HomeMy WebLinkAbout15873-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20738 Date MAY 19~ 1992
THIS CERTIFIES that the building. ACCESSORY
Location of Property 840 PINE TREE ROAD CUTCHOGUE~ N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block 1 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 18~ 1987 pursuant to which
Building Permit No. 15873-Z dated APRIL 4, 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 ACCESSORY STORAGE SHE~ AS ~PLIED FOR.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ROGER & MADELYN STOUTENBURGH
//uil~ing Inspector
Rev. 1/81
I~OR~ NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 15873
Z
Permission is hereby granted to:
..~ .......... :~ .......... .t.~.: ...... ~-~
~ ~ .... ~ . ..
of premises I~oted at ..............................................
I~uildlng Inspector.
Building Inspector
Rev. 6/30/80
Form No. 6
BUILDING DEPARTMENT ·
76511802
APPLICATION FOR CERTIFICATE OF OCCUPANCY "~'~' "
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
Approval of electrical installation from Board of Fire Underwriters.
Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead. ~
- ~. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
. ~. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-c~nforming uses, or buildings and
'Tpre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicator.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessor~y building $25.00,
Additions to accessory building $25.00. Businesses $50.~0.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ..................................
Jew Construction ........... Old Or Pre-existing Building .................
IIouse No. Street Hamlet
)nwer or Owners of Property. .~... . ....
'ounty Tax Map No 1000, Section...~..~.~. .... Block.~..~.~). ...... Lot .... /../., ..............
uhdivislon .............. Filed Map ...... Lot.../ ~ .......
ermit No ............. Date Of Permit ..... Applicant ........
ealth Dept. Approval ...........
............... Underwriters Approval .......................
lanning Board Approval ........................
-~qumst for:
~e Submitted- $
.......... Final Certicate ...........
Temporary Certificate .
APPLICA~NT
INSPECTORS
Victor Lessard
Principal Building I~spector
Curtis Horton
Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone.(516) 765-1802
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
1~¥ 15, 1992
SCO'I'I' L. HARRIS, Supervisor
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
ROGBR STOUTENBURGI~
840 PINg TREE ROAD
ClYrCROGI3R, ~ 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xxx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
The check is~~not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT ~ 15873-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TO%~N BUILDING DEPT.
]65-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION
FRAMING
REMARKS:
ROUGH PLBG.
2ND I- *1 INSU~_.~N
[~FINAL
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION 2ND ~
FRAMING
REMARKS:
ROUGH PLBG.
INSULATION
FINAL
0 UN D;, T I 0.~;
~
OU~DATION (2nd 1
OUGH FRAME &
PLUMBING
iNSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIO~;A'L COMMENTS:
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
.TEL.: 765-1803
.,
., 197..7: Permit No. /.~..~.7.~-..
Disapproved a/c .....................................
Received ........... ,19...
(Building Inspector)
· APPLICATION FOR BUILDING PERMIT
Date 21 ]'3 . 19~.7
INSTRUCTIONS
a. This applicatior[4 .=,~ gte~'~ in by typewriter orin ink and submitted to the Building Inspector, with3
sets of plans, accuraq t~l~t 1519 ~ .(l~l~ccording to schedule.
b. Plot plan ~ ~ .lo~ ~'c ~'d of buildings on premises, relationship to adjoining premises or public streets
or areas, and ~ 'de,~ tel~ 13n of layout of property must be drawn on the diagram which is part of this appli-
cation. _~.~' ~',t~,'~_~
c. Th~ c~ r~'~org ~~?EI ~'~n may not be commenced before issuance of Building Permit.
d A~o~am0r~ }oft~&tl PPI~ ~q, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall ge~"~p~ t~h~} ~¢.~ ~.~ 'for inspection throughout the work.
e. No~S~l ~ _~e_~ r%]~ie or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have be'~fgri~it~l~ t, by~ t~filding Inspector.
