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Home My WebLink About16261-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z. 16..2.5.4 ......... Date October 6, 1987 THIS CERTIFIES that the building .... 4 d..d.i.t.i.o..n ................................... 1210 West Road Cutchogue Location of Property h~tJs~ h/o~ ....................... ~}/e~t' ....................... t4am/o* County Tax Map No. 1000 Section . I I 0 .Block 5. ........... Lot 13 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 20, 1987 pursuant to which Building Permit No. 16261. Z dated ...J.u.l.y...2.3.,.. ! .9.8.7. ........... 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 ......... .l~e.cJq.oql.d.it~pn to an existing one family dwelling. The certificate is issued to J.A.M..E.8..N. :..T.R.E.N..T.A.L.A.N..G.E..&.. L..E.O.N.A..R.D..I.N..F.R.A.N.C..A..(.t..r .u.s.t.e.e..s.) (ownor, lq~,ffet~ ?~rXt~zlikffzrX X X X of the aforesaid building. Suffolk County Department of Health Approval ..... .N./.A. ................................. UNDERWRITERS CERTIFICATE NO ............. .N./.A. ................................. PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FOR~[ HO. S 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~ 1626J z Permission is hereby granted to: ..... ~...~~..~.~.~:.~, .......u~s...~...~....~_...c~.:.... · ...~.~...~...~.:~--.'.~..t. ..... ,a .~~.....~..~....~.....~.~.......~..~...~ ......... o, ~e~,,,, ,=,.~ o,..~.~.~.~......~....~.~ ...... :~~....~....~..'~.,...'..~.~.~.. County Tox Map No. 1000 Section ........ 1,~,.,~. ........ Block ...... ~J~,..~.. ....... Lot No .....~.-.~... ............. pursuant to application dated ........ ...~. ,~....~.....~. ..................... , 19..~..].., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCU Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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. Subm it 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 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. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $I0.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.'00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.C. $ 50.00 New Cons truc t i on ...... Old or Pre-existing Building Location of Property . .~...~..0 ..... .~..d.~.~. ?....~..~... House No. Date .......................... ~:)f.~ .... Vacant Land .,.~.~.~. ..... .... L./. 23 Street -- Ham/et Owner or Owners of Property ~..~,//~./21.~-,~. ~.~.,. ~-.~.(.z']~.)~.. County Tax MapNo. 1000 Section .,.]~ ........ Block ..~ ........... Lot...l~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~' ~.~ Date of Permit ............ pplicant .............................. Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $... ~..~. ...................... Construction on above described building and permit meets alt applicable codes and regulations. UNDATION (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL · ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~-~I~AL REMARKS= ,/~_. ~,,- ~ ~ DATE ~//~/~/~ ~ ,NSPECTO~ TOWN OF SOUTHOLD BUILDING DEPARTMENT SEPTIC TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL MAIL BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... FORM ' TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOIl BUILDING PEIIMIT Date ................ 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 ora 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 building for necessary indirections. ~ (Signature of applicant, or nanSe, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plun~ber or builder. ........ .~. ~..~.. ~. ~¢?~ .~...~..~=~...~.. Name o~ow.~ o~am~ . ~.~ ~.~.L~. ~~. ~.~. ~:.. ~ ..... (as on the tax roll or latest dee~) ~ ~ ~ ~ ~ If applicant is a corporation, signature of duly authorized officer· ~ ~u~ ~ ~ (Name and title of corporate officer) - ALL CONTRACTOR'S NUST BE SUFFOLK COUNTY Builder's License No .......................... LICENSED 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 TaxMap No. 1000 Section ...].F.C~.....~..~. ..... Block ..~ .... Lot..~.. Subdivision ........ ' ............................. Filed Map No..~ t(':..~.. C-q.~.... Lot ...C.~. ( ~.: .c?. ?..~.. (Name) 2. State existing use and occupancy Ofrl~remises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....[~)L .x.~} ~'~ .~?~.~...~. ...... .~...~.t~ ......................... b. Intended use and occupancy ...~..~.~.·.. ~ · .¢~...t::~:~t:::2., ..~: ......... .: .................. 3. Nature of work (check which applicable): New Building ' Addition .......... teration .......... Repair ..............Remgval .............. Demolition ..............Other Work ............... (Description) 4. Estimated Cost . .(.~ Fee ~ ~' (to be paid on filing this application) 5. Ifdwelhng, number o(dwelhng~umts....d'~'~fie...~ .~. .... Number of dwelling units on each floor .... ~ ..... If garage, number of cars .... ~ Y.~,.~'~ ................. 6. If business, commercial or mixed occupancy, specify nature and extent of each iype of use ' : .............. 7. Dimensions of existing structures, if any: Front...~..~..-.'~. .... Rear . ~ .... Depth j..~.,~,.,, ~ .... Height ..<::T:~-....~ N ~ber of Stones .... ~ ............................................. Dimensions'of same att~:0Iur, e~With alterations or additions: Front . .~~ ..... Re'hr .. ~~ ...... Depth . ~:0.[.,~i · ' Height ...~. ~ ......... Number of Stories...?..~... ~ ......... - $. Dimensions of entire new constr ctmn: Front .......... . ..... Rear ....... Depth ............... Number of Stories Height ....................................... 9. Size of lot: Front ...; ................. i Rear ...... :. ........ ' :. ~ ...... Depth ...................... 10. Date of Purchase ....... ~ ................ Name of Former Owner . '~:~ .~ .~-. · .'~. ~ .t,:,..%~9.;."/"~%. . 12. Does proposed construction vio!ate any zoning law, ordinance or regulation: ...~? ....................... 13. W~ll lot be regraded ..... t~ ............ Will excess fill be renloved,[rom premises' Yes 14. Name of Owner of premises .~..~"-A~...~.~..~..'~..~..~.g .~Address . ..g~..~. Phone No..~'..~.~...':-..~(....X"~.. Name of Architect .. r-, ..... ~ ................. ,~...~ Address ................... Phone No ................ Contractor . \~.m,~...~.. i..t~. :¥.%.~..~...~ .... Address .... : .............. Phone No..~. Name of c..z. 15. Is this property locatedlwithin 300~feet of a tidal wetland? *Yes ..... No ~,~.. · If yes, Southold Town Trdstees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all s~t-back dimensions from property lines. Give street and blockI number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOR~I~, COUNTY S.S ...~.~. ~ ..... ~.~ ..~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual s~ning contract) above named. He is the ............. ~,. ~.~ ~. ...... ~..~ .......................................... (Contractor, a~t, corporate officer, etc.) of said owner or ownem ~d is d~ly authorized to perform or have performed the said work and to ~e and file this application; that ail statemants contained ~ this applicatio are true to th~ his knowledge~eiief; and that the work will be perfo~ed in the m~npr set forth Sworn to before me this No ta~Public ....... ~.,.~ ;~.. County ~~~f -- H~EN &DE~