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Home My WebLink About16004-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No ..Z15783 A Date May 22, 1987 THIS CERTIFIES that the building Acces so. ry .......................... 5180 New Suffolk Road Cutchogue Location of Property/~,3sa ~/o ...................................... · Street Hamlet County Tax Map No 1000 Section I l 0 .Block 0 8 .Lot 13 Subdivision ................ ·..Fried Map No ........ Lot No ............. conforms substant,ally to the Apphcahon for Building Permit heretofore fried in flus office dated .... .A.p r. ~ .1. .3.0. : . .1.9.8. 7. pursuant to wtuch Bmldlng Permit No. 16004Z dated .M a y .2 I , I 987 ......... was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued ts · ..A. cc..es.s.o.r..y building as applied for. The certificate is issued to BEN. N.ETT ORLOWSKI (owner, of the aforesaid building Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO ..... ~ ./.3. .......................... PLUMBERS CERTIFICATION DATED: N/A Rev 1/81 l~OR'sr NO. B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16004 z Permission is hereby granted to: .......... ..~~....~.:.~..:...?...~..~..~.. pursuant to application dated ..~ ~-~-- 0..~......~_~.. ................ , 19.~., and approved by the Budding Inspector. Fee $ Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thru apphcat~on must be filled in typewmter OR ink, and submitted I / to the Building Inspec- tor with the followmg; for new buildmgs or new use' 1. Fmal survey of property with accurate location of all buddings, property lines, streets, and '..nusual natural or topographic features. 2. Final approval of Health Dept of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of e~ectrica~ installation from Board of Fire Underwriters. 4. Commercml buddings, Industrml buddings, Multiple Remdences and similar buddings and instatla- tlons, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed rote plan requirements where applicable, B For existing buddmgs (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property hnes, streets, buddings and unusual natural or topograph lc features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ddings 3. Date of any housing code or safeW mspect~on of buildings or premises, or other pertinent reforma- tion required to prepare a certificate, C, Fees: Addztions $25.00 1. Certlficate of occupancy New Dwellzng $25.Q0, Accessory ,$]0.00 Business $50.00 2. Certificate of occupancy on pre-exmtmg dwelling $ 50.00 3 Copy of cert[f~cate of occupanc¥ $ 5.00, over 5 7ears $~0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ......................... NewCons truction ..... Old or Pre-exlstmg Bulldmg .......... Vacant Land ............. Location of Property ..... 5-1 ,~.0. }1¢.,~- ~;t' ~ House No, I-lanier Owner or Owners of Property ..... ./.~ .... ~.~ .......................... County Tax Map No. 1000 Sect,on . .//~ ......... Block ....... .~' ...... Lot.,./..~ .......... · Subd~vm~on ........................... Fded Map No ........... Lot No .............. Permit No .......... Date of Permit .......... Apphcant .................................. Health Dept. Approval ...................... Labor Dept. Approval ........................ Underwriters Approval ...................... Planning Board Approval ...................... Request for Temporary Certificate ................ Final Certificate ....................... Fee Submitted $. ~/O Rev, 10-10 78 OUNDATION ( ls t) 3UNDATION (2nd) OUGH FRAME & ?LUMBING NSULATION PER N. Y. STATE ENERGY CODE FL':A L ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~AL DATE INSPECTOR FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y, 11971 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. NOTIFY TEL.: 765-1802 CALL ................ Examined "y"~Qo~,%) , 19'7 c"%L ~dt~.~e_ //¢35'" Approved ................ . . . TOWN OF SO,O,HO,LD (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date .~ , 19~ INSTRUCTIONS a Tins apphcat~on must be completely filled in by typewriter or in ink and submitted to the Budding Inspector, wi sets of plans, accurate plot plan to scale· Fee according to schedule· b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc str or areas, and giving a detailed descnphon of layout of property must be drawn on the diagram which is part of this al cat~on. c. The work covered by tins application may not be commenced before issuance of Buildmg Permit. d. Upon approval of tins apphcation, the Building Inspector will issued a Budding Permit to the applicant. Such pe~ shall be kept on the premises available for mspection throughout the work. i e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupn shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Budding Department for the msuance of a Bml&ng Permit pursuant to 'Building Zone Or&nance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buddings, additions or alterations, or for removal or demohtion, as herein descnl The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulaUons, an, admit authorized inspectors on premises and m budding for necessary lns~0ections. ~ ~f'~, ,¢ (Signature of appbcant, or name, if a corporation) (Mailing address of applicant) State whether applicant ~s owner, lessee, agent, architect, enDneer, general contractor, electrician, plumber or buff, Name of owner of premises If applicant is a corporatmn, mgnature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No Plumber's License No ... Electncmn's License No Other Trade's License No .. Location of land on ~vtuch proposed work will be done House Nmn ~er $tr¢¢~ County Tax Map No 1000 Sect]on //o Block .. (as on the tax roil or late~ Ceed):~d.'-~l~'~ *~& ~'O ' [D ' 8> .... Lot. /.~ 2 Subdivision Filed Map No Lot (Name) State ex~stmg use and occupancy of premzses and intended use and occupancy of proposed construction 4 5 Nature of work (check which applicable) New Burddmg ~ddltlon Alteration Repmr Remove1 ...... Demolition ....... Other Work Estimated Cost .. . / .,~, ~. If dwelling, number of dwelling units . If garage, number of cars ......... (Description) ....... Fee ......... (to be paid on filing this application) Number of dwelling units on each floor .... If business, commercml or mixed occupancy, specify nature and extent of each type of use Dimensions of existing structures, if any Front . . Rear ....... Depth .... Height ... Number of Stones ............ Dnnenslons of same structure with alterations or additions Front ...... Rear .. Depth .............. Height ...... Number of Stones ............ $. Dimensions of entire new construction Front . ~ . Rear .. ~. ...... Depth . l ? ... Height Number of Stones 9 Slzeoflot Front /-~c~ / Rear ,,oc~" ..... ~'~,~'*~' ' ' t~-~''~' ....... 10. Date of Purchase .......................... Name of Former Owner ........................ 11 Zone or use district in which premises are situated . /~.~.~. ,5.o t~..,~'t~./~' ........................ 12 Does proposed construction violate any zoning law, ordinance or regulation ....................... t3 W~ll lot be regraded .............. Will excess fi~l! be removed from premises' Yes 14 NameofOwnerofprem~ses~.~.~rET/q.~>.~&~.--q/,('l. Address4/,$~?.~A~ .... PhoneNo '~e'~;O.~ Name of Architect .. ... . .. . Address ......... Phone No. .. Name of Contractor . .i~.L./.~' ...... Address ............. Plmne No .......... 15. Is this property located within 300 feet of a tzdal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ~ndmate all set-back dimensions from )roperty hnes. Give street and block number or description according to deed, and show street names and indicate whether ntenor or corner lot ,..~~ ~ >(! '~ , ;TATE OF NEW YORK, S S ?OUNTY OF .............. (Name of individual signing contract) ,bore named ..... being duly sworn, deposes and says that he is the apphca, (Contractor, agent, corporate officer, etc.) ,f smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl pphcatlon, that all statements contained m th~s apphcatmn are true to the best of his knowledge and belief, and that t cork will be performed in the manner set forth m the application filed therewith. ,worn to before me thru ........ ~f,....dayof.. ~ ....... ,197~. . ~ ~8L1~ ~ ~ ~w ~ (St~ature of apphc