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Home My WebLink About16611-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19548 Date NOVEMBER 30, 1990 THIS CERTIFIES that the buildin~ ACCESSORY Location of Property 1180 COREY CREEK LANE SOUTHOLD~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 4 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 6¢ 1987 pursuant to which Building Permit No. i6611-Z dated NOVEMBER 9, 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 ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A SANDRA RAVE & MARY TLOCZKOWSKI ~~Buil/din~Inspector Rev. 1/81 FOltM NO. t TOW'N 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) 661 I z Permission is hereby granted to: ~..~..~..%....~..~ ..................................... ~~;L~....~.:~.:....:.g.~.l ........... , _. ~-~ County Tax Map No. 1000 Section Q~"~ Block ~A Lot No. purs,ont to opp~co,on dot~ ..... iO..~~......b. ............... ~9.~..'1.., ond opprov~ by the Building Inspector. Fee $~...~..:..:~ ..... Rev. 6/30/80 TOWN OF SOUTHOLD BUILDINC DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION ....... OLD OR PRE-EXISTING EUILDING ...... VACANT LAND ........ Lo~a~o~ o~ P~op~r~ ......... ~. ~ Z~ //fY ..................... ~ ...................... HOUSE NO. STREET HAMLET co~s ~ ~ ~o. ,000 s~o~ .... ~Zo~ ~ no~' fZ~ ........... Subdivision ....................... Filed Map ........ Lot .......... Health Dept. Approval .................. Underwriters Approval Planning Board Approval ................ Request for Temporary Certificate .~.. .... ~ee Subm£tted: $.~.~_. ............... Final Certificate APPLICANT ~~ .......... rev. 10114188 ?'iELD .t,,S, .~. · .LO ~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ~PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ION~L COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~r~FINAL DATE F/~ ~//~ ,NSPECTOR~~/~ .. 3 SETS OF PLANS ..... FORM NO. I SURVEY TOWN OF SOUTHOLD CHECK ~,~'~";: :¢ :~/: ? BUILDING DEPARTMENT SEPTIC PORM ............. : TOWN HALL $OUTHOLD, N.Y. 11971 NOTIFY . .~ .~.~.~..~.~./.~.... TEL.: 765-1802 CALL MAIL TO: Examined .~..o~'As'~...~...3.., 19~.?. Approved ~. · .~k~v~ · ~.., 19~..3. Permit No. 1 .L~. t k .~... Disapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. INSTRUCTIONS ao 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 authorized inspectors on premises and in building for necessary Jnsnectirms..~~ / - _ .'. ::::: ............ (Signature of applicant or name, if a corporation) ........... (~,lailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ....................................... .; .: ...................... Name oi owner olpremises .'~llt. tCt ~.' .... t. '.. J ~.~. .... ~ . ~ . .' .... ~ ........... ) ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED 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 ............. ' ..................................... Cerey ............ ..... House Num b~r Street Hamlet County Tax Map No. 1000 Section ...~. ~.~ .......... Block ....O..~ ........... Lot....O./(O ........... Subdivision ..................................... Filed Map No ............... Lot (Name) 2. State existing use and occupancy of premises and intended 'use and occnpancy of proposed construction: a. Existing use and occupancy . .' ............................. ~ ..................................... b. Intended use-and occupancy .: 3. Nature of work (check which a plicable): New Building . .4/ ...... Additio j ....... ' Alteratmn~ .i.I · · .[. · · Repair .............. Removal .............. Demolition ..... ~1. Ii.'.. Other Work .,..~:~'~.i ....... l]~ t~i ~ (Des~jip. tion) 4. Estimated Cost ~ ~00,~ Fee ..... ' ' filing this applica on) 5. If dwelhng, number o f dwelhng:umts ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of'use . .' .................. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Number of Stories ' Height ...................................................................... Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth Height Number of Stories Dimensions of entire n~w construction Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ pth 9. Size of lot: Front .......... ~ .........~... Rear ....... '.:... ........... De ...................... 10. Date of Purchase.........................~ .... Name of Former Owner ............................. 1 1. Zone or use district in wh~c premises are mtuated .................. 12. Does proposed construction wolate 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 ! .. Address ... Phone No. Name of Architect ......... ' .................. Address ................... Phone No ................ Name of Contractor Address ' Phone No I5. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes ..... No ...... · '~if yes, So~nhoid Town Trqstees Fermit maybe required. PLOT DIAGRAM Locate clearly and distinctly al! 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 sigfiing contract) above named. He is the ..................................................... . ................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du.'ly 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 .................. ~.. ...... day olf.. · .~.. · .~. · ............ 19:.~'.7 Notary Public, .. .~f.-. i .X:/.~..cf...d~.. ...... Couniy -' l'srt~'~x~i~os ~r?~ 30, 1~~ t~,~ ~-' (Signature of applicant)