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Home My WebLink About15773-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z-15392 Date March 20, ~987 THIS CERTIFIES that the building D e c k A d d i t i o n Location of Property 1305 Leeward Drive Southold, New York ft3~s~ '~'oi ....................... 'S't/e3i ....................... h3/nie~ County Tax Map No. 1000 Section 79 ...Block 7 .Lot 2 I Subdivision..M/p..L.e.e.w.a.rfl..A.c?.e.s ............. Filed Map No. 5599 .Lot No. 36 conforms substantially to the Application for Building Pemit heretofore filed in this office dated March 16, 1987 15773 Z ........................ pursuant to which Building Permit No ...................... March 17, 1987 dated ............................... 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 ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued toDONALD SAYRE ..................... ?o~n'o'r,'l~¥ggdgs;g'~ ..................... of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FOUWr NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 15773 Z D0te / 7.. Permission is hereby granted to: ~) ......... at prem,ses located at ..../....~....~...~....~....)...~.--.~.: ...... -~. .............................. cou,,~, To× ~op No. ~000 Sec,ion ..... .m~..3 ..... B,ock ...... ..~.3 ...... '.o, No ....... ~ .......... Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted ~i ~m~iii 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: 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: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]o.qo 4.Vacant Land C.O. $ 20.00 ~ 5.Updated CoO. $ 50.00 Date .... ~. ?. .......... NewC°ns%z"ucti°n ...... Old or Pre-existing BuiIding ............ Vacant Land ............. Location of Property ............ House No, Street Nam/et Owner or Owners of Property County Tax Map No. 1000 Section ; 7~i Block "~ Lot.. ~¢ Subdivision.. .~¢- ~% .Filed Map No. ~;' .Lot No. Permit No ..... . Date of Permit ... Applicant ¢-~. ~.~'¢7 Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and pA'C~nit meets all~ app,[i~ble codes and regulations. Applicant....~. ¥,'-~-¢~.~..~..~ ..................... Rev. 10-10-78 OUNDATION (1st) OUNDATION ( 2nd ) OUGH FRAME & PLUMBING LNSULATION FERN. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ~,ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION DATE?~~/~ BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY .......... TOWN OP SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.¥. 11971 TEL.: 765-1802 CALL ................ MAIL TO: Examined ................ , 19... Approved ................. 19... Permit No ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 ~ 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 inspectom on premises and in building for necessary i~tions./~/~/ (Signature of applicant, o~f name, if a cgrporation) z./ .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .~.~.~.~..er k ................................................................................ Name of owner of premises ...~. ~?.~.(f~...~..:..~..~..~ .~.q...~-..~.~.~q~/rT..~w.: ............................. (as on the tax roll o~ 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 ..... Location of land on which proposed work wiI1 be done· · .5c ........................... ........................ House Number Street Hamlet County Tax Map No. 1000 Section ..... Subdivision .... ~.:,~..,~,?,,r':,~...~.C~.C.~.~%. ....... Filed Map No.. ~.'~.~-. ?. ~. .... Lot 5 ...... (Name) State existiug 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 W~ork (check which applicable): New Building ..... ' ..... Addition · · .. i ...... Atteratio, t) ...... n...// Repair~'. '...'2 ......... Removal .............. Demolition ............ i. · Other Work./.o'..~.... ~..r~.. (Description) 4 Estimated Cost ~ei?, ~ · · . Fee .......... i .................... ~"~. ' (to be paid~ on filing this application) 5. If dwelling, number of dwelling un-]~.... .......... Number of dwelling units!on each floor If garage, number of cars:----~_..., ..... ~~ '.2 ......................... i~ ........-../7 ............... 6. If business, commercial or mixed oc_cupancy, sp~nature and eXtent of each typel of use ..................... 7, Dimensions of existing stru~~ Fr. ont .... ~ ..... Rear ........ . ...... Depth ............... Height ............... Number~es .......... ~ .............. 2 ........................... Dimenslons'of same structure with ~ditions'. Fron~,<C/ ........ i ....Rear .................. Depth .................. Height ..................... .~mber of Stories .............. ? ...... 8. Dimensions of ~j~tire new construction.: Front __./.~,..t..~ ..... Rear ..."D~..~.t.I ..... Depth ... t~. . . sHi:ieghotf ,;i../.~. ......... ~ ~ , Nun~ber of Stories .~__~:..~-..'2,~. ......................... 9. 10. Date of Purchase ........................ Name of Former Owner ..... .'~.-,,<,& .................. 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 re~ov~d, fro/n premmes: Yes 14. Name of Owner of premises .~.e,,.~(~f..~..: .~.+',-.,;¢c. Address~:'~. ~.7..5./% .~..d..~4~/.~./Phone No..~.g~-.-..~..q.~... Name of Architect .................... Address .... ' Phone No Name of Contractor .......................... Address .... : ........... [.. Phone No.../,~ ........... 15. Is this property located within 300 feet of a tidal wetland? *Yes! ..... No ..z~... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show ~treet names and indicate whether nterior or corner lot. ;TATE OF NEW YORK, S.S ,OU 0 ................ .... ~. . .. .r.?~.. .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bove named. te is the ............................................................ i .......................... (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the application filed therewith. ;worn to before me this ........... l .~. ......... day of .... .~~ ...... 19 ~otary Public ...... '~J~/b/... ~:.. j~..1~.~.~. .... County I~t~ ~ D£V0~ (Sifnature of applicant) NOTARY PUBLIC, State of New. York 14o. 4707878, Suffolk Term F. xptms f~ch 30,19....~ l