(THIS PER/~IT MUST BE KEPT ON ~HE PRE~I~£S UNT!L :ULL
COMPLETI6N OF THE WORK AUTHORIZED) i ~
10927 Z D~t~. ~ZX~ ......................... , ~.~
Permission is hereby orahted to: * ~ :
Rev, 6/30/80
'"'i'"'
...................................... ~ ......................................... , .... ; ~ ' ' t ..........
· /. ~, ' B o~ ~Z.~:~ ..~-~o~ No ..~Z~ ..........
Codn~ Tax Map No. 1D00' Section ...... ~....: ...... h,~....,.., ..... ~, ~ ·
, and.
pUrsuan~ ,to application dated .C~./~,~......,~?...~.,!..., 19~. approved by ~he
Building Inspector.
~ ~ ~ :( ~ , 2 ' ~ .......
-TOWN OF SOUTHOLD
Building Department
Town Hall
SouthoId, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m -- _ to the Building Inspec-
tor w~th the following; for new buUdmgs 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 buildsngs, 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), Nomconformin~ uses, or buildings and "pre-existing"
land uses:
1. Accurate sUrvey of p~operty 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: Additions $25.00 ?OOLS $25.00AL?gRATION $25.00
1. Certificate of occupancy New Dwelling $25.Q0, Accessory ,$]0.00 Busiuess $50.00
2. Certificate of occupancy on pre-ex~sting dwelling $ I00. O0
3. CopY of certiflcate of occupancy $ 5.00, over 5 years $10.~0 /
4.Vacant L~nd C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ....................
NewC°nstz*uctl°n ...... Old or Pre-existing Building ............ Vacant Land .........
................................
blouse No. r'~ Street
Owner or Owners of Property & ,,~./k3 I'd/~
County Tax Map No. 1000 Section.,/..C9'.~.. ........ Block -/.~.. · ...... Lot.
Subdivision ................................. Filed Map No ........... Lot No ..............
PermitNo /~"2~.7 Date of Permitl¢2-?l~?. . .Applicant ~..~.~.~ 7-- ~'~d--)Z~/'_~ ..
Health Dept. Approval ........................ Labor Dept. Approval ................ ....... .
Underwr ters Approva .V~t-~. 2 ~:~. ~
................ · ' Planning Board Approval ..................... .
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ........................ ~ ....
Construction
Applicant ~ ............................
Rev. 10'10-78
:L000?Tl THE NEW YORK BOARD OF FiRE UNDERWRITERS
BUREAU OF ELECTRIGITY
85 JOHN STREET, NEW YORK, NEW ~ORK 1OO;38
~,.., ~em~r ~?, ~ ~..~.o.~o.o.~.~ ~Ta~- m N 578722
THIS CERTIFIES THAT
~rb~C 8~rs, wis ~tro~n
~n the~ollow~g Io~atloa; ~ Basement ~ 1st ~7 ~ 2nd FI. Section Biota Lot
was examined on ~eZ~ ~3~ ~ and found to be in compliance with the requirements of this Board.
9 ~3
DRYERS
SYSTEMS
NO. OF FEET
S E
2-G.P.C.I.
Detector
1--Z.O ti.W. }~t W~
R V I C E
AWG
OF NEUTRAL
2ul~l El~c. Co.
P,O. ~ox 143
F the Boa~rd'
cOP¥~,~qR BUI~.OIN$ TH!,,$ ANY MANNER.
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND []/INSULATION
/
FRAMING [/] FINAL
INSPECTOR
FIELD INSPECTION~ C0ff~ENTS ~
FOUNDATION (~st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.Y.
STA~E ENERGY
CO.DE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined .. ~.(~. .....19 Application No,...~.. .........
Approved ~ .'-f...~.c? ...... 19~.~.. Permit No,fC,/.~.~. 7.~- ~
Disapproved
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 Pemdt 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 all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections. ~
..... ..................
