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Home My WebLink About15732-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the BuiJding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No....Z.1.67.9.4 ......... Date April 13, 1988 THIS CERTIFIES that the building Deck Location of property ......... .1.4.2.5 .8.k.u.nl.c..L.a.ne . . . Cutchogue Ho~o No. '~'t/~er ...................... h3,fi/e~ County Tax Map No. 1000 Section ....9.7 ........ Block ....4 ........... Lot .. ?/.o 7 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 3, 1987 15732Z ..................... pursuant to which Building Permit No ............ ' dated .. March. 9~. ~137 .............. was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which fifis certificate is issued is ......... .................... .d.e.ck .a.d.d.i.t.ip.n..t.o.p.n.e..f.a.mfi_.ly..h.o.u.s.e. .......................... The certificate is issued to ...... S.t.e. pkeg .&. Carol 0 ' Conner ...... io;4n'oi','l~de'dr'e3fiah~l ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ............... N/.A ................................ PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 ~'OBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEF~tIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 15732 Z Permission Is hereby granted to: ~.~ ~....~'. .................. ..~..~......~.......~..~, ,..~....~ ................... · ..~.~.~_ ?.4 ....... .'..~..~.~ ........ , ,o .~.....~..~.J~......~..~.~.........~......~ ............. o,,=,,i,, ~,o, ed,,.....~.~_~ ..... ~.~..~....~ ...... ~.,~--. ................. pursuant to application dated .... .~.~....~.... ................... , 19.~...~., and approved by the Building Inspector. Bul'iTdlfig Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 BLDG. DE, PT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter 0 R 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 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: I. 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 asto 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 $25.00 New Dwelling,S25.00, Accessory ,,$|0.00 Business $50.00 I. Certificate of occupancy 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 ..'~..Q4~. :-.~¢~y.---- ~'~ /~..~.~. ..... NewC°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./.~'~' ..~.~..O.Z'J,.~. &.~,.~/ .~ .~...~.~..~.O.~r~../~... ~,ou~ 'N'o: ........ >' ~. ~. . .~, . .o~ .............. Street /-/am/et Owner orOwnersofProperty County Tax Map No. 1000 Section ..... q.~.. ....... Block ... ~. .......... Lot ...... 3 ......... Subdivision ................................. Filed Map No ........... Lot No .............. , z Fermit No.. A~..77.~... Date of Permit ..... .7.Applicant.. ¢..'a~. ~.~.. ~...~. ZV~'.~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Undm~vriters Approval . ~- .......... -.-~.,..--; ....... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~,~. ..................... ~/¢:~C/~' ~ ¢~r~,4- Construction on above described building and perr¢it p~eets all applicable codes and regulations. Applicant ............................. Rev. 10-10-78 UNDATIO~; (1st) UNDATION (2nd) UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~- ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: [~INAL DATE ~/~////// _INSPECTOR ,/-'/~ OUNDATION (1st) OUNDATION ( 2nd I OUGH FRAME & ?LUMBING U~SULATION PER N. Y. STATE ENERGY CODE FINAL · ADDITIONA'L COMMENTS: 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Approved .~.&~..~ .... , 19~.'.7. Permit No.t .~77· .~.~..~. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT Rece±ved .......... i ;"1'~~. . . 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 schedhle. 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- cafion. 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 construcfion of buildings, additions or alterations, or for removal or demolifion, as herein described. The applicant agrees to comply with ail 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 corporation) I.+. 9. ½,9 · ' (Mailing address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, p?~amber or builder. Name of owner of premises ....~.-..r~....~.....~.. ~ .[n...Q. '.~.q ~.g.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) Builder's License No .......................... Plumber's License No ...... .~_.tqt~.~...~. .......... Electrician's License No ....................... Other Trade's License No ...................... 1. Location or'land on which proposed work will be done .................................................. ...... ..... .... ............................ House Number Street Hamlet County Tax Map No. 1000 Section ..... 9.'~. ......... Block .... .~. ........... Lot..~/~... ~ ......... / \ Subdivision .... '. ?..~,[,p....~w..I..?-:~.. ................ Filed Map No.~ (...~. 0q O.~-.) ..... Lot .... ~.. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... . .¢"'~ ~'~...~. ~..,.~.~.~. ........................................... b. Intended use and occupancy ...~.'~' . ~ ..................................... 3. Nature of work (check which! applicable): New Building ... ' . .~...r~.:~. . Alteration ......... Re~.~., '~i~ ...... R6moval .............. Demolition Other Work, ~ ~..~.00. (Description) 4. Estimated Cost ................................ Fee .................................. (to be paid on filing this application) 5. If dwelling, number of dwelligg units ...... /. ........ Number of dwelling units on each floor ............. If garage number of cars ~ ~ ~ ' · If busxness, commercml or m~c{ed occupancy, specify natu.r~ and extent of each typ~ of use ........... ., ~ ....... 7. Dimensions of exi/sting structgres, if any: Front ..... ~.~ ....... Rear ..... 7.~ .~ ...... Depth .. ~.~.~.. ........ .. Height ..... /.,~ ........ N~mber of Stories . I. ........................................ Dimensions of same structurel with alterations or additions: Front .... . .~..~ ....... Rear .. ............... Depth .................. i ....Height · · ~ .......... Num bet of Stories. ~) ......... ! ......... 8. Dimensions of entire new construction: Front ..... .~.'. ...... Rear ............... epth .. [.~. .......... Height ............... N_u¢~er of Stories ............. ! ......... ~ ~ · 9. Sizeoflot Front fib Rear /7.6. .... ) O'2'dhx" ...... 10. Date of Purchase ....... .A/.~'~ ................. Name of Former Owner . . .~./~.Q,~. 5r.4g~ ............. 11. · Zone or use district in which premises are situated .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . .,5/0. i .... i.. i. ii. iiii. 1111121 13. NWfll lot ?~.regrade~d .... .... 27--~'°~,~X'~ '~ ',': ':,,'ri'': '-.'' Will exce.s.s f. ill~b,e ren)ov~d from premises: Yes 14. amc o~owner et premises .~-tq/: .m~.~.....% .V.t4:~tN.0(~Address .IX'L-)..~4.~ ./~../~..... Phone No.. ?)~.. ame of Architect , · ............ Address Phone No. Name of Contractor ~2'~.tbfflJ 0 t ~.~/.l..M o[( .................................. .... Address ................... Phone No ............... PLOT DIAGRAM .Locate c~early and distinctly all buildings, whether existing,or proposed, and. indicate all set-back dimensions from property lines. Give stree~ and blodk number or description according id deed, and show street names and indicate whether interior or c*rner lot. STATE OF NEW YORK, COUNTY OF. · ..... ! S.S · · '~ ......... , ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. : (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 contg~ned ~. ~, -,~ arp.cat~on 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 o~ ........... 19.. Notary Public, . ~'~MNDA J. COOPER Notary Public, State of New No. 4822563, SUffolk County X~ (Signature of applic~t) Term Expires December 31, 19