The URL can be used to link to this page

Home My WebLink About16352-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16689 Date March 3~ 1988 THIS CERTIFIES that the building ....... .A.d..d .i.c.~.q .n ............................... L°cati°n°fPr°pertyh3t~sbR:'O'''~':''('B'a''x'~'e'r's')'~/'o~ ' Bridge Lane Cutchogue ................................streot h~d~iel County Tax Map No. 1000 Section 072 .Block .. 0 I .Lot p / o 1.4 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A..u.g.... ! .2.,.. !.9 .8.7.. ~ pursuant to which Building Permit No...1.6.3. .5.2.z ............. dated Au g. 2 I, 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 ......... Construct a deck addition to an existing one family dwelling The certificate is issued to . ROGER VORCE .................... ?o¥,'o;, ~s~'~g4dX ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... .R./.A ................................ UNDERWRITERS CERTIFICATE NO .................................................. PLUI~IBERS CERTIFICATIOI~ DATED: N/A Rev. 1/81 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) NO- 10552 z Permission is hereby granted to: , . ...~..~.....~.:.X.:..o../.~..~..~X .............. , ~.~.~~..,,....~....~~....~., ............... .~ ............................................. · .o..,~..~... ............ ~...~ ~ at premises located at ,.~ ......... (..~ ~ ) .~. ...................... Coun~ To, Map No. ,000 Se¢,,a~..~.~..~ .... B,~ ........ .~...~ ....... ~ot ~o....7..~...J.:.~ ...... pursuant to application doted ..... ~A,,~.ln4~d..~.....~....'~.. ........... 19..~.."~., and approved by the Building Inspector· F ee~...~ .~ ..~,~..~...~. ....... Building Inspector Rev. 6/30/80 BLDG. DEIT, TOwN OF SOUTHQLD TOWN OF SOUTHOLD Building Department P ~- Town Hall Southold, N.Y. 11971 765- 1802 ' 'PLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing ali 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 825.00 1. Certificate of occupancy New Dwelling $25.(10, 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 $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ..f~.~. ~l ,17.~.~.. New Cons truc t ion ...... Old or Pre-existing Building ............ Vacant Land ............. House No, Il ~' Street Ham/et Owner or Owners of Property . .f.~. ~ :~.? .... .t_~g?.~. ~_~ ........................................ County Tax Map No. 1000 Section ..... ?.-~. ...... Block ...... ~ ......... Lot..~. '~ ~. ~.. ! ;'.~. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .... Date of Permit Applicant .... ?~. ~ ..... P. ............. Health Dept. Approval ........................ Labor Dept. Approval .................... .... Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate .. Z .................. Fee Submitted $..o~ ....... Construction on above described building and pe~rmit meets all applicable codes and regulations. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL DATE COMMENTS ADDITIONAL COMMENTS: / /~~ __ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE INSPECTOR BOARD OF HEALTH ...... 3 SETS OF PLANS ~FORM NO. 1 SURVEY .......... TOWN Of SOUTHOLD CHECK .......... BUILDING DEPARTMENT'. SEPTIC FORM ............. : TOWN HALL $OUTHOLD, N.Y. 11971 e. ,~ TEL.: 765-1802 Examin . .t~q.'~..;~..I.., 19 .~.'~ Disapproved a/c ..................................... .... ........... fl~ 3/3/tS ~o ~V0 7 ~ (Building l~spector) //~, fd APPLICATION FOR BUILDING PaaalT NOTIFY CALL ................ MAIL TO: INSTRUCTIONS a. This application mt~s~'be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fcc 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 inspections. ' (Signaturd of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect~_e.r,~neral C°--ntr~to~r,~-'-----"----~. / electrician, plumber or builder. Name of owner of premises .././{tO. qe.C... L~.t~.CC, O-~. ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name aud title of corporate officer) . AL1, CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ~. O, CD. ~ 1. Location of land on which proposed work will be douc..