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Home My WebLink About15165-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y Certificate Of Occupancy z14781 August 11, 86 Date ............................ 19. THIS CERTlFIES that the bmldmg . enclosed exzstlng porch Location of Property 800 Prazty Lane Cutchogue, N.Y. 11935 House No 1 09 OStreet 27.1 Hamlet County Tax Map No. 1000 Section .......... Block ............. Lot .............. Subchvis~on ........................ F~led Map No ........ Lot No ........... conforms substantmlly to the Apphcat~on for Bmlding Permit heretofore fried ~n fins office dated ~ug¢~s.t~. ], .......... ,19 ~.6. pursuant to which Braiding Permit No... ~..5 J.65. Z. ........... dated ..A.u.gu.s..~ .2, ......... 19 8.6. , was ~ssued, and conforms to all of the requirements of the apphcable provisions of the law The occupancy for which ttus certificate is msued is ....... ....... ej~c$gs?..~..xz.st%.ng, po. Fc.h' qn .ex%s.g.:l..n~. o.ne...f.a.m.~l.y..d.w.e.l.l.zn.g .... The certfficate ~s ~ssued to .... of the aforesmd bmlding. {owner, ~ae~x ~e~Nx x Suffolk County Department of Health Approval ........ ~/.~ ....................... UNDERWRITERS CERTIFICATE NO ......... N /A Rev 1/81 Buildmg InSpector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWFI HALL SOUTHOLD, FI. Y. N°. BUILDING PER~IT (3'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15165 Z Date ...,~,/~.,~,.....,,~,,,. ...... Perrmss~on ~s hereby granted to' ...~.~..~....,,~.......~ ~ ....... .~.~~~...~:~..,...~.~.~...x..~ .... ............................. o, ~,~,,, [~,,~ ~, ...~ ...~:.~~~ ...... ~~ ..................... County Tax Map No 1000 Sech~.l~... Block .... .~.~... ....... Lot No...~..--)...1..~ ....... pursuant to application dat~ . ~~ ..~ ........ , 19~.~., and approv~ by the Budding Inspector Fee $.,w~..~./ 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 This application must be filled ~n typewriter OR ink, and submitted m~ 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 Planmng Board approval of completed rote plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and 'pre-exist~ng" 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 safeW inspection of buddings or premises, or other pertinent informa- tlon required to prepare a certificate. C, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng $15.0 0 3. Copy of certificate of occupancv $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date ..c~.~,~.'~_._ .......... New C on s t ru c ~, [ on ...... Old or Pre-existing Building ?,~ ~.~.J~..-~J,~.,~(~Lacant Land ....... LocationofProperty/~.~u.se~f.~,~...~v/.~..~'..~..~4.. ~.. P. [' ~.tr?~ ?. ~.. cL ~. . . . ] . .~. . .~. . f