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HomeMy WebLinkAbout15350-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z14916 Date .S?.p..t:,?.m.b. er..29~. .... 19 86 dock addition THIS CERTIFIES that the building ................................................ Location of Property 470 Moose Trail~ Cutchogue~ N Y House No. Street Hamlet County Tax Map No. 1000 Section . .. ] .0.3 ...... Block ...4. ........... Lot .... 1. .2 ........... SubdivisionH/O Moose Cove Filed Map No. 32.3.©. .LetHe. 37 conforms substantially to the Application for Building Permit heretofore filed in this office dated .S..ep.g.e..m.b.e?..2..~., ..... ,19 .8.6. pursuant to which Building Permit No .... J .5.3.5.0...Z .......... dated S.e..p ?.e.m.b.e..p..2.9. ~. .............19.8.6., 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 ......... de. ck addition to existing one family dwelling The certificate is issued to . .P.a..~.~.c.k..&..L.o.u..~.s.e..I..p.e.l.q .n.d ............................. (owner, ~4YeTo~: of the aforesaid building. Suffolk County Department of Health Approval N /^ UNDERWRITERS CERTIFICATE NO .............. .N/.A. ................................ Rev. 1/81 ;ng Inspector ' IPOB, M NO. J TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15350 Z Permission is hereby granted to: ........................ ...~~~..;.~..:.%.:...~.!~. ............. at premises located at ................. ..~. ~....~ ......... .,~.L~..~.~ ............................... County Tax Map No. lO00 Section ..~....0..~ ........... Block .... ...~...~. ......... Lot No..!....~... .............. pursuant to application dated ...~.~"..~,~1~...~.~ ............. , 19.~...~, and approved by the Building Inspector. Fee $....~....'..:~... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 Instructions This application must be filled in typewriter OR ink, and submitted ~ Immmmm 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. 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 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 other pertinent informa- tion requ ired to prepare a certificate. C. Fees: 1, Certificate of occupancy $5.00 2. Certificate of O~cupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 9/26/86 5.Updated C.O. $15.00 Data .......................... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 470 Moose Trail Cutchogue, N.Y. House No. Street Hamlet Fatrick & Louise Ireland Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section .. 103 Block 4 Lot. 12 Subdivision ~/.0. ~qo.s..e..C.o. yp ................ Filed Map No. 3230, . .Lot No. 37 PermltNo..'15350Z Date of Permit 9./.2..9./.8.6. Applicant [at.~ick Ireland Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ 5.00, Construction on above described building and~ meets all .applicable codes and regulations. A pp cant .- .~'..~.'... ,~.....~z~,~..~..~ ....................... Rev. 10-10-78 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL LD IN iPECTION ~DATION COMMENTS ~DATION (2nd) IH FRAME & PLUMBING JLATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~.~a~..~.ul., 19 .~.~ Approve~.Wg~/:~ka4..~.c~., 19 .~.b' Permit No. ]..~ .~ .~.~....~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG, t>EFT. TOWN OF SOUYHOLD Received ........... ,19... Date.. 9./0~ ~. ........... 19 .~.~. 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 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 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 in~?l?ec, tion~. /~,/~ (Signature of applicant, or name, if a corporation) .... ,,. . State whether applicant is o~neL~.lessee, agent, architect, engineer, general contractor, electrician, plumber or .......... ......................................................................... Name of owner of premises . . ~ .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature 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 ..... .~:'.'.~.5T'TTi .......... 1. Location ofland on which proposed work will be done .................................................. House ~ir;;i I~t'a~n'l~i ~ zTr Number ~//,~/__0 ~ County Tax Map No. 1000 Section ...... .../(..~.f~. ..... Block ..... ~.. .......... Lot ..... ~ .......... ~ (Name) 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 Building .......... ~ Addition . .i . .k~,.... Alteration .......... Repair .............. Removal .............. Demolition . .......... i... OtherWork ............... ~ ! (Description) 4. Estimated Cost ............................. Fee (to be ~aid on filing this application) 5. If dwelling, number of dwelling units ... ~ ......... Number of dwelling uni!s on each floor ................ If garage, number of cars ...... 2..~. ~.<~.~/~ ........... i ........ 6. If business, commercial or mixed occupancy, specify nature and extent of each tv,~e of use .... ..... ~ 7. D~mens~ons~f e~stmg structures, ~f any: Front .... f~. ....... Rear .. ~.~ ....... Depth... ~ ........ Height .. ~ ........ Number of Stories .... Z ~ f'. ................. ~ ............................ D~ensmns of ~ ~tmcture w~tn alteratmns or aaa~o~s: Front ...... ~d...; ..... Rear... ~. .......... Depth ...... ~ ............ Height ....... ~P. ........... Number ofi Stories ..... /.~ .............. 8. Dimensions of entire new construction: Front ............... Rear ........ ~ .......Depth ............... Height Number of Stories : 9. Size of lot: Front .... ~ LL ............ Rear ..... ~ ............. ~Deoth ...... ~ .............. 10. DateofPurchase ~f~.~ ........... Name ofFomer Owner .'~.~.. ~~... 11. Zone or use district in ~hich premises are situated ..................... 12. Does proposed constrnction violate any zoning law, ordinance or regulation: 13. win lot ee regraaed ...... 4 .................... Win excess an ~e remo~ frpm oxe~ses:, ~es No 14. N~e of Owner of premises/f~&¢ P~Z~o&aa,o,~ .~:~ Nme of Architect ........................... Address ............... I .... Phone No ................ N~e of Contractor .......................... Address ..... ~ .... Phone No ................ 15. Zs th~s property located within 1.00 feet of a t~dak wetland? * ~Yes ..... No . · Zf yes, Southold To~ Trustees Permkt may be required. PLOT DIAG~ Locate clearly and distinctly M1 bufld~gs, whether existing or proposed, and. indicate M1 set-back d~ensions from property Hnes. Give street and block number or description according to deed, ~d sho~ street n~es and indicate whether inte~or or corner lot. STATE OF .N'EWr2ffl)l~g/~( S S COUISITY O~ ...... ' ........... (Name of individual signing contract) above named. and says that he is the applicant He is the ~.-q.~_.. (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are -true to the best ofhisiknowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ¢:~.oz~...~....dag'of ........ 194a'~/. Not~P~u~blic, · .~./9~ .... ..-~p,~..~:~.. County ~ (Signature of applicant)