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Home My WebLink About12821-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No ...... Z.1.2532 ..... Date ..... June 8 .......... 1984 THIS CERTIFIES that the building ...~1~.~.~.% .o.n. to existin~ dwelling .......... Location of Property ....4.1.50 ............. .~/.u.r~u9.w.e.~..a..R. qa..d ........ Cutchogue House No. Street Ham/et County Tax Map No. 1000 Section ...... 1.1 ~...Block ...... 1.4. ....... Lot , 24 Subdivision ....... ~[a $ ~/~.~. ~ ~ J-.~ ( ..........Filed Map No. 1. conforms substantially to the Application for Building Permit heretofore fried in this office dated ....... D.e.c emb.e.n. ] 9., 19~3. pursuant to which Building Permit No. 12821 Z dated ..... J a n n.~. y..4 ............. 19~.4.., 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 ......... ............ a~Ldi t i.o.n, t~..~ ~.t.~g..d.w~ ~[.i.~g ................................. The certificate is issued to ......... FS~EDE~.ZC. J....I~ .U.C E (owner, of the aforesaid building. Suffolk County Department of Health Approval ................ .N./.~. ...................... UNDERWRITERS CERTIFICATE NO ............... ~ 6.4.L 7. ? .4 ........................... Rev. 1/81 Building Inspector FOBM NO. 2 TOWN OF $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12821 Permission is hereby granted to: .,,~.~.,,.L~.~.'~.~.~:..~: ............. .~~:~..~ ...... ~~. at premises I~ated at ...<ZL~.....,~~_~:~...~ .................................... ................................................................................. ..... ~~..~-~ ........................................................................... X~.~.....X~ ....... Co~.~ T~ ~ No. ~000 S~tio. ...... L~ .......... etak ....... ~.~ ...... Lot No...~ ....... '~ ~e ' ~ 19~and by the pursuant to application dated .... ~.w./~ ..........L..~ ................... , approv~ Building Inspector. Fee $, .~,, ,~ ................ Building Inspector Rev. 6130/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall <,~outhoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY \ Instructions {~,. 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: I. 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. Fees: Certificate of occupancy $5.00 1~i Certificate of occupancy on pre-existing dwelling / land use / 3. Copy of certificate of occupancy $1.00 ~ --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ~//y,~/,,~A,/~-A Location of Property .~,?.¥~(D ~ ............. .~. ~T~,~'~,,~¢~, .~,_Y //~Y-- House No. Street Hamlet Owner or Owners of Property ....~..~:~-~..~..(,~.' '~ ~-/~,~:/¢~ ............ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~. ~..~, .')ST.~. Date of Permit ...... Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $,. ,~..~.~..... ,~...~. I .~. .......... Construction on above described building and per '~meets al! ap~b~es and regulations. ApplJca.t ~~' ~.~ ......... ..... '.' FI~[~PECTION 1. FOUNDATION (1 FOUNDATION ( ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL DATE COMMENTS d) I ~ .--~(I/ ~ .~ i .~-' ,. .~ '?"V ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 // TEL.: 765-1802 Examined . ..~..xv.. ......... ,19.~>~ Received .......... 19. ...... ,19 / ermitNo. Disapproved a/c ...::. :.-~7 Y ............... ~z~'~ · ' ' ~' ' ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. ,19... INSTRUCTIONS a. Tiffs 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 tiffs 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 .gbde, housin/g~ode,.N~_ regulations, and to admit authorized inspectors on premises and in building for necessary inspectJ~ff~. . / / ~'~h~,7~ ' - __ (Signature-------- 'nt or~ame'ifac r ° iofapplicant, orname, ifa op rat'on) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ................................................................................ Name of owner of premises /~ ff',~.'~."~/.~. · . .7~. · · .~./2 q .~.~7 .......................................... (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~. .... .~.~../~.~..~. ,~'..~.~.,ff. W,4O) Plumber's License No ......................... Electrician's License No../.~'. / ..... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .......................... :~ ....................... .. ..................... .. .......... House Number Street Hamlet County Tax Map No. 1000 Section ..... ./[.J. ......... Block / "/ Lot .O.~.7 Subdivision....,~...,~..5..-~..~..6~ J~O?..'~./T... FiledMapNo ............... Lot ...4;~.~.'.fz ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~..ffA~"..~fi:".~.~ /,6/ ~.~,,2d'// b. Intended use and occupancy 3. Nature of work (check which aDplicable) New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............. ~ 7 ~ ~ ~f C!f~...~ (Description) 4. Estim ed 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. Dimen,sions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w,ith alterations or additions: Front ................. Rear .................. Depth :. ' Height Number of Sto~es 8. Dimensions of entire new const¢ction: Front ............... Rear ............... Depth ............... Height ............... Number of Stodes ........................................................ 9. Size of lot Front .... Rear B~nth 10. Date of Purchase ..... .................. .~ame of Fomer Owner 11. ~ Zone or use district in which pr~mises are situated... ~(g~./.~i~t~ ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ............................ 13. Will Io~ be regmded ........ ~ ................... Will excess fiil be removed from premises: Yes. No ' ' [ 14. Nme of Owner of premises .. ~ ................. Address ................... Phone No ........ Nme of Architect 2 Address Phone No Nme 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 lifies. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or Corner lot. (Name of individq~l sigi above named. IS.S ing contract) being duly sworn, deposes and says that he is the applicant tie is the .......................................................................... (Contractor, agent, corporate o'fficer, 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 conthined in this application am 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 , T~m ~. Maroh 3~ 19~, ~ ,