APPLICATI~ }I~E iy MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordi{~ ke of the.Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for tjae' ~nstruction of buildings, additions or alterations, or for kemoval 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 ~ctions.~/~'~ ~ .
· ~ /-;~ ~r~ a corporation)
........ i&iiii i' OOii&i i5 .......
State whether applicant is o~lessee, agent, architect, engineer, general
contractor,
electrician,
plumber
or
builder.
...................... ............................................................
Name of owner of premises ....... .~. '~' i ' ' i ' ' ~0¥~ '~' ~TFJO .........
tas on rne 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 .........................
Electrician's License No .......................
Other Trade's License No ......................
House Number ~ Street Hamlet
County Tax Map No. 1000 Section ~O Block .~ ,O O Lot ~ {} ' ~
(Name)
State existing us~. and occ~?.~ncy of premises and intended use and occupancy of~s_~d construction:
b. Intended use and occupancy ...~{~cn .... ~ .... ~ .............................................
3. Nature of work (check which hpplicable): New Building .......... Addition .......... Alteration ..........
Rel~air ~ .~ .... , ....... Removal .............. Demolition .............. Other Work ...............
4. Estimated Cost . . , .... ~.~_ Fee .................... -.: .....
! (to be paid on filing this application)
5. If dwelling, n mber of dwelli~tg units '- ~ .... Number of dwelling units on each floor... 7;. ~-. ........
If garage number of cars ' --'---- , .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use...7....~ ..-TT., ..........
Dimensions of existing structfires if any: Front ....... .75. ...... Rear .... ~ ........ Depth..Ti '.
e,g ............... Number of Stones ........................................................
Dimensions of same structure iwith alterations or additions: Front Rear ~
Dept .................. , ....Height ....... ~ ............. Number,of Stones - .. ..........
(, 8 , ,'~Dlmenslons ~f ent'.re new cons~ruction Front /.(2 .. Rear ...l ~ ......... Depth ltd. .
Height .f~ ........... Number of Stories ....... [ .................. ,.
9 Size of lot Front /~. ~. ' ,.~ Rear /'O ~ . De~th / c/, 7.7~ ...........
11 Zone or use district m which premises are s~tuated .............. ~.~ ~[O~...a cc. ~-
12 Does proposed construction violate any zoning law, ordinance or regulation: . iii. iiiiii i,~,., i
13. Will lot be regraded ....... 5 .... ./r~..O... ;--' ....... Will excess fil1 be removed from t)r,~mises: Yes
Name of Architect ...... /9..O../?~7 ............ Address .... ,~ ............... Phone No ................
Name of Contractor ~ ~ ff~"fi ~ Address ~ "',. · :2'" .~ Phone No
15. Is this property locate~ withinl,O0 feet of a tidal w~tiar~d?, * Yes";..,;. Q~ .....
· If yes, Southold Town T~ustees Permit may be required. ~i,f:N "/
.. i PLOT DIAGRAM "~ ,/" .... '. ' :..
Locate clearly and distinctly all b. kuildinjLs, whether existing or l d,: in tt a3t% l set?ack dimensions from
property lines. Give street and block number or description according to deedf'im,~sho~y,~tro~,t hames affd indicate whether
interior or cornm lot. e ,~ ~,~ ~,' , ,
~0~
STATE OF NEW YORK, ,-~4 ~F'oC/(S S
COUNTY' OF. ~Sjq .%T.,ffP.c.0.... , ·
..../~..Q .~.~..~... R ~..Q M TT..~.~, .~. ~..Ol..~. ~ .~... being duly sworn, deposes and says that he is the applicant
(Name of individual si~ning contract)
above named.
He is the ...~ ~ ~ ~ ~~. ~
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is dhly autho~ed to perform or have perfomed the said work and to m~e and file this
application; that all statements cootained N this application are true to the best of his knowledge and belief; and that the
work will be perfomed in the m~ner set forth in the application filed therewith.
Sworn to before me this
....... ......... .......