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Home My WebLink About16122-zFORM NO. 4 TOWN OF 50UTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.-15881 ' Date June 25, 1987 THIS CERTIFIES that the building ...... D..E .C.K.. A. p p.I.T.I..O.N ........................... Location of Property 805 Looton Drive Southold, New York ft~d$'e ~o~ ........................................................ Street Hamlet County Tax Map No. 1000 Section 059 .Block 01 ..... Lot 24 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June I1, 1987 161222 ....................... pursuant to which Building Permit No ...................... dated Jun e 24, 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 ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to ADDI SON & BARBARA BURKE ..................... ?o¥.'e;, ................... of the aforesaid building. Suffolk County Department of Health Approval lq /A N/A UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Building Inspector 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) Date Permission is hereby granted to: ~.~..e.~:....u.:.~.:.....L,..E..:.'..~ ....... . ~ , ,o ~-'~.~.,...~'"-'.'~"~.-~'~_.~,_~ ~, ~, ..................................................................................... at premises located at ....~..?..~,~.....~.~..q'.:............. · · · ..-....... ................................. County Tox Mop No. I000 Section ...... .~...~..~ ..... Block ...... .C~...I ......... Lot No ........~..~ ............ ~ ..ti 1~! ] pursuant to application dated ....... ~ ............... .............. , ......, and approved by the Building Inspector. 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. This application must be filled in typewriter OR ink, and submitted i ~ 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 ACCESSORY $]0.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.'00, over 5 )'ears $i0.00 4.Vacant Land C.O. $ 20.00 ; 5.Updated C.O. $ 50.00 Date ..~I..I-~ (0~.'-.~ New C on s t r u c t, i o n ......Old or Pre-ex isting Building ~ ......... Vacant Land ............. Location of Property .~O2,.G, f ~.~ (~ J; ,°7~. '., ')¢ u-~-*-' ?,0', ,~,~..~.~o/~ House No. Street Ham/et Owner or Owners of Property ~c[¢! t~...d~q...-J.: ,j,, ,~,a, ,~.~?, r.,;z.. ~...~..?.(~. ~.~.~ ....................... CountyTax Map No. 1000Section .... i.~.. ....... Block ..[ ............ Lot..c~. ,% ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. 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 permit meets a~!~/~ble codes and regulations. 7GS.1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~FINAL REMARKS: UNDATION (1st) UNDATION (2nd) UGH FRAME & ?LUMBING SULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: oc BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY ......... * TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N,Y. 11971 TEL.: 765-1803 CALL ................ MAIL TO: Examined . .~d4~A~t~ .;k.t{ .., 19~.''/. Approve{. t.~dd':~t. . .~..~.., 19~. 7. Permit No..lk ./ 77 77/. .~:'. Disapproved a/c ..................................... (Building Inspector) APPLiCATiON FOil BUiLDiNG P£R~/HT Date...~..~ Z .~ .......... 19~..'7.. INSTRUCTIONS a. This application must be completely filled ih by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accura, t.e plot plan to. scale. Fee accordlng to ~chedule. b. Plot plan sl~owing loc~ti0n of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving ~i d~'tailed descripfion of layout of property must be drawn on the diagram which is part of this appli- cation. - '~ '' , ~ c. The work covered by thigapplication 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 MAI~E tS the Building Department for the ~ssuance 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 necessaryfin4pections. /~ ,d( ! ~ (Signatnre o~/~pj~lidal~, or n_ame, ifa corporation) .......... i~i~ili;i ~;es~ o~ applicant) l l~' ~ ~ State whether applicant is_gwner, lessee, agent, architect, engineer, g~neral contractor, electrician, plumber or builder. Name of owner of premises ............... dg),m..J.,.., ............................ (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 Plumber's License No .................... Electrician's License No ....................... Other Trade's Licefise No ...................... 1. Location of land on which proposed work will be done .................................................. .. 3.,.¢&.. ................. d ...... House Number Street Hamlet County Tax Map No. 1000 Section .z..--~.~ ........... Block ...1 .............. Lot.',c~.¢.-- Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~ tCba. ................................................... b. Intended use and occupancy .... .~..~.~. ....................................................... 3. Nature of work (check which applicable): New 'Building .......... Addition .~ ...... Alteration ... Repair Removal Demolition ' Other Work ~ . (Description) 4 Estimated Cost ./7/ 6 6 ~ . ...................................... Fee ........... , .......................... (to be p~id on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type ?f use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ........ ~ ..... Depth ............... Height Number qf Stories Dimensions of same structure with alCerations or additions: Front ............. I... Rear .................. Depth ...................... Height ...................... Number of Siories .... .................. -8. Dimensions ofantire new construction: Front .......... . ..... Rear ......... i ..... Depth ............... Height ............... Number of Stories 1 9. Size of lot: Front . 1..~...~ ................ Rear ...................... Depllb ..., .... · ............... 10. Date of Purchase . . .~ .q'...I ..................... Name of Former Owner .~.'~ ./.~ .&.¥ .]~-tO.: ! ............... 1 1. - Zone or use-distriet in4¥hich-prem4sos a~e~situate6 .............. ~. 7.: ....... !; ........................ 2 2. Does proposed construction violate any zonin~ law, ordinahce or regulation: ,..] ................ - ...... · regraded ...... ~,. ,,. ......... ] ........ Will exbess~fill be ren];$Jti from premises: Yes 13. Will lot be -- Name of Architect ........................... Address~ ~~ Phone No ................ Name of Contractor Address ' : i Phone No 15. Is this property located within 300 feet of a tidal wetland? *Yes! ..... No ..... · If yes, Southold Town Trustees Permit maybe required. . PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and. indigate all set-back dimensions from property lines. Give street and block number or description according to deed, and show Sfreet names and indicate whether interior or corner lot. OCCUPANCY OR USE iS UN WFUL WITHOUT CERTIFICATE OF OCCUPANCY ~TATE OF NEW YORK, ~O JNTY OF ................ ................................................. being duly sworn, deposes and says that he is the applicant (Name ofindfviduaI signing contract) tbove 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 :pplicatlon; that all statements contained;in this application are.true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this ' ' .............. /.'( ........ day of ..... . · .~d-z'~?~-~-... ........ , 19 .~...~ qotary Public,.. ~HEt£, & D£.E ~ .d.~...~.'..~..~. ..... County ~ [,I0~1t? PUSUC ~ d ~ ~' ' (Signature of applicant) o. 4707878, Suffolk County~.~, Term Expires M~i'eh 30,19. -~r ,/