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Home My WebLink About16625-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17314 Date SEPTENBER 15, 1988 THIS CERTIFIES that the building. Location of Propert~ 12400 House No. County Tax Map No. 1000 Section Subdivision ADDITION NEW SUFFOLK AVENUE CUTCHOGUE Street Hamlet 116 Block 6 Lot I2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 12, 1987 pursuant to which Building Permit No. 16625Z dated NOVEMBER 16~ 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 GARAGE ADDITION TO EXISTING ONE FAMILY DWR3~.ING. The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBER8 CERTIFICATION DATED RUSSELL B. CASE (owner, PENDING Building Inspector Rev. 1/81 l~'O~,lt~ NO. ~ 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) 16625 z Permission is hereby granted-to: . / I ~, ~~/~r-ntr~"e5' 7 ................................................ County Tax MapNo. 1000 Section...... 1.1..0. ......... B~o~k ...... ..~...(e. ....... Lot No....!.& ............... pursuant to application dated ..~.~.......J.~ .............. , 19.~...~..., and approved by the Building Inspector. Fee $...~...a .............. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 'N FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted ,=, mm=m=m~ 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 19574 Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25 00, 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...~l.[~l..~ .............. New Cons tr uc b i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .I.~..~.~..(~.. ~.~ ~0~11~ ~/~ House No.' ' ' ..... ' ...... Street Ham/et Owner or Owners of Property ............ f',.)~.~'~. (J... · ..... ~.; .COt.....~..~.~. ... .................. . . County Tax Map No. 1000 Section ..... 11 .~ ...... Block ...... .(~. ...... Lot ...... I..~ ....... Subdivision ................................. Filed Map No .......... . Lot No .............. Date of Permit 1 ~. I./.~. t ~..-/.A pp lice nt .................................. Permit No. Ith pt App Hca De. royal -.- ..... -..........LaborDept. Approval ....... Underwriters Approval ~ · ........................ Planning Board Approval ...................... Request for Temporary Cer~:ificate .................... Final Certificate ................ Fee Submitted $ ............ Construction on above described building and permit,m~ets all applicable codes and regulations. ~ Applicant ...... /..~ ,'~'"',',b ,(--~',~-.,L~ ' .................. ............... Rev, 10-10-78 FOU~DATION FOUNDATION 2. (2nd) ROUGH FRAME .FLUMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001433 BUREAU OF ELECTRICITY ~-- 85 JOHN STREET. NEW YORK, NEW YORK 10038 OCTOB~iR 19, 1988 57638788/88 N 0~062b ~t~ ~ppl~ation No. on ~le THIS CE~IFIES THAT ~R. RttSS CaS~, N~W SUF~Oh~ AV~., /POh~ ~45-5, CUTCNO(;tI~, N.Y. ~TOBRR 07,1988 ~ examin~ ~ a~f~nd to be in com~ian~ with th~ r~ui~ments of th~ ~rd. RXTU~ RXTUIII$ ILAN~ES OVENS EXHAUST FANS SlaVIC! D4SCC)NN~'T S E R (;.~.C.I. 3 2/0 ¢ THOHAS O. P.O. BOX ]3'08 SOWI'HOI,D, NY, 11971 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors 11 ~ ~ BUIUMNG DEPARTMENT. BOARD OF HEALTH ...~.. 3 SETS OF PLANS . 'FORM NO. 1 SURVEY . ~,'~5~'1' '' TOWN OF SOUTHOLD CHECK,-4'~o4,,,0.1' . - BUILDING DEPARTMENT SEPTIC FO~M TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-180~ CALL MAIL Examined ~.~.. !.~.., 19.~.'~ Approved .~.~.../.tO.., 19~. .7. Permit No. ~.~. {,a..-~..~..~.,,,~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ................... 19... a. Tins 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 ttfis 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 building for necessary inspectio~a~ admit authorized inspectors on premises and in ~ ~ .~.. j .~th~q~' (Signature Bf applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 i~IUST 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 .................................................. ltouse Nmnber Street Hamlet County Tax Map No. 1000 Section ... ]/.C~ ........... Block ...0.C~ ............ Lot.. }..~....* .......... Subdivision ..................................... Filed Map No ......... .~ ..... Lot ............... (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~. ~a~. ....................................... b. Intended use and occupancy . .~..ff~....~..: .'.~:. ~..-~..__ 3. Nature of work (check which applicable): New Building ' Addition., ......... Alteration .......... Repair .............. Removal .............. Demolition .......... .... Other Work ............... (Description) 4. Estimated Cost ...................................... Fee~ ......... i ............................. (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 ......... i,. .......... 7. Dimensions of existing structures, if any: Front ..... 25,.o. ....... Rear .....~.o. ........ Depth ....~..~ ......... Height ..... ./.~.' ... Number of Stories ./. ........... ! ........ Dimensions'of same structure with alterations or additions: Front ........... i ...... Rear Depth ...................... Height ...................... Number 6f Stories ...................... Dimensions of entire new construction: Front ...... T-:/'ff.: .... Rear .... .YqP.. ' Depth Height ............... Number .of Stories . .. :.~' ..... ' 9. ........ i ............... , ............. Size of lot: Front ...................... Depth ....'~. 7.O. ...... 10. Date of Purchase /.~..--7. ~' Name of Former Owner i '7 1 1. Zone or use district in which premises are situated ........... ..................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...! ............................. 13. Will lot be regraded ......... ~.~..~ ..... .n .,-') ..... Will excess fill be removed from premises: Yes t~o 14. Name of Owner of premises . ~ .~O{..~.~..~-~5~kddress ~_~...~ i..~-~ Phone No 'T..~ .c( .~..~ (.~.~:.. Name of Architect .......... ,/ ................ Address .... : .............. Phone No ................ Name of Contractor ......................... Address ................... ' Phone No ........... ..... 15. Is this property located within 300 feet of a tidal wetland? *~es .- ... No . :.'~.. *If yes, Southold Town Trustees Permit maybe required. ~ PLOT DIAGRAM Locate cleariy and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensionp 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 NE ~, o OF ....................~'~(Name mmuivinua'; I signing co tact) being duly sworn, de 3uses and says that he is the, applicant He is the .................. ~' (- (Contractor, agent, corporate off{~he~'T~md w°r an c~ of said owner or owners, and is duly authorized to perform or have perforr& and file this application; that ail statements contained in this application are true to the b}e~ ~~ andthatthe work will be performed in the manner set forth in the application filed therewitl~ Sworn to before me this ............. . ./~.~. .... aayof ..~ ....,19~.7 - CLAIRE L. GLEW ..... ~ ' "/~ .,./~/k "~ .......... Nelely Publlo. State of New York , Ne. 4879~05 ~, ) E , (Signature of applicant) Qtlallfled In Suffolk County ~ (~mm~lo~ Expires December 8, 19~ _ / If ~opper tubing is used for ~mter distributing ly~lam; piping shall be of Wpes ~ PLUMBER CEI IT/FICA TION ON LEAD cON;"ENT BEFORE CERTIFICATE OJ ~.OCCUPANCY sOLDER USJ !D,IN WATER sUPPLY SYS rEM cANNOT EXCEED 2/1,) of 1% LEAD. I I~"s,'~""~ "~ .................. OF OCCUPANCY ~ ~' [ C~ ~ ................. · t. ESIGNED BY ............ ; ..... DETAILED BY ...... ; ............ CHECKED BY .............. · ..... '1 CHECKED BY ................... II