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HomeMy WebLinkAbout16290-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17103 Date JULY 21~ 1988 THIS CERTIFIES that the building. Location of Propert~ 405 FLEETWOOD RD. House No. County Tax Map No. 1000 Section 137 Subdivision ADDITION CUTCHOGUE, N.Y. Street Hamlet Block 4 Lot 15 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 28,1987 pursuant to which Building Permit No. 16290-Z dated JULY 30, 1987 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to DOROTHY J. FALCONER (owner, ~{Y~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Building Inspector 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 AUTHORIZED) N~_16290 z Date Permission is hereby granted to: ..... County Tax Map No. 1000 Section ...... ~,...~.,~. ....... Block ...... .,~,..~ ....... Lot No....,I.,~, ............. pursuant to application dated ....... ~/t~...~ef....~. ................... , 19.~..,[..,~'~ and Building Inspector. approved by the Building Inspector Rev. 6/30/80 M~r~/a~c~ /~, Town Hall ~, ~/ Southold, N.Y. 11971 ~b,,~%~ ~q IIoC~> 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUF FORM NO. 6 TOWN OF SOUTHOLD Building Department Instructions This application must be filled in typewriter OR ink, and submitted m I~==~a 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 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, occapancy 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: Additions $25.00 POOLS $25.00ALTERATION $25.00 1. Certificate of occupancy New Dwelling, $25.Q0, Accessory,,$10.00 Business $50.00 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.O. $ 50.00 Date ...... .......... / New C one truct ion../V~... O d or P,or~ ~,/¢e~xisting,/Building ............ ~acantJ~a~nd .............. House ~ . // ,~'D '~ ~,¢eet/~ ~ ~Hamlet Owner or Owners of Proper~..~.~, ./~,~.~ ~.. i, ~ ,~,'-~~,, ,~,,, ............. '~ County Tax Map No 1000Secton .] ~. ~..... Block .~..~.. ....... Lot..~.. ~.~..~.-~ ..... Subdivision ................................. Filed Map No ........... lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate.. ,, ................... Final Certificate .... ,~... Fee Submitted $. ~..~. J .~.~...?..~..~-~ ...... Construction on above described building ~"'~ermit r~eet~, applicab~e~odes.~:~regu~a/tions. /- Rev. 10-10-78 UNDATION UNDATION {2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ;ZND FRAMING REMARKS: [ ] ROUGH PLBG. [ ] INS~ULATION [ ]/~FINAL DATE INSPECTOR / 3 SETS OF PLAlqS 'FORM NO. I SURVEY . . . ~,...~.'.. , TOWN OF SOUTHOLD CHECK .....qt~ O~... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL SOUTHOLD, N.Y. NOTIFY TEL.: 765-1803 CALL .......... MAIL TO: Examined . .~. 4' ~13'" 19 .~.7 Approved . ..~~. .~..., 19g. ?. Permit No..l .~.~..~.~..~ Disapproved a/c ..................................... · ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 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 cod% and regulations, and to admit authorized inspectors on premises and in building f°r nece~~'~-.~.r~ ~.'{f~. · · · .  gnature 9f al~p~i~'a, nt, or naF/'e, if a corpo,~tion) State whetherApplicant is.owner, lessee, agent, architect, engineer, ge~'~t~ct~r, ~'~ncian~_d~iumber or builder. Name of ow,er of premises ................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) , ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No....~.. ~'...~...~o..~..~..~. ....... I. Plumber's License No ...... Electrician's License No .... Other Trade's License No ........ .~3./..~. ........ 1. Location of land on which proposed w~rk will be done ............................ ; ................... ·. House Number ' Street / Ham!~t County Tax Map No. 1000 Section ...' .... /..~..~. ...... Block ......... ~. ....... Lot. /.5' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy c~premises and intendeC?use and occupancy of proposed construction: a. Existing use and occupanc ............ . ................... b. Intended use and occupancy . PI~~/~ ....... '.L~. ?.-.C..~. ............................ 3. Nature of work (check which aplplicable): New Building ' Additibn . ion .......... Repair .............. Removal ............ Demolition .............. Other Work ............... ' ~l~ (Description) ~ cteo ~ , 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 i ...................................... ' ......~' ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each Wpe of use*./.'... ': ........ 7. Dimensions of existing structures, if any: Front... ;.~ ...... , .- ....Rear .... ; .- ......... D~pth ..: ............. Hmght ............... Number of Stones ....................................... Dimensions'of same structure with alterations or additions: Front .../.~ .* ......... Rear'...' )~'t.............. ............ Depth .......... I Height ................... Number of Stories ...................... '- 8. Dimensions of entire new construction: Front .......... ' ..... Rear ............... Depth ............... Height ............... Number of Stories ....... i.. ................................................ · ' " :,. , .~ ~'.:. :..~ ~ ...... Depth 9. Size of lot: Front ' , .. -l~ear..'. 10. Date of Purchase .......... ~ ............... Name of Former Owner ............................. 11. Zone or use district in which ' ' are situated .................. premises ................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~ ................... Will excess fill be removed from premises: Yes No 14, Name of Owner of premises .. i ................. Address ................... Phone No ................ Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor ........ i ................. Address .... : .............. Phone No ................ 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes .~.. No ..... *If yes, Southold Town Trustees Permit maybe required. i PLOT DIAGRAM Locate clearly and distinctly all' 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, ' S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sigmng contract) above named. He is the ....... (Cpntractor, agent, corporate officer, etc.) of said owner or owners, and is duty 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 Nffi'Altq-~tl0,--,-~Y°~ ~' : (Signature of applican ) Term Expires March 30, t. '!