The URL can be used to link to this page

Home My WebLink About16163-zFO RM l~lO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. zi6020 Date August 6, 1987 THIS CERTIFIES that the building A d d i t i o n L _ ~p ~ 3870 Bayshore Road Greenport ocaIIon O! roperty ....................................................... House No. Street ' ' ' I~r~/e~ County Tax Map No. 1000 Section . 055 .Block 06 ..... Lot 33 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated , ' .J..u.n.e..2. 3. ~. 1 9 8 7 . pursuant to which Building Permit No. 1 6 ! 6 3 .Z dated . . .J.u. 1. ¥..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 ......... Deck Addition to an existing one family dwelling as applied for. The certificate is issued to . ROBERT PACICCO (owner, I~d~fdOPYdfoltrYtJt X X X of the aforesaid building. Suffolk County Department of Health Approval .... N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FORM 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~ 16163 z Permission is hereby granted to: .... ..g. ~ .. ......... . a remises I ~ 0 t p ~atod a, ......... ..V.' ........ '...~.....'%..~,m.~.....,.~.., ........ ..~..~.~ ................. County Tax Map No. 1000 Section ........ ..O....~...~..... Block ...... ...~....~. ....... Lot No .......~....~ ............ pursuant to application dated ....... ....~..~.~..~.. ................ , 19.~..~., and approved by the / Building Inspector. Fee $..~.~....:.....'~.. ..... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 m =,-,=--=--, to the Building Inspec- tor with the following; for new buildings or new use: 1. Fina~ survey of properW 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" {and uses: 1. Accurate survey of p~Pperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 ott~er pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancv New Dwelling. S25.00, Accessory !SI0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50. 00 3. Copy of certificate of occupancy $ 5.'00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5. Updated C.O. $ 50. O0 Date ...~'..~/~/.~f...~-.~../~.~..~... V NewC°nstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~ ,¢~, Z~, .............. ; ................. ,/~,'~/, ...... House No, ~. .~Z~..~.~.~). .~. Street f Ham/et Owner or Owners of Property . ~.~..~5.~...~.....~..~..E,~...~=~_~=¢~ ............................... County Tax Map No. 1000 Section .,. ~'-~ Block ~.~, Lot 33 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../.~./..~. ~. Date of Permit .?A./~..~..Applicant .~.0.~./. ,,~,~i?,~, ,(,~-~..~.~__~,.,. Health Dept. Approval ........................ Labor Dept. Approval ....................... . Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~, .............. Fee Submitted $ ..... .~j.~, .O~'.,. ~. ~. ............. Construction on above described building ap~Lp, ermit meets all applicable codes and_regulations. t/?/z? VNDATIO~ (lstl UNDATION (2nd) UGH FRAME & FLUMBING SULATION FERN. Y. STATE ENERGY CODE FINAL . ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [,~NAL REMARKS: ~)/~ INSPECTOR ~ ~ r" o 0 ~o.o '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 CALL ................ MAIL TO: TEL.: 765-1803 x m ned Approved 19~. ?. Permit No. /.~.././~...~. ·~· (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 wi/1 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 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 necessary inspections. · .~o.~.~. g. ~...~..././.~c, ............... (Signature of applicant, or name, if a corporation) .. ~ .~..cm~...~... ~%. (Mailing address of applicant) State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .............................................................................. Name of owner of premises ./~t[.~.n ~..~..~.....~.... ?...g~_..t..C:..C..Q .......................................... (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 CON, TRACTOR'S HUST BE SUFFOLK COUNTY LICENSED Builder s License No.../.~.! ~. ~.O. .'7. /:/. ! ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which propdsed work will be done] ................................................. ....~-~.....~?.~ ..... ~.~..,-f'~..,:,.~c... /-~- ...q---~...~, ..... ~q .................. House Number ~ ' kir~;i ...... t'' Hamlet ~ County Tax Map No. ,000Section ...~ ......... 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. Existing use and occupancy .... I a~ ,I ~,¢~ ............................. ;~&'g ~b~d'~ :~ ;m~gg¢i w'm~: *~ .............. b. Intended use and occupancy .................................. 2c~:,?. d~¢k?. ~J ?,:'~/-? ................. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alterat~n ......... Repair .............. Removal .............. Demolition ............. Other Work .~. ,~--~-~.. (Descrigtion) 4. EsfimatedCost..~.~..,l ~..~?.1:~ .. ........................ Fee ..................................... [t ~ (to be paid on filing this application) 5. If dwelling, number o f dwelling units .... .~. ,-.~( .~. .... Number of dwelling units on each floor ............... If garage, number of cars ....................................................................... 6. If business, commer~cial or mixed 9ccupancy, specify nature and extent of each type of uss ....... ~ 9.. Dimensions of existing structures, if hny: Front .... .-g.~. ,/ ...... Rear ,..'74ff../. ....... Depth. i i i i,~i i i i '. Height . :./~.t Number of Stories Ot~.~.. ~ .~ ........ Dimensions'of same~structure'with alterations or additions: Front ... Depth .... ~r~t .............. Height ...... ~ .~... ........ Number of Stories .... .O. tff.~.. .......... '-~8. Dimensions of entire new construction: Front .... ~ (..' ..... Rear .... ~.~.(. ....... Depth .../~.1( ......... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .... Rear ...... 1..O ............. Depth ... 1~../. ........... 10. Date of Purchase ~t~2 .......... Name of Former Owner ... ]~(5/-o~/'YT.(--~ .... ' 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...t~..O. ......................... 13. Will lot be regraded ....... ~ · .~. ..... ._ ....Will excess fill be remQved .from premises: Yes No 14. 'Name of Owner of premises .~O~..k-'~...~.I~XCCJP.. Address {.~"~. ~..q& }t~.~..~.... Phone Nt~90. l.~ ~4~...'r.~..*o~/P. .Name of Architect ~ ....... : ............... Address .... t.~i~t~r4,~.t~4..%/..~..g~...,~.~.~. Phone~.C'JT~'-t~ No ..... Name of Contractor ~0~{~.~ X~.~ lO.~.~ ....... Address .... :... 15. Is this property located within 300 feet of a tidal wetland? ~Yes ..... No . .~,-~. · If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all setiback dimensions from property lines. Give street and block number or descr/ption according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~7'ORJ~,~. fi/z/ o o COUNTY OF,~-f.~ ~'~ ...~ .~L~.t4~. '~. ~5. t~'. ~ .................... being duly sworn, deposes and says that he is the applicant (Nam~ of individual signing contract) above named. He is 'the .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly;ahthofi~ed to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfumed in the m~ner set forth in the application filed tge~ewith. Sworu to before ~e this , :: ............ .... .... , Notary Public, ~ . . ~~ounty ~ -- ~ -- ...... ~_ _~ ~ (Signature of applicant) - ~e~ In UU~~ ~ou~ ~ ~ comm~ss~ E~lt~ D~er 8, 1~ ~'o