HomeMy WebLinkAbout16656-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-17111 Date JULY 22, 1988
THIS CERTIFIES that the building. ADDITION
Location of Property 1030 HORSESHOE DRIVE
House No. Street
County Tax Map No. 1000 Section 095 Block 04
Subdivision Filed Map No.
CUTCHOGUE~ N.Y.
Hamlet
Lot 18.17
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 27, 1987 pursuant to which
Building Permit No. 16656-Z dated NOVEMBER 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 DORMER ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to
JAMES & BARBARA ANDERSON
(owner,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N-013358
PLUMBERS CERTIFICATION DATED JULY 21~ 1988
~/i'lding Inspector
Rev. 1/81
FOlt~ NO. ~l
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO_ 16656 Z
Permission is hereby granted to:
.._ .~_1.~.~.~...~.~. .............................................
,Z-..~r...~.~..~.~..:~..,...t.L.~.~,~...
at premises located o, ..../...0.....~........~.....~......~, ........ ~'~.~f~R....,
.............................................................................
County Tox Map No. 1000 Section .... ..~..~...~. ........ Block ...... ..~....~ ......... Lot No...J..~...!..!.~ ........
pursuant to application dat~:J ..... ~.~.,..~....~ .............. , Jg.~..~..., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
765- 180Z
APPLICATION FOR CERTIFICATE OF OCCUPANCY
FORM NO. 6,
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
Instructions
This application must be filled in typewriter OR ink-, and submitted I~ 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 instaila-
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 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 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 $25.00, Accessory.i$]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.p0I
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ...................... ~/..f/.
New C on s t r u c t i on ...... O~J-o~P re-ex isting Bu ilding ............ Vacant Land .............
Location of Property ..... 1.0.~..0. .... ' .... .~q .~.~'f.{ .~?.~. ~..~: ........... .C~A: .~c,.~]~ ~p.~.
Owner or Owners of Property ........ ~f~..~-/...~...r?,t~/~. ~./~ ./~/~. .... .~ .~,?.¥[~..~ .o.c~ ...............
County Tax Map No. 1000 Section ..... .~.~..S. ..... Block ...... ?..~ ..... Lot .~...~. ¢;. l .~....
Subdivision ................................. Filed Map No ........... Lot No .............
Permit No../. ~ .... (o .~.~ . Date of Permit Nov......~o./ .... ~7'~pp ',cant .......... .~.~ ! .-~. .~.~?.. rJ ...... ./~.~ j .~.b.~-7~.....
Health Dept. Approval ........................ Labor Dept. Approval ..................... . .
Underwriters Approval ........................ Planning Board Approval .....................
Request for Temporary C,~rtificate ..................... Final Certificate ......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and re§ulations.
Applicant ........ ~.~. .... C~...~ ......................
Rev, 10-10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date
Building Permit No.
Owner '~ 'P' ~ ~+ ~' (please print)
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
Sworn to before me this
~/ day of ~]6~.~. ,
£?.
public,I~F~Z//~'~/ County
Notary
(plumber' s signature
Notary Public
UNDA J. COOPER
Notary Publlo, State of New Yo~/~
No. 4822563, Suffolk Cou ~nty ~(
Term Exl)lres December 31,
JOHN C. BORN
BUILDER
FRAMING-DECKS
INTERIOR FINISHING
MODIFICATIONS
RENOVATIONS
FOUNDATION ~ 1st}
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N, Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
76S-~.802
BUILDING DEPT.
_ JNSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
, A
INSPECTOR ~
BUILDING DEPT.
INSPECTION
]FOUNDATION IST [ ] ROUGH PLBG.
] FOUNDATION 2ND [~NSULATION
[ ] FRAMING
REMARKS:
[ ] FINAL
DATE
'\
INSPECTOR~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
11953 ~J2 BUREAU OF Ei. ECTmCITY
85 JOHN STREET. NEW YORK, NEW YORK 10038
53323988/:~8 N 01,'1358
THIS CEKTIFIIS 'THAT
[] Ist FI. ~] 2nd I,']. ,~ction ~lock Lot
and ~ound to be in compliance with the requirements of this hrd.
OVENS
SilVICI DISCONNICT S
MOTORS:I-]. H.P.
s~og~; ))ET~CTOR:-I
P.O.BOX ~768
SOOTI{O~D, NY~. ~197]
This cerfiftcafe must n~ be o~r{KI in an,/ m~m?r _tutum t?~ffi~ ~f th~ ~rd if. ir~orr~t. ~ll~._r~, ,~m ~_b~f:~ ~i
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y, 11971
TEL.: 765-1802
BOARD OF HEALTH ......
