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Home My WebLink About15745-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16059 Date August 14, 1987 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property ...6.0..R.a.m.b. 1..e.r R..oad Extension Southold, N.Y. House N'o. ' ............. 's't/e3i ....................... h~g~id County Tax Map No. 1000 Section 088 .Block 05 ..... Lot 36 Subdivision M/o Terry Waters .Filed Map No..2.9.0.1 .... Lot No. 46 conforms substantially to the Application for Building Permit heretofore filed in this office dated December 24, I986 pursuant to which Building Permit No. 15745. g dated.. ......... March 12 ,........1987 ......... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttds certificate is issued is ......... ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to BRUCE & CECILIA LOUCKA (owner, Idt.4&g~lg X of the aforesaid building. Suffolk County Department of Health Approval 8 6 - $ O- 13 0 UNDERWRITERS CERTIFICATE NO. N 8 2 5 74 6 . PLUMBERS CERTIFICATION DATED: August 11, 1987 Rev. 1/81 ffOB~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEP. MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NM 15745 Z Permission is hereby granted to: · ~ ~~....~.:.~...,....!.!.3.2.) ......... __---..-. ......... ; .................... : ......... ~ ....................... ~.~ ......... ~ .................. ~: .................... at premises ocated at ...~...~.~~.i.....~....: .................. : .......................................... Coun~ Tax Map No. 1000 Section ...... (~).~ ...... Block .... .Q~....~. ........... Lot No ..... ~..~ ............ pursuant to application dat~.~......~....~. ............... , 19~..(~..., and approved by the Building Inspector. Building Insl~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall BLDG. DEPT. Southold, N.Y. 11971 TOWN OF SOUTHOLD 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted .m Ilmmm~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 buJldings~ 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 pz~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 1. Certificate of occupancy New Dwelling~$25.00, AccessoryiS10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50-. 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ?J./~.(/ NewC°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . . . ~O )--~44'~ J)//'t'~ '~..' House No. : :. .~"~, . .~'~-.~ ~" ' ~ Street I-lam~et Owner or Owners of Property .... ~' ' J ~1~ ~ County Tax Map No. 1000 Section ............... Brock ............... Lot.. Subdivision · · ~. . Filed Map PermitNo..~... ;2t~;;;:i~it' })~2~plicant No...~~..~.~.<., ........ LotNo .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .................. ' Applicant ~~ ~ ~ / Rev, 10-10-78 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date..(~.~. To I .~.~ · ¢~/ .......... ' ~.~ · .. Z.~~..~:%.. 1~ ~.~.~ ....... PLEASE TAKE NOTICE that yonr application dated .. for pe~it to Location of Property House No. ' ............. ~e;( ...... County Tax Map No. 1000 Section ...~. ~. ~ ...... Block ~.. ~.~ ...... Lot ...~.~ ........ Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds. Od~,~ .-~'..~¢-~-~ · !.~ .~ f(Y' ~ ~ ~_~ ~ ~ %.. ~ ~ ~.~. ~.~.,..~ ~.~.,. ~..~. ~ ~. ~.. ~...O~&~ ........ Building Inspector RV 1/80 OUI~DATION ( ls t) OUNDATION (2nd) OUGH FRAME & PLUMBING iNSULATION PEN N. STATE ENERGY CODE FILIAL , ADDITtON~b COMMENTS TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner~c~ 9 (~ (please print) Plumber 0 '~-6~J~,/[1%, q O/-fl~3 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this ~ day of ~ Notary Public, ~/J~F~ / ~- County Notary Public 765-1802 BUILDING DEPT. INSPECTION [~FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~ PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE INSPECTO '~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ('[ ]~)ROUGH PLBG. FOUNDATION 2ND [//j~NSULATION FRAMING [ ] FINAL ~6S-"t802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE INSP R 7GS-~802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND I- ] INSULATION [ ] FRAMING REMARKS: FINAL DATE ~///~'~'"~ INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLD. N.Y. 11971 TEL,: 765-1802 ., 19:9¢. Permit No~ l~ece±ved ........... ,19... Disapproved a/c ..................................... ~ * ................................ : ..........- ............. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inmec~ions. / .,~ , ~ ..... /;Z..x .~.~, ,r...r_4'.,~. I~'~,;,,~, .,x.. ,.....c~..:. .... (Signature of applic, cg]~, or name,,if a corporation) ........ 1:~. ~... ~.(~..~../~. ................ · -q'~'~d'J'¢,~, ~.. ...... ........ ~giiiA~' ~g~ '~.~' ~iicant) ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ~builder. ................... ............................................................. Name of owner of premises..~'ff~'/-~. · .~. · C/~.'~ · ~. ~.'/'/~' · '~ ~¢ ~' 'I~' ................................ (as on the tax roll or latest deed) If appl~o o~,ration,~sigjmtu~o~d~ authorized 9~,99r. · (Name and title of corporate officer) Builder's License No ..... t,; ............... /f.. · ,~ t~ Plumber's License No....~.' .~.~..~ ,~'~ * Other Trade's License No ...................... I. Location of land on which, ore,posed work will be done ................................................... House Number Street Hmnlet County Tax Map No. 1000 Sectio~! ........... ~. ..... Block . .~ ............... Lot....~..~ ............. Subdivision...~..~/~..~...~.~.~...~....-~-~...'g'"'~ / f~ .... FiledMapNo..~..~'.ff./. ..... Lot..~..~ 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ..................................................................... b Intended use and occupancy .~..~.....~.../.~ ..~..~...-~..&.~, . ",i . 3. Nature of work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. 'Estimated Cos ....... ~..~..-7. ................ 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 .... ....~,,.E',. ............................................................ '6. If business, commercial or, mixed occupancy specify nature and extent of each type of use ..................... 7. Dimensions of existing stmctures, ifany: Front ........ :'.;" . Rear Depth Height ............ :.. Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ........................ Height ....... w e 't ........... Number,of ~tories ......... .. · ·, .,a .tr ..... 8. Dimensions of entire new e0ns[ruction: Front .... ~.~. ........ Rear ..... ~ ....... Depth .a4.~.: '..o. ....... Height ............... Number of Stories ..................... r ............... , ...... 'r ............ 9. Size of lot: Front ..... /./~...~.~.:'. ........ Rear ...... J.../, O. ~ ........ Depth ...,~..~..~ ............. 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~..a .......................... 13. Will lot be ?egraded ..... /~./ei~. .................... Will excess fill be removed from premises: Yes (~ 14. Name of Owner of premises~ .~: ~ (~f~:~ .~t~lress ,/P*. ~t0~/~ .t07. (.rk.~..t~. Phone No .g~2 4.'fill -. 4':~¢...~ Name of Architect ..., .,. ;..? .t ...... , ........... Address ....... ]~.t.~t,~,tn:;. Phone No ................. Name of Contractor . .~.'..~ ~¥~4.~..~.... Address ]~.gl~,.r.,..~,~. Phone No..9..~..F.??.~...c~.... 15. Is this property locatedI wxthin 1.00 feet of a tidal wetland? W'~'~s . .~.. No ..... · If yes, Southold Town Trhstees Permit may be required. 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 inter{or or corner lot. STATE OF NEWvYORK, ~! o ,~ ' COUNTY OF .~._~....~ ~a.a. / . ............. kd. . .... being du, sworn, deposes and says that he is the applicant (Na~he of individual signing contract) above named. ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d01y 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 man~er set forth in the application filed therewith. Sworn to before me this ~ ...... ~..~. ~C./,~ ........... ~ay 4f. 3..~, 19 .~P(o j / u~4coo~Y.n _. _ ~ '~' ................... ',2" ~ .... ;'".''"2 i Norar~ Public0 St~te of N~wY.~/ (~ignamre or appHcanr) No 4822563, Suffolk Count¥,-~/~ ,Term ;=xi)ires December 3~, 19 ~ ~ Z 0 0 %.. l -~z~ :~ ~< 0 ~J < o~ "t'l 0 I- ...q