(Signature of appli~nt, or name, if a corporation)
/x~, ~'~. o.. ../... ~./..,'~.'./-C.,.'/..~,.~./: .2.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... ~..~ ~, ~- ................................................................................
Name of owner of premises ...~.. ~C! .c.'~.,~. ~n~.; .~4'.t'..~....~-..,~..~...j(..off..g.%~.' .~. fi.'./~./.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.'7-.~.~.~. .... /..~../ ............
Plumber's License No. ,~'.'.~..~..7~.,. ?./.-.?. &.,'..,~.~ .....
Electrician's License No ~..~.,. ).~..~/..,o:~..%/. ......
Other Trade's License No. ~.'{~...~.?.o. ,~ e.~. ?.:'. .....
Location of land on which proposed work will be done ..................................................
~ ~' ,~ ,~ z, ,ri,: ~ ,,,~,,~ ~ ,,~. + ~,~, .~-~.~/, ~ . ....... .¢.~ ..r..c. ,,(¢. cf ~' ""~' · ..............
House Number Street Hamlet
County Tax Map No. 1000 Section .. ~.~J~. .......... Block .., ./.~.. ............ Lot..(.9../.~.~. ............
Subdiwsion ..................................... 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 .... /. {?. ( .~.. ~. ?..,~...L.?.~. .............................................
b. Intended use and occupancy .... ~.. ?..a4...~.o. q .,~...?.. f.,'.d.: .~ ff .o,. ~.~ ~.~.: ............................
3. Nature of work (check which applicable): New Building .......... Addition ....b~.. .... Alteration
Repair .............. RemOval .............. Demolition .............. Other Work ........ ~ ......
./~.~ , ~,.,~.. q (Description)
4. Estimated Cost. · O/.~q ........................... Fee . o
(to be paid on filing this application)
5. If dwelling, number of dwelling Cnits / 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 .....................
7. Dimensionsofexistingstructurds, ifany Front ............... Rear .............. Depth ...............
Hight Numbe of St '
e ............... r orles ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
Size of'lot: Front ........... ~ ........... Rear ...................... Depth ......................
Date of Purchase ' Name of Former Owner
Zone or use district in which premises are situated
D
ocs proposed construction violate any zoning law, ordinance or regulation: ................................
Will lot be regraded ...... A/PI ................... Will excess fll be removed from premises: Yes ~)
Name of Owner of premises t~t,.c:? m ~?.~.~. { ./:~..b.x. ~r~ldress . Co.r.~.~.~.e...,-~--. ...... Phone No. ~.a ~/.-.¢'.~.~. ~
Name of Architect ..... 19..~.~...o~. .............. Address . .~?..~.c.,(.o.~. . .~.~-. ..... Phone No...~ .... .~' ........
Name of Contractor ...~. rtV/.~.7..tV.: .~1".*. ,?. ~ ..... Address . ~.*:.z~! .z. t~. ¢/.~./..~ Phone No.,Z ~. ~'r..~.d.~. ~ .....
10.
i1.
12.
13.
14.
PLOT DIAGRAM
Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines, Give street and block aumber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW~f'~RK. .~ ,
- (Name of individual signlff~ontract)
above named.
duly sworn, deposes and says that he is the applicant
Heis the .................... ~ .... ~ ..................................................
(...~°ntrac.~2?gent ' c°rp°rate ° fficer' etc')
of said owner or owners, and is dlal~y auth6nzed ~o perform or have performed the said work and to make and file this
application; that all statements contm~ned 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
....... .......... day o!.. ....
ot ubl?,. ............... County
I ~/ .. /ELIZABETH ANN NEVILLE . . . .'-:w. v--rT~t-~c~-... ~/,-. _':: ,-~:, .: .... .~. ,.:,, ...~
! NOTARY PUBLIC, State of New York / / t~gnature oz appucanu
NO. 52-8125850, Suffolk Cou_n.tl~
Term rxpires March 30, 19~.~"'