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Home My WebLink About11075-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z.1.Q 4.3 7 ........ Date ...... J[l~t'i]l..6 .................. 19...8 1 THIS CERTIFIES that the building ................................................ 2715 Nassau Point Road, Cutchogue, N.Y. Location of Property ............................................................... House No. Street Hamlet County Ta× Map No. 1000 Section .... ~. 0. ~ ..... Block .... 0.1. .3 ........ ]Lot ...0.0. ~ ........... Subdivision... lq. aa,sa.tx .Po;JJal~. ¢l.Rl~. l~r. ql~ ,Filed Map No...1.5.6....Lot No....1.0 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated 81 11075 Z M a r c h 1 7, 19 pursuant to which Building Permit No. dated ..... i~.a.r.c..h..2.5. ,. ............198. !. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy ~r w~ch this certificate is issued is ......... Deck Addition to Dwelling The certificate is issued to .... R. i. 9 .h.~. cl.. !d.a.1..1 ,..,S.r., ................................... (owner, I~.o~ t~p,a~t,) .... of the aforesaid building. Suffolk County Department of Health Approval N/R UNDERWRITERS CERTIFICATE NO. N / R Building Inspector Rev. 1/81 FOENI NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N!. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) 11075 Z Permission is hereby granted to: ...... ~,~<~:~.~.~:...~.~..~;: ........ 5~.~ , to .... ~ ................................................. at premises located at ............ ~: ................... ~ ............ ~ .......................................... ......... .... Coun~ Tax Map No. 1000 Section ...~.~ ........ Block .~..~Z~ .......Lot No....~2.~.~ ........ pursuom to oppli¢otlon doted .~¢.~......~ .............. ~....., 19 ......... ond ~pprowd by the Building Inspector. ~e~ *../..~...: ..... i, I~ilding ~lnspector ........... 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 buiidings, 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. Commercia~ buildings, industrial buildings, Multiple Residences and similar buildings and instalta- 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 buddings (prior to April 1957), Non-conforming uses, or buildings and "pm-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 $5.00 New Building ............. Old or Pre-existing Building ... ~ .... Vacant Land ............. Location of Property..~..~.~/~.~. ....... .~./~.~$.4~.%.. ~.~, ?. ?.... '~. -~. ........................ House No, Street Ham/et Owner or Owners of Property ..... /~.~(; ,~.~.'/~.~. ~ ..... ~,~, .~./~....~'. ,~ ............................ County Tax Map No. 1000 Section ..... ./. f.c/. ....Block .... .~../.-~. ..... Lot ..... ~ .D. ~, ..... Subdivision ................................. Filed Map No..../.'~7.~. . .Lot No .... ?.0. ....... Permit No..//0. ~,-~.. Date of Permit . :- pplicant ./.~/.~. .~c~ ,."~/./)~3 Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... ~equest for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..',,.~ ?..~.. .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .... /.,~, ~'/--/¢/~,~c~ / Rev, 10-10-78 FIELD' IS~S~ECT I 0N COMMENTS FOUNDATION FOUNDATION (2nd) ROUGHFRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,; 765-1803 ...... 19.& / .................. ;~.~-.~ ...... ~.'..~ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application NO..././. d?.,.~.~.. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building .nspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildmgs on premises, relationsh,p 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 issue 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 ,hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or l~,egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to zdmit authorized inspectors on premises and in buildings for necessary inspections. .... .................. (Signature of applicant, or name, if a corporation) d 77....;.~.,../.& .6-'. ~.. ,,c_~,. ::,,3., .~,.,d.,,.. ~.,K. (Mailing address of affplicant) ~tate whether applicant is owner, lessee, agent, architect, eno~neer, general contractor, electnman, plumber or builder. ....... .&,,:,.:?. . . ............................................................. '4amc of owner orpremises ...,,~,k .C-.t~¢f.[. , (as on the tax roll or latest deed) tf applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ?.../7. :.~ ............. Plumber's License No ......................... Electrician s License No ....................... Other Trade's License No ...................... .¢. - 1. Location of land on which proposed work will be done ..... ... :-.: .&~... ....... q..7/.Z ............................................................................. House Number Street Hamlet County Tax Map No. 1000 Section .../..~., .~.. ......... Block ...~../..~. .......... Lot.....~....~..~..~. ..... Subdivision ..................................... Filed Map No. .l' ...~-.~. ........ Lot . ./..~. .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... OA~.~.X...PT..~'.,7.*.r.,.~.-V...~//./.~...'-'~h. ......................... b. Intended use and occupancy ...~..~-... ?.~.o.-~.~....~.~....O./~.....~..~...~'! .............. Repair ......... Removal .............. Demolition .............. Other Work .... ~..[e_.~. .... ~/,.~. ~ ~ /~-- ~-~ (Description)_ 1 Estimated Cost Fee "~ (to be paid on filing this application) L If dwelling, number of dwelling units .............. Number of dwelling units on each floor ............... If garage, number of cars ...................................................................... L 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 ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth ...................... Height ...................... Number of Stories .................... L Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ...................................................... L Size of lot: Front ...................... Rear ...................... Depth .................... ). })ate of Purchase ............................. Name of Foru~er Owner ........................... 1. Zone or use district in which premises are situated ..................................................... L Does proposed construction violate any zoning law, ordinance or regulation: ................................ L Will lot be regraded .......................... Will excess fill be removed from premises: Yes No . L 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 -operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. rATE OF NE~,~RK, .~ o ~ ~' r(-/~_~ (Name of individual signing contract) oove named, eisthe ........................ ~."['....~.. ................................................. (~nt, corporate offi~,e,r, etc.) f said owner or owners, and is duly au~ed 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 ,ork will be performed in the manuer set forth in the application filed therewith. worn to before me this ....... / .'7~'.~ ........ day of..~.~ ...... 197./ IotarK P_.gbli.c, ........... ~ ..... ~ County, ~. LIZ~IIErH ANN SEVILLE ................ i INOT/IRy PU,BLI0, State of IN0W York (Signature of applicant). ' Ne. 52-8125850, Suffolk Oocgt~ Term £x~lrc$ March CO, 1~ ~ -< .C~ 0 & - z4': . ,I