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Home My WebLink About16285-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z16388 Date November 10, 1987 THIS CERTIFIES that the building..A..d .d.i.t.i. 9.n ..................................... Location of Property 865 New Suffolk Rd. Cutchogue County Tax Map No. 1000 Section ...1.0.9. ...... Block 7 .Lot 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J .u.l.y...2 .4 .... ! .9 .8.7... pursuant to which Building Permit No..I .6.2. 8..5 .Z .............. dated J u 1 y 3 0, 19 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 ......... .... .A.n..a.r..b.o.r...a.ddition to an existing one family dwelling. The certificate is issued to John J. CHALONER (owner, of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO .................................................. N/A PLUMBERS CERTIFICATION DATED: Rev. 1/81 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 ^UTHORIZED) N~ ~6285 Z Permission is hereby granted to: ................. ........ ..~.~.~..,..~..-.~.,.....L~.~.~...~ ............ ~~~ .~..,:.~~.~...~~.,.~.~ .......... : .......................... at promises ,~ated at ..~.~.~....~.~..~~..~.,......~.~ ....... County Tax Mop No. 1000 Section .... ,L.O....°/. ......... Block ..... ~)..'~. ......... Lot No.....C~....~.. ........... pursuant to application dated .... ...~, ~..,..~.~. ................. , 19.'~..-L, end approved by the Building Inspector. ,J Fee $..~... ................. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 ~ 765- 1802 ~ APPLICATION FOR CERTIFICATE OF OCCUPA N Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~mmmmmm 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. §,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 p~operty 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 safetv inspection of buildings or premises, or other pertinent informa- · tion required to prepare a certificate. C. Fees: Additions $25.00 New Dwelling~$25.0.0, Accessory ,.$10.00 Business $50.00 1. Certificate of occupancy 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~0 ~OI I'8 '~' 5oUpdated C.O. $ 50.00 Date ..~--..---- ........... NewCons t, ruc %ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...~.~.~ ...I~..~.,~.. ~-~[JL~-~L~[~-' ~-"~' ...~..~.~/? House No. Street Owner or Owners of Property ....~.0..I.'~.,, .~..L....~J~..~...~.. ................. County Tax Map No. 1000 Section ............. Block. ............... Lot ................ Subdivision .............. ~, ................ Filed Map No...~( ...... Lot No, ,. ,~, ........ /~'~ ~,/~(:;/?,~,App Ii Permit No. Date of Permit cant ....... Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $ Z,~',O0 Construction on above described building and p, ermit meets all applicable codes and regulations. Applicant .,~. ,~~1~ . . .; UNDATION (2nd) UGH FRAME & FLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION ZST [ ] ROUGH PLBG. £ ] Fou/u, Jd~TION ZND [ ] INSULATION [~],~RAMING [ ] FINAL REMARKS: DATE /~/~F"'~ INSPECTO ~~:~ OCCUPANCY u~ e~-~,~~o. USE ~$ UNLAWFUL ¥~! [' ~OUT CERT]F~~ · 7~5..1~2 9 A~fi TO ~ F~ F~)~ THE .OWING ~ SPEC FIO~ , 3. ]:)~T~ L BOARD OF HEALTH ..~,;.. 3 SETS OF PLANS ....... FORM NO. 1 SURYEY ., TOWN OF SOUTHOLD CHECK ~,~: :q~f- - BUILDING DEPARTMENT SEPTIC FORM ............. ; TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~ · Approved. 19 ..7. Permit Disapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT * INSTRUCTIONS NOX~rX7 3" CALL ................ MAIL TO Date ./}...~ ...... , 19 ..g~. a. This application must be completely filled in by typewriter or in ink and submitted to the Building In~ector, 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 shali be kept on the premises available for inspection throu~out 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 oi 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 inspectom on premises and in building for necessary insp ns. , t (Signature of applicant, or name, it a e'orporation) ,., ?¢. (Mailing address of applicant) [/9 $') State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . '~/4,t..~ ~/4~(ax.,~ ..~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALL CONTRACTOR'S MU~,T BE SUFFOLK COUNTY Builder's License No ............... ~)~. Plumber's License No ......................... LICENSED Electrician s License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done: ...~..~..frS. .... ./~..e.t~.... ?..'.~.~f.g'~.4/.(....../fi.O.: ........... ........................................... ~. wT.c.~e~ .<e.. ~ .,5<: ¥:..././.q..~.o7 ..... .,q,.v...,q.o.~ .,g.~ ?... House Number Street Hamlet County Tax Map No. 1000 Section .... /O..~. ......... Block ....... ~. .......... Lot..~.. x3 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premiseg and intended use and occnpancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy (_.~ /~,~ 0 ¢ ,q F,J.I~. ~/4~¢ ~ 7" //~.. ?. ..q.O. .t~ , *If yes, Southold Town Trdstees 3~ Nature of work (check which app ~cable): New Building Addition ..... Alteration ..... Repair .............. Remgval .............. Demolition .............. Other Work....~. ..... 4 Estimated Cost , Fee : ~' (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... 6. If business, commercial or m~xe¢ occupancy, specify nature and extent of each type of tine ..................... 7. Dimensions of existing structures, if any: Front ................ Rear ..... , ........ Depth.. ............. Nuniber of Stories Height .................................................................. Dimensions oLsame structure with alterations or additions: Front ................. Rear . Depth ..... .~..~t.~.2~.~... 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 Date of Purchase ~ Name of Former Owner 1 I. Zone or use d~stnct in which prpm~ses 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 premises .. 4 ................. Address ................... Phone No ................ Name of Architect ......... : ................. Address ................... Phone No ......... .~ ...... Name of Contractor ........ ; ................. Address .... : .............. Phone No ............. ~.. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No ..... Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all property lines. Give street and block interior or corner lot. buildings, whether existing or proposed, and. indicate all s~t-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, S.S COUNTY OF ................. ............................ i'. .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ! ' He is the ..................... i .................................................................... (Contractor, agent, 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 tlie 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 of applicant) HELEN K. DE NOTARY PUgLIC, SMe of New Ymk . NO. 4707878 Suffolk Cmmty~,, lerm Exp res March ~0, ~9,,..~