3 SETS OF PLANS .......
SURVEY ..........
CHECK ..........
SEPTIC FORM .............
NOTIFY
carl
MAIL TO:
Examined ./0...0q'A'.~....~.....~., 19~..''/.
Approved )0...&3-M~'*O.....[13.~...."~.., 19~?. Pe~it No.
Disapproved a/c .....................................
.................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . :~..0 .-~..
75..~. ...... ,19 .g7
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 tiffs 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 inspections.
......... ..... ; ...........
(Signature of applicant, or name, if a co potation)
..x ............. w. ..
............ y,.. z
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .... .~.~.m. ~-5.. !.qY?P...~. ~../40.../~./).' ~.DCt~,q ~..~ ................................
(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 MUST BE SUFFOLK COUNTY LICENSED
Builder's License No .... ~P.].~.~. ~..
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
...... t 0. 3.¢ ................. /~ g.s.e.~ .~.<..bg., ~.eT. ............ ~ ~c.- .~ .+q .~.~.~-. ..................
House Number Street Hamlet
County Tax Map No. 1000 Section ..... 95 ........... Block .... q ............. Lot../.il.. 1.? ...........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction:
a. Ex~shng use and occupancy ...... ~...0...~... }rjocm. l.a.V.' D..~.. ~.~..L./..,¢.~.
/
b Intended t se and occupancy .......... .b.~.C.... '~..47~ l~.)/....~..~..a.~..I/.q~.:...~.Do.g~ e.~.~..j~.. PQJT-I ~...~..
3. Nature of work (check which applicable): New~,Building ' Addition 'i' ~ Alteration
Repair Removal Demolition .' Other Work
(Description)
4. Estimated Cost .......... fO.y .0. 0.t?. .................... Fee ......... ! ............................
(to ' '
' be ?aid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor
If garage, number of cars .............................................. 1 .................. ..........
6. If business, commercial or mixed occupancy, specify nature and extent of'each ty~e of use ....... ' ............ ..
7. Dimensions of existing structures, if any: Front ............... Rear ....... I ....... Depth ...............
Height ............... Num bet of Stor/es ...............
Dimensions'of same structure with alterations or additions: Front ........... '.i .....Rear ..................
Depth ...................... Height ...................... Number o¢ Stories ......................
Dimensions of entire new construction: Front .......... . ..... Rear I Depth
Hight f St '
e ............... Number o cries ............................ : ............................
9. Size of lot: Front ...................... Rear ...................... IDepth ......................
10. Date of Purchase ............................. Name of Former Owner .i ............................
11, 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 ......... , ................... Will excess fill be removeld from premises: ._Yes No
14. Name of Owner of premises .~.,9p. ~s.../~J. p,~.w~.c?,~. Address Io~o.,
· ' ' ' '~ ~¢'~4¥a'dff-to' ',~ ,' ................
Name
of
Arcintect
· · .~e- ........,, ............. Address ............... h... Phone No ................
Name of Contractor . .,d¢.er~..~.../~;¢~AI ......... Address ~e~4PX..g.,o~.. ;,..i' .... Phone No. 7eq. 3= .?,. 6.7·¢ ....
15. Is this property located within 300 feet of a tida~w~etf~a~n~.OP/Yds ..... No
· If yes, Southold Town Trustees Permit maybe required.
!
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. inldicate 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.
"8.
STATE OF NEW~ORK. ., S S
COUNTY Z_ r
.......... .~-77..C>.~'Xt'./... ~ .... ~.~ .~ ........ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. [~1~;~ ;~~
Heis the ................ ~., . ...... '. ...........
/ ~Contractodagent, corporate offic~f¢¢¢.}~ x .[ , ", ,
o said owner or owners, ~d is dul~ autho~ to ~form or have perfonne~ ~ sai~ w?k and to m~e and file this
application that all statements contained ~ this application are true to tile bes~ bf~3~%7~lk~t'i'a'&¢lt~and that the
work will be perfo~ed m the maner set forth m the application filed therewith~ f¢[~[~} ~ ~.~Z,; ,;.;.:.Z[[~¢~
S~om to before me this
.......... ..... .... .
............ .............
~ ~otatV ~~M~k-~ork (Signature of applicant)
No. 5~ 25~O~uffolk ~
Term Expires Octo~r 31, 19 ~