The URL can be used to link to this page

Home My WebLink About16469-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17394 Date OCTOBER 7, 1988 THIS CERTIFIES that the buildin~ ALTERATION Location of Property 2300 DEPOT LANE CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 102 Block 2 Lot 2.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 16, 1987 pursuant to which Building Permit No. 16469Z dated SEPTEMBER 25~ 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 ALTERATION & RENOVATION TO EXISTING DENTIST OFFICES. The certificate is issued to CPK PARTNERSHIP of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED PENDING Building InSpect'or Rev. 1/81 l~Olt~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16469 z Permission is hereby granted to: .~~.~..~......%.L~.t~.~.. ,?,. "" ,,' ,~"~"~'"'~""'""'"': ............ i~ ....... '~"~ ........................ '~ ............................. ,,, pre,,,,ses ,=ted o, ......... ~ ......... '~..,,~ ......... :'~...*. ..,......~.~,X...., ....... Cau.~/ To× Map No. lO00 Sect~.....l....O......~.. ...... mock .... ..O.......Z=. ....... Lot No....~...:.2.~;~ ....... pursuant to application dated .....~. ~....~...~ ......... , 19~..~.., and approved by the Building Inspector. Fee $. L...1~...:..,./~.........'~ 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 ,= ~a===~a 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 build{ngs (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: t. Accurate survey of p~operty showing all properW lines, streets, buildings and unusua~ natural or topographic features, 2.Sworn statement of owner or previous owner as to use, occdpancy 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 $25.00 1. Certificate of occupancy New Dwelling~$25.QO, Accessory~$10.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5 00, over 5 years $]0.00 . 4.Vacant Land C.O. $ 20.00 ' 5.Updated C.O. $ 50.00 ~e .... .~././.?,/..G. .... NewC°nstructi°n ....... Old or Pre-existing Building .... ,~,~ ..... ~/';c2~t* ~/d' i. ,~, i i i.i .... ..... ..... >; .... Owner or Owners of Property .... (,-~', .A./ .... .~-~....J/~~ .............. County Tax Map No. 1000 Sect on .... Block ....... ~ ..... Lo;_... ,~,, ,',c~.. .... ............................... Permit No./~..~..~..?. DateofPermit .~/~..z~..~./~pplicant ......... LotNo ..... : ....... 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 per.~mit meets all .a~ble .co~ and regulations, FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION FERN. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS BOARD OF HEALTH 3 SETS OF PLANS 'FORM NO. 1 SURVEY .......... TOWN OFSOUTHOLD ~ CHECK .......... BUILDING DEPARTMENT 9EP~TIC TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971, TEL.: 765-1803 CALL FORM ............. : (Building Inspector) APPLICATION FOR BtJ!LD!NG PERMIT , Date IN STRUCTION S a. This application must be completely filled in by typewriter 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 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 removalJ:m4emolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code,/l(6usiB~ code~.,anj;1/regulations, and to admit authorized inspectors on premises and in building for necessar~ec~Jti.~s. /'~.. / pSigp.~rjlffJ/6 og/applicant, or nam,e, if~q corporation) (Mailing addrefs of applicant) . State whether applicant is owner, les~g~ent, architect, engineer, general contractor, electrician, plumber or builder. (as on t~Se tax roll or latest deed) It' applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plu nber s License No ......................... Electrician's License No...~...~. · .~...~. · .~.T .... Other Trade's License No ...................... :.. 1. Location of land on which-proposed work will be done' '? - / ' ..... ....... ....... iiiiiiii House Number / Street Hamlet / County Tax Map No. 1000 Section .... /~...~.. ..... Block ..~...~.. ......... Lot..~..:..~.. ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended Use and occupancy of proposed construction: a Existin us ' · g e and occupancy~."/~~ /,/~ ~' ./'.:~...., ....... ~. .....r~.. ~. · · '~ ..... ~5~'"".--~'~. "wS'k~l"r. - ~;"~T~'fl · · '/7 ........ b. Intende~ use and occupancl~r~~~~. · /./ - /"~- U' ~ 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .......... Repair ......... ,.,... Removal .............. Demolition .............. Other Work ............... '~ . ~~..~ _~ (Description) 4. Estimated Cost ..... ~r..~'..':'. .-.: ....................... Fee ./~r...~.~..~.~...~. ........................ ' " (to be paid on filing this application) 5. If dwelling, number of dwelling units . ~ .... Number of dwelling units on each floor. If garage, number of cars .... I-../~'-2.~. .~:-~. .'. ....................... -. ..... , .......~ .... i.. 6. If business, cQmmercial, or mix6d ,occupancy, specify nature and extent of each type of'uge' 7. Dimensions of,existing s~m~6tir~,S~.if any: Front..."~-~ ......... Rear . ."~-. ~ .... : .... Depth..~.'~.~ ...... Height . f.5~'..'. .........re -- 'Nh~n'~b~r of Stories. ~.;..'(/'0. · ~_ ~ .... : ...... '"" '" Dimensions'q[,s~m~e ~tml~t:~' e. with alterations or additions Front ................ Rear ..,- ............. Depth .... ~ ............ ~i · Height ........... Number of Stones (,/ ,) · Dunens~ons of entire new ¢ons~ra~t~on: Front ,.~ ,-~,'~,,. Rear . ,¥ ............ Depth ............... Height .. . ; "..~.~urnb~,r of Stories (../M:~P'. c//~.N~ ~ / . . · ~. Size o~lot: ~;;nt'. :': :).-~:~':'~: :.. ' '~ 5~a~ !:.: ~'.4.:.'i/~ ': ,'~ ..... D'~'p;i,' 1 1. Zone or use district in which p~emises are situated ................................................... 12. Does proposed coastruction vgl/aB any zoning law, ordinance or regulation: ...~..'.~i .................... 13. Will lot be regraded ..... :,/Z~.,~f/,....,.. ~.. (:~... t)Vill exco,~, fiI1 be..remm/ed from premises: . .... 14. NameofOwnerofprem~se~..r.."/,.. .t'i't~./~?~ess.-~,,r~,~'~'~'~'Zr"Ph°ne~ '°~'~--, ~' "~ Name of Architect ......... i .................. Address ................... Phone No ................ Name of Contractor ........ i .................. Address .... : .............. Phone No, I5. Is this property located:within 300 feet of a tidal wetland? *Yes ..... No ~.. · If yes, Southold Town Trustees Permit may be required. · ; PLO~ DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from, property lines. Give street and block number or description accordin~ to deed, and show street names and indicate whether: interior or corner lot. STATE OF NEW YORK, , o o COUNTY OF ............ .~.. i°'°,/ .... '. . . :.1. t. .o. . .. ' ................ being duly sworn, deposes and says that he is the applicant (Name ol~individual signing contract) above named, i r ................. ' ................................... Heis the :. (Contracto, agent, corporate, officer, etc.) of said owner or owners, and is duly authorized to perform 0r have performed the said work and to make and file this application; that all statements con(ained 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 · Nota,¥. ............... Public,, , ...~..'~' .~._...day .%~...:,. . N0~'~RVN0.'' 4707878,"USLIoS£L£N~'~"'" 'KSuffe~/ateDE VOI;'~'0!~ Ceu,t~-'~Ne' '~:'¥0~ '~/'~'~' ' ''']~ ' ....... Couniyl 9 ~.~.~ ~~; ~ lika'ri'ti ! r Term Expires Mai'ch ~0, 19 o z