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Home My WebLink About15462-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NO Z-15212 Date January 2], ]987 Deck Additzon THIS CERTIFIES that the bmldmg ..................................... Locahon of Property . 5.0. I.n.di.a.n .Nec. k .La.n..e., ........ P..e.c.on.z..c.,..N;.Y., ........... House No Street Hamlet County Tax Map No 1000 Section 08 6 ,Block 04 .Lot 1.3 7159 Subdivision M/o Peconic Bay Cove .Fded Map No ....... Lot No. conforms substantmlly to the Apphcahon for Building Permit heretofore filed in this office dated October 31, 1986 15462Z ................ pursuant to which Building Permit No ................... November 6, 1986 dated ................. , was issued, and conforms to all of the requirements of the apphcable prowslons of the law. The occupancy for which this certificate is issued m ...... DECK ADDITION TO EXISTING ONE FAMILY DWELLING. GEORGE A. & MARGARET M. TINTLE The certificate is issued to .......................................... (owner, Te~areT. o~ ~X X of the aforesaid budding. Suffolk County Department of Health Approval .. N / A UNDERWRITERS CERTIFICATE NO ......... N/A PLUMBERS CERTIFICATION DATED: Rev 1/81 N/A Building In~pe~ t or FO~,~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15462 Z Permission is hereby granted to . .......... · ~...:~~. ..... ~.:..H..: ............................ ot premises located ,~t ...:~..'~..~~..../~J ~'....~..~ ....... .~...~ ............ County Tax Mop No 1000 Section C~ pursuant to opphcahon dated .. C~..~"...~.~a.~4~ ~l.J .... , 19~/~, and approved by the Building Inspector Building Inspector Rev 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Budding Department Town Hall Southold, N.Y. 11971 76.5- [802 APPLICATION FOR CERTiFiCATE OF OCCUPANCY Instructions A. Th~s application must be fdled in typewriter OR ink, and submitted I ~ to the Building Inspec~ tot w~th the following; for new braidings or new use 1. Final survey of property with accurate location of all buildings, property hnes, streets, and unusual natural or topographic featu res. 2. F mai approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commermal buildings, Industrial buildings, Multiple Residences and similar buildings and mstalla- t~ons, a certificate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or braidings and "pre-existing" land uses' I. Accurate survey of p~operty showing all property lines, streets, buddings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety Inspection of buddings or premises, or other pertinent informa- t~on reqmred to prepare a certificate. C. Fees' 1, Qe~tff~cateofoccuoancv $25.00 -- BUSTRESS $50.00 2. Certificate of occupancy on pre-existing dwelhng $ 50.00 3. Copy of cert~ficate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~ 5.Updated C.O. $ 50.00 Date ..... ~.~. · ....... NewConstruction ....... Old or Pre-ex,sting Budding ............ Vacant Land ............. Location of Proper~ ~ /1~/~ ~C~ ~ Hou~ No. Street H~/et or ..... Coun~ Tax Map No. 1000 Section ..... ~ ...... Block .... Z ......... Lot ..... /,~. ...... Subd~ws~on ..................... Fried Map No ........ Lot No ............ Perm,t No. Z'~-~".z/~...~... Date of Perm,t ...... Apphca t . . . ~. .... ~. ~;. ..... Health Dept Approval ..................... Labor Dept Approval ....................... Underwriters Approval Planmng Board Approva~ ..... Request for Temporary Certificate .................... Final Certificate ..................... Fee Submitted $ ...................... Construction on above described bu,ld~ng and pe~eets all apphcable !o~regulat~ons. ^pp,icant . ........... OUNDATION (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y 11971 TEL. 765-I 802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because,of the following reasons. /_~ An application for Certificate of Occupancy is not on filc. ~L4~~ ~~, /_--/ No Underwriters Certificate on file. /~ The check is(outdated/not on file.) /--/ No Health Dept. Approval on file. /_--/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # / 5-- y ~ ~ Z Building Dept. ***/Z/ No Plumber Solder Certificate on file. ( all permits involving plumbing bexng issued after April 1,1984 ) ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y 11971 TEL,. 765'1802 Examined Approved 11986 Received ........... ,19.. Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Date.. <~' 31 .... IN STRUCTION S ~ Tbas 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 buddings on premises, relationship to adjmnmg premises or public streets or areas, and g~ving a detailed description of layout of property must be drawn on the diagram which is part of this apph- cation c The work covered by tl~s apphcatlo_n~l d. Upon approval of this apphcati ~h~ shall be kept on the premises avada~e~ e. No building shall be occoffi~ll r'us~ shall have been granted by th~u~t~ APPLICATION IS HEI~di~E Building Zone Ordinance ,of t~ ,.~ Regulations, for the construcl~l;~ The applicant agrees to comply~.~*t~ t admit authorized inspectors on pfl~l~ a~ ~ o~t b~ ~gnmence.~t before ~ssuance of Budding Permit I"~u li~I~lf~t~o~'~['~sued a Budding Pem~t to the apphcant Such pemzt otl ~g~ work. ~, ~e~ for any purpose whatever untd a Cegificate of Occup~cy :~ [a~ ~ounty, New York, ~d other appbcable Laws, Ordinances or =~ ~ or alterat~ons, or for removal or demolmon, as hereto described ~ ~aws, ordmanees, building code, housmg code, and regulatmns, and to ~fldmg for necessaw mspectmns (S~gnature ~ apphcant, or name~corporatmn) .... ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu,lder. Name of owner of premlses /~/Txsf ~ ~~ ~ ~/~W%~' . ..... (as on the tax roll or latest deedg...~OV~ If apphcant ~s a corporabon, s~gnature 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 Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Secbon Subdivision (Name) Block ¢ Lot. . Filed Map No 7r'--5'~¢ Lot. 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable) New Budding ..... Addition..~/ ..... Alteration ,.. Repan- Removal ......... Demolition O t h e r W o r k .(~')~c-ff~: J.. (Description) 4 Estimated Cost ............................. Fee ........................... (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 ...~... ~ ............................................... 6. If business, commercial or mixed occupancy, specify natur~ and extent of each type of use .....-----~. ........... '/. Dtmensions of existing structures, if any' Front.. .3. ~ ..... Rear . ~.~ ........ Depth . .~-vi~- ..... Height . ~ ..... Number of Stones . f ."-C. ............................... Dimensions of_same structure with alteratzons or additions ?font ... ~..t ........ Rear....~..~. ( ........ Depth ...~.~.t ...... Height ..~t~/~3'7...~ ...... Number of Stones .. ...~.....! .... 8. Dztnenslons of entire new construction Front . ~ ..... Rear .... ~,~?..~ ...... Depth ...-f~' .... Height . . ~. ~. .... Number of Stones ............................... 9. Size of lot Front .............. Rear ................. Depth ................ 10 Date of Purchase ............ Name of Former Owner ...~..~r.,?p 7- ......... 11. Zone or use &strict in which premises are situated .................. , ............... 12. Does proposed construction violate any zoning law, ordinance or regulation' ....~. ................. 13. WflI lot be regraded ~. ............... Will excess frill be removed from premmes Y~e~ .* ~: ~"~/.. ~.~,~... Address . ~ .~'.~'c,',~.' . . .x.x.x.x.x.x.x.x~f~. ~ Phone No. ,7'.$~- ..7',r~, ,~-,,~. 14. Name of Owner of premlses . ~ . ~/ .Address ' '~ ' " PhoneNo r, Name of Architect ..... ~, ' ' t'~ ' ' ' ~- ' ' 't] '; ° ',;' ' ',/' ',, ;,' ~"-~ ' Name of Contractor .................. Address ............. Phone No ........ 15. Is this property located withinl~0 feet of a tidal wetland? * Yes ..... No ~.... · If yes, Southold Town Trustees Permit may be requzred. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exlstmg or proposed, and. indicate all set-back dnuenslons ftc property hnes Give street and block number or description according to deed, and show street names and indicate whetb mtenor or corner lot. STATE OF NEW YORK, COUNTY OF. F5ts .~e~o~/<~. S S (Name of individual signmg contract) above named [xz& being duly sworn, deposes and says that he is the apphca He ~s the ..... (~)a.2.,~-.-..~ .c.q~.~,~ .,,g~ .~...,~. ............. (Contractor, agent, corporate officer, etc.) of smd owner or owners, ~d ~s duly authored to perfo~ or have perfo~ed the satd work and to m~e and file fl apphcatmn, that all statements contmed m this apphcat~on are trite to the best of h~s ~owledge and behef, and that t~ work will be perfo~ed ~n the m~ner set forth m the apphcat~on filed therewith. Sworn to before me thru . . .... .... ~ ~MI~ 6m~ ~ ~ y~ - · · N~ ~I I~ (S~gnature of apphc~ ~Z ~