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Home My WebLink About16108-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy PLUMBERS CERT[FICATYON DATED: No. zi6366 Date November 5, 1987 THIS CERTIFIES th ttl b ildi Accessory a lc u ng ............................................... Location of Property 65 EbIORY Road Cut:chogue House NO. Street Hamlet County Tax Map No. 1000 Section 103 . .Block 4 .Lot /40 Subdivision, ,@.u,n)~.y.,,S.h.qr.e..s ............... Filed Map No. 323 1 .LotNo. 17 conforms substantially to the Application for Building Permit heretofore filed in this office dated June 2, 1987 pursuant to which Building Permit No. 16108z dated ...~.u.n..e..2.2. ·..1.9.8. 7. .......... 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 ......... .... 6 .c,c? s.s. ? ?y .~. ?.~ 1.a.t..n.g. As...~.p.p. ~..t.e.a,. f. ?,L' .................................... The certificate is issued to 3'OSEPH H. HETZNER ..................... ~o¥.'d., '~e~g~;;~ xx ................... of the aforesaid building. Suffolk County Department of Health Approval . N/A UNDERWRITERS CERTIFICATE NO. N/A N/A Rev. 1/81 ]FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*_ t6~0~ Z Permission is hereby granted to: .................. .... :~-~"~:~¥'D?~ .................................. ...~......~.~...,...~/...~..~ ....................... at premises located at ....~..~.......~..~...~?.A'~.../......~..O.~..7...~.~..?...~..'.~.O...~....~....~..r/~.~.~. ................. County Tox Map No. 1000 Section ....... /.~?~... ....... Block ..... ~ ............ Lot No ...... ,.~....~.. .......... pursuant to application dated ...... ....'~./..~...~... ................................... , 19~...~..., and approved by the Building Inspector. Fee $...~..~... ~ . · / ~fildlng 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 This application must be filled in typewriter OR i~k, and submitted tor with the following; for new buildings or new 1, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2, Final approvat 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 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: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$]0.00 Business $50.00 2, Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, ove~ 5 years $10.00 4.Vacant Land C.O. $ 20.00 5,Updated C.O. $ 50.00 Date ........ .7/ ....... New C on s t r u c t ~ on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .. ,~, .~7, ,~..~.?.'.~.7.../.~.~. .................. /-louse No, Street Ham/et Owner or Ownersof Property -v/o 9 ,%~ ~ /Y~.~ 7' ~,,t,'.~ ~.'~, County 'Fax Map No. 1000 Section ... / ~ ~ Block ~.~. Lot .... /~.~. Subdivision, .~'.~ .,~/./~. ¥..~. ~.o..~?..~. ............ Filed Map No. Permit No./~./.O..~..~.. Date of Permit .~/~./~.7,:Applicant.. Health Dept. Approval ...... ./~..~'. ............. Labor Dept. Approval , ~ ~ .................. Underwriters Approval ...... z47. ~ ............. Planning Board Approval ...................... Request for Temporary Certificate Final Certificate Fee Submitted $ .... ~..~..~ ?..o:......P~..~..~.~,~.... Construction on above described building and permit meets all ~des and regulations. Rev. 10.10,7a U~D~TION ( 1 s t ) UNDATION (2nd) UGH FRAME & FLUMBING SULATION FERN. Y. STATE ENERGY CODE FINAL · ADDITIONAL COMMENTS: BLDG. TOWN OF SOUTHOLD Examined .............~-ekz~... .~..7<-.., 19~..~.. Approved l, Permit ?...Z'- Disapproved a/c ..................................... " ' t~t~ii ~ ~) ........ APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH 3 SETS OF PLANS ....... 'FORM NO. I SURVEY ~- YOWN OF SOUYHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM · TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1~02 CALL ................ ~A~L TO; ~, Date ..... :? 7.g/..~ ....... 19 ~...P' INSTRUCTIONS a. This application must 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. 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 c, ommenced 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 fgr 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, bnildi.n,g code, housing code, and regulations, and to -admit authorizcd mspcctors on prcmisea and i~, ~uildi:-~g ~%r ucccs~a.