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Home My WebLink About13202-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~269~ Date August ~0 THIS CERTIFIES that the building ..... qi.~.Q~., .~.d.d.~.~..i.o.u. ........................... · t~OO Betts Street Cut chogue Location of Property ~l~fis'e h]o~ ....................... 'S't/e~i ....................... County Tax Map No. 1000 Section ....fl .'l.O ..... Block .... .6 .......... Lot .. 9 .............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fred in this office dated ' 19 ?. 32o2z ,May.~8 .·z ........... , ........... pursuant to which Building Permit No ..................... dated June '10 19 ............................... 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 ......... deck sddition to existing one-family dwelling. The certificate is issued to HARRY & FIARIE FAGAN (owner, of the aforesaid building. Suffolk County Department of Health Approval ......................................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 I~OB~ NO. ~ TOWN OF $OUTHOLD 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.o ~0~ z Dat, ...... .~.L...O. ...................... , Permission is hereby granted to: ~.~..J ........... ~.....~.. ......................... ~..~_~......~..,..~.,......u...~..o.. ....... ~ , .~..~..,..~....~...~...........~...~....~..~.~.,..u~.....~.~....~... at premises Iocloted at ...,,~.,~,,.0.,.0......~,~,,..~ ....... ~.~ ................... · n ~ I ~ Block ..... .~,. .... Lot No . ~ . County Tax Map No. 1000 Sector ....................................................... pursuant to application dated .~...!....~ .................. , ]9.~...LJ..., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD E~uilding Department Town Hall ,~;=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~plic;tc 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 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/ land use -- ?re-~;x:i_s t,±ng C. 0. $15 · 00 3. Copy of certificate of occupancy $1.00 Yacant, ~.a~c] C.O. $ 5.00 New Building ............. Old or Pre-axisting Building ....... Vacant I.and ............. Location of Property 4; / / M~'~-~/?z~/~' / Street Hamlet House No. (, ~ Owner orOwnersofProperty ....~./~,~. ~ ,~.~.~.~/.Z~- ~.~.~...~. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. ................................. Permit No,/;--?.~..~.' .~.. Date of Permit .Applicant ./~i.?~' '/~'~/~ Health Dept, Approval ........................ Labor Dept. Approvel ........................ Underwriters Approval . ' ................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~...~..~....~.~..~.~.~ .......... ~'~' ~' ~55% II ' ' ' ulatlons Construction on above described building and permit meets a applicab~codes ano reg ' · ......................... R~v. 10-10-78 FIELD ~SPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING 3. INSULATION FER N. STATE ENERGY FINAL COMMENTS ADDITIONAL COMMENTS: 477-0400 LI.I I~l El E:I~ At LC INC. A~ .... n AS NOI'I:~ NOTIFY BUILOING DEPARTMENT AT 765d80~ 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR P~U~EP CONCRET~ 2.ROUGFJ - FRAMING & PLUMBING 3.INSULATION 4. FIN~[. - Cq~YSTRU~-m~N MUST BE C'~A4~ FTF FQR C O. ALL COKm-~'~CT!ON SHAI. L MEET & ENFRGY FOR DESIGN OR ~UCIFION ERRORS. 76S-1802 BUILDING DEPT. INSPECTION- FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION 2ND Il INSULATION FRAMING X] FINAL DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 Examined .~...t~O:~&.. ?.~ ...... 19 .~}t Approved .~...~?~....). 0 ..... , 19 .~ ~. Permit NoJ.~..a:..o.~..~-.. Disapproved a/c ~l~,~4~.~.~'t,~....~...~...~3~. .................. ............ :": ........ 7' ...... ~ __~..- (B u ildin g I n specto r ) APPLICATION FOR BUILDING PERI¥11T Application No .................. Date ~r.,~.,,,v-'. /'3 19.~.~' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit anthorized inspectors on premises and in building for necessaryinspecti~ f~/~ (Signature of apl~licant, o~r n~fne, Pa corporation) ... K~ .,:.~.z.. ~ .r'e~.,,t~..'""..~...y: .u..~.,, ............ (Mailing address df applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of preinises . ./~..~.~.'.~...~...C. ~7' ~'' ~(~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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ............ ./.D. r ................ .&. .................... 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 ..................................................................... b. Intended use and occupancy . .~..~.~.t~.~..~/.~.~.... ~ .~. ~dl ~ ................................ 3. Nature of work (cheek which applicable): New Building .......... Addition ~ Alteration Repair Removal Demolition Other Work ' i (Description) 4 Estimated Cost ~ (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 ..... 1 ................................................................... 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 Num'ber of Stories ' 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 ........................................................ 9. Size of lot: Front ~ ........ I ........... Rear ................. Depth ...................... 10 Date of Purchase ;/a~ ! ~,,~ ..... . ...... ..... '-~' ' ' '~" 'i .................. Name of Former Owner ..... .~'..~'.~.~. r..~5.~. ....... 1 1. ~ Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... k ....... ~ ..,.~. _ ...... Will excess fill be removed from premises: ~' Yes No 14. Name of Owner of premises ?.'./'.'..~.,~.~.~..~...d.~. .... Address,~. ~.~: .~(~.~.~..,~.l(.~.././.,f?qPhone No.~'.r.~..,-Y.~..~..~.~..~'... Name of Architect ............................ Address ................... Phone No ................ Name of Contractor ......... ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate 'clearly and distinctly alll 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 YORK. . COUNTY OF. :~...t,( .~-.~..D.a. ~ .... (Name of individual sign above named. 'S.S · ?.~.' ............... being duly sworn, deposes and says that he is the applicant tng contract) He is the... 19 M/'~'~ (Contractor, agent, corporate officer, etc.) of saki owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; that all statements cont0ined 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. S. wom. to before me this/,~ ~ : ... .day ., 19e :. NOTARy PUBLIC, S[a~e at N¢~ Yor~ ...................... No. 52'4524771 ~ ( 'gnature of applicant) ~uaI~led ia' SuUol~ Couoty Commission Ex~ires March BO, 198, ~