}5..O...~,-. :-tB. eJ',otr, ax...Co?...sk 7'..5.~°-. ~k.. .... e-:nM._ ..... ................ ltouse Num her Street Hanllet Couuty Tax Map No. 1000 Section .~.'~ ............. Block ...... [ ........... Lot..~./O..Iq q. ........ Subdivision ..... '.-". ~. cag~-.~.C "* ............... . ........ Filed. Map. No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use aud occupancy of prbposedconstrnction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy .. ¢.~. ~ . Repair .............. Removal .............. Demolition .............. Other Work .............. (Description) 4. Estimated Cost ............ i ....,,~z'~ ~').42.;33.. .......... Fee ................................... " (to be paid on filing this application) 5. If dwelling, number of dwellinginnits ....... I ....... Number of dwelling units on each floor ............... erap, e nunberofcars ........... .. .., ............. 6. If business, co,m~?cial 9r'mixefi occupancy, specify nature and extent of each type ot~ u~e } ?.t ! ?/.. i.. ......... 7. l)imensions'of existing stn ctur6s if any Front. ;, ' . '... Rear ..., ......... , Dep!h ...... lteight ............... Nu~fiber of Stories .: ........... ; ............ ' ............ ,' ................ Dimensions of same structure with alterations or additions: Front ................. Rear r. ................ Depth ...................... Height ...................... Number of Stories ..................... · 8. Dimensions of entire new construction: Front ............. ... Rear ............... Depth .............. Height ............... Number of Stories ....... '. .......... ; .... ' ................................. 10. Date of Purchase .......... e .................. Name of Former Owner ............................ 11. Zone or use district in which prgmises are situated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... Will lot be regraded ........ ' .................... Will excess fill be removed from premises: Yes N~ 14. Name of Owner ofprennses . . .~cxe& ...... Address ................... Phone No ?,lk.9 ....... Name of Architect ........................... (lo Address ................... Phone No ............... Name of Contractor ........ .................. Address .... ; ............ ,~t~Phone No ............... 15..£s this property locatedlwithin 300 feet of a tldal wetland? *Yes ~.. No ..... *if yes, Soathold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dhnensions fro~ property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whethc interior or corner lot. STATE oF NEW YOP, K, ~ : S.S COUNTY OF ................. i (Name of individual signing contract) above named., ..,. ; ' being duly sworn, deposes and says that he is the applicar lte is the .................... ~ ................................................................... (Contractor, agent, corporate officer, etc.) of s~,id owner or owners, and is duly authorized to perform or bare performed the sakl work and to make and file th application; that all statements co~itained in this application are true to the best of his knowledge and belief; and that ti' work will be performed in the mare}er set forth in the application filed therewith. Sworn to before ~ne this .... [ ........ day Of ..... ~. ............ 197/. : ' ,oW 'uh,c.. .... ........ County }fttEl4~l)£VO[ ,, / /¢~.-, ~,r~- -f~, ....................... t~t~'V~Jt~tlO, St~teol~ew.v~ "'6-'./'''' ~ 7i' ....... .~. ' ' ' "an~ I~ 47078'fll, Suff~te0t~ntl~q 11 ~tgna~ure Ol appJ~.c, Term Ex~iros :~erch 3fl, lgL.--~4 25 - HA-p j~ENDEp. AF,~ 27, tcya7 RODERICK VAN TUYL, P.e. -- -- , YORK SUFFOLK CO. HEALTH DEPT. ~PP~OVAL H.S. NO. STATEMENT OF INTENT THE wATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS f~)R THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF ~I'HE SUFFOLK CO. DEPT. OF HEALTH SERVICES. Jsj APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO · APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. .1CK30 ~2 I. ~/0 L4 OWNERS ADDRESS: DEED: L. P, TEST HOLE STAMP ~_~,~,y .: LOAM. CLAYEY _, SEAL 0 0 0