~~N ~-~__~ ~_ . ~--~ · .)'~-.--. · .bl~A~. · · .~7'. . ' ~ur~ [ ~Oplicant, o~r nan~,~a corporation) ........ .~io..~.../..o5~...-.-...<' ~ .,. ~.~.~..o.. 6:.o. s-. ? '/i-' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O v_~ ,~,' o__i~,. ~ . ........................................ Name of owner of premises . .~..o.~. ?...:?../).. ~..q....~'t...~..~/.~'7.. './~.../~.. ~ '~' (as on the tax roll or latest deed) If applicant is a corporation, signature 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 ......................... Electrician's License No ....................... Other Trade's License No .......... : ........... 1. Location of land on which proposed work will be done .... ........... ~'~.. ~,}n o....,,~r ..... ~)~CYt. .... - . . ................. ..... ~ .,57. .......... .~. ~,: .o. ~. ~ .... ~., ............... .<.~?.l-..,.-.a...o.. ? ..o. ?..: ............ ttouse Number Street Hamlet County Tax Map No. 1000 Section ...... ./0.3 ....... Block ...... l~/' ........... Lot....~. '..O. ........... Subdivision..~.'? .~. ~.Y...~. h .o..,.'~. ~ ..9. ............. Filed Map No...~. °.c)-.~.I ....... Lot.../.7.... ....... (Name) 2. State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... b. Intended use and occupancy ...~...~/.-.rf_.ff.o:. ~..~.' ./! .°.-':'~..-7 . '~<~..Zr....~..'/.~?../5~.~..~?.e...: ................... 3. Nature of work (check ' ' ' ' ......... which apphcable): New Building ... ~. ..... Addition .......... Alteration Repair .............. Removal .............. Demolition .............. Other Work .............. 4. Estimated Cost ................................... .w'.~i~. ~ Fee ..................................... ~ ' (to be paid on filing this application) 5. If dwelling, number of dwelling units .. /b'jl Number of dwelling units on each floor... If garage, number of cars .... i. e~/r'~ ............................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~..'9 ................. 7. Dimensions of existing structures, if any: Front ........ ~ ...... Rear ... ~.c}. ~. ...... Depth ...3 ~.. ~ ...... Height ..... ,/O~. ....... Number of Stones .... / ................................................... Dimensions'of same structure ' ' with alterations or additions: Front ................. Rear .................. Depth ............ i'. · He ...................... Number of Stories ...................... Dimensions of entire new construction: Front ..... ~'..~..' ..... Rear ....~. ~ Depth ight 0 ' He ..... ./~. ........ Number of Stories ....................................................... 9. Size of lot: Front ..... ./.,57.0 ........... Rear ..... ,~.../.O~..'~.., .... Depth ./.~... 10. Date of Purchase ......... .'~../.4 ~'/.~fl..: ........ Name of Former Owner ....77:.... ~ .o. ~. 11. Zone or use district in which p~emises are situated .................................................... .¥ 12. Does proposed construction vi61ate any zoning law, ordinance or regulation: ../~..~ ............................ 13. Will lot be regraded ........ ~.., A,'~' ............... Will exces~s...f~ill be removed from premises: Yes No 14. Name of Owner of premises .~.Zl~.C: T.~-~q'..eC.t.~... Addr.ess ~4.~..~',~,,e ~r. f~..~:... Phone No.."Z.~ ff. 7.~. d 4 ~... 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 w~.. · If yes, Southold Town Trustees Permit maybe required. ' PLOT DIAGRAM Locate clearly and distinctly al.1 buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether property lines. Give street and bloct interior or corner lot.~&a,~6 ~r I' STATE OF NEW YORK, · i _ ~ , COUNTY OF ........ ; ' ...... ;~. 9.~..f_0~ ......~..~..'~.'.~ .C/( .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .................. ............................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly 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 manner set forth in the application filed therewith. Sworn to before me this ............ ~.'~. .day o:f .... ~ 19 0 Notary Public, . .................... Co ' No, d7~7476 Qm~lifiod in S~af~olk