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Home My WebLink About13097-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12821 Date .... Sep.t....28 ....... 19 THIS CERTIFIES that the building ...];~g~.qur~cl..aw~ra~,r~. ~.qq ~./a.r~4..f.e.r~q e. ....... Location of Property ....5.~.3..0, ?.~.q .u.a.s.h...~¥.e.. ................ Cutchogue House No. Street Hamlet County Tax Map No. I000 Section ....1 .~.0. ..... Block .... .0.5 .........Lot .... .3.5 ........... Subdivision ............................... Filed Map No ......... Lot ]',To .............. conforms substantially to the Application for Building Permit heretofore f'ded in this office dated .... ~ ~ ? .~,1,. 2. ~ ........ , 198. ~.. pursuant to which Building Permit No...1.3.0.9. 7. .Z ............. dated ..... ~..ay..7. ................. 19 .Sfi., 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 ......... .... ~[~g~.auBct..aw~mr~J, ng..p, q9 [..a.r~cl. t'.e.nq e ....................................... The certificate is issued to .......... ~a ~p.y..P... S~eppa~.d. &..V. ee c>nJ.ca. S~.ap para .... (owner, X~C ~r~r~tX X X X of the aforesaid building. Suffolk County Department of Health Approval ......... ~/.A. ............................. UNDERWRITERS CERTIFICATE NO ................. ~ ~.4.7. 4.4.7 ......................... Rev. 1/81 Building Inspector I~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13097 Z ~o.. .~...~.~.~.~...~.J ~~.~..~.~.~.~......I~.~...??.~#......~ ~,.~, ......... ~ ............................................................................................................... at premises I~ated at ..... ~.~ .......... ) ...... ~....~C~.~.~ · ..~:.,..~....~...~ ................ ~.~,~ ....... ~ ..... .~ ...... ~ .......... ~.~-~ ................................. ...... .~....~ .......... ~......Z~ .............. .~ ....... ~f ........................................................ Co~.~ v~ M~o. ~000 Se~.o~ ....... ~.~ ........ m~ ....... ~.~. .... ~ot ~o ...... ~.~?~ ....... . ~ .:.~.~. .............. ,~.~.~ ~ ~rov~ ~ ~ ~t to ~i~tio~ a~t~ ..~/~ ........ , , Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall · ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subm~tteG,iccc~J,' ' '"~'* ...... to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ail 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. B. For existing buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate sun/ay 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 / land use --?z,e_Exis ting C.O. $15.00 3. Copy of certificate of occupancy $1.00 Vacant land C.O. $ 5.00 New Building.. .....~, · , , Old or Pre-existing Building · ......... · - Vacant Land . .......... . , House No.' ............. ' ......' Street Ham/et Owner or Owners of Property . .~. ~ County Tax Map No. 1000 Section .../J.~ ..... Block .. d..~..-~. · · · Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [.c~4). ~/.?· ~. Date of Permit .,~/7/¢.~... ·Applicant· .'~,~ ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Appr6va, . ~ ~. ?. Z~..~. Z ........... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ -'~ .......... Construction on above described building and permit meets all applicable codes and regulations. -z/k. .?¢', O. Memorandum from... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, BOX 728, 8OUTHOLD, N.Y. 11971 765-1802 Sept. 25, 1984 Dear Mr. ~ Mrs. Sheppard: I spoke to Modern Comfort Pools today regard- in the C.O. for your pool. They told me to contact you. I am enclosing an application for a C.O. for the pool, please return it along with your check for $5.00 so we can issue it. The final inspection has been done and we have the Underwriters certificate in the file so every- thing has been completed except the application. Thank you. Yours truly, Building Dept. THE NEW YORK BOARD OF FIRE UNDERWRITERS 100071~) BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 N 647447 THIS CERTIFIES THAT in tke following Iocatim,; ~ Basement ~ 1st FI. ~ 2nd FI, ~t~ Section Block Lot was examined on ~ ~ ~ ~ and fout~d to be in eotnplianee with the requlren~ents of this Board. FIXTURE OUTLETS DRYERS RECEPTACLES 1 FIXTURES RANGES OVENS EXHAUST FANS SWITCHES 1 MULTI-OUTLET SYSTEMS NO, OF FEET E R V I C NO, OF CC COND A,W.G. j NO. OF HI-LEG A,W,G, qO. OFNEUTRALS A.W,G, PER ,ff OF CC COND. OF HI-LEG OF NEUTRAL OT R P ATUS: ~gIM~ING PO~e: This certificate covers cce~01tance at the date of inspection only. Becan~ of unusual environments it is e~visable to have frequent test and/or repairs n~de by a qual. ified R.C. ~lec~rio 4 ~o "La~e ~, N.Y. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors GENERAL MANAG~EE m~¥ be identified by their cred~H¥1ols. , THI ' OF CERTIFll DIN ANY MANNER. FIELD INS?ECTION COHMENTS FOU[,]D/~T I Oil ( 2nd ) ROUGI1 FRAME & ?LLMB~NG ~ISU[,ATION PER N. STATE ENERGY C~ODE 4. FII,~AL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . ..X'~. Y~ ..~..-)..., 19'~ ~. Permit No. ! 13.0. (~'.'7..cb~_. Disapproved a/c .......................... ' ........... Application No .................. (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 dia~am 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 Occupahcy 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 applicant, or name, if a corporation) %'~' '~"'' (M ailing addre ss df applic ~'~' ('~? ~C~ ~7c State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................. of owner of premises'~.~'~ .~ .'~..~...[~.-~-.'.~..~'..~.. '~'~' '~'~' ' '~'!;~d"' ........................ Name (as on the tax roll or latest ) Cpplicant is a corp~r~n, si,gnatur, e of duly authorized officer. (Name and title of corporate officer) Builder's License No... '.~./.O. ................. Plumber's License No ......................... Electrician's License No. /<9' ~)~ . ,qt. ~.~:c:(~) Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ........... ............... .... .ho. ...... ?..% ............... House Number Street Hamlet ' c~)imty Tax'Map 'No. 1000 Section ..... /../. q ........ Block ..... .O..~. .... .... Lot.. (~.~.'~..-'i ........ ~ Subdivision ..................................... Filed Map No. I ./.~ F.~. 7.~. D. Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed,construction: a. Existing use and occupancy ........ .~.gqv.~.r~. · · t~'- .ffS?~. · · ./.~. .' .~' - · - *~ ; ................... b. Intended use and occupancy .1.~. ' .~.'~.~.~. ! .'- .--~.~...k~. -~.Z.~.(~ ...~'' '~'~'~'' '~" '\~'~'~' ' '~' '~'~' ' ..... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration . ./~ ...... Repair .............. Remoyal .............. Demolition .............. Other Work~/.. ....... .... ~' (Description) 4. Estimated Cost .... .~., ~.':"(~.., ......................... ~) Fee . .~.. ............................... / .'~..'~'..~.'~. ! (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... 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. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories '. ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth: .................... I.. Height ...................... Number of Stories ......... ' ............ 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... 9. Size of lot: Front ...........! ........... Rear ...................... Depth ..................... 10. r)ate of Purchase ........... i .................. Name of Former Owner ............................ 11. Zone or use district in which premisos are situated .................................................... 12. Does proposed construction violate any zoning law ordinance or regulation: ............................... 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of pmmises ... ................. Address ................... PhoneNo ................ 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 property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, i S.S COUNTY OF ,.~ ................ '-~_ ............. /.~.~70../~. (~ ...... .~././?LJJ.t../ .... being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. (C~~ agent He is the .................... i , corporate officer, etc. 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 ................ day of ............ Notary Public, .... .~..~.'.. :/hi..L~. ~ .~...ff~.... Coun H[I EN KL DE VOE t..~ No 4/0787~, 8uffolk C, otm~.. (Signature of applicant) . lerm [~p~res ~!arch 30, L U z mm~o~ ~z~ 0 ~m DmO*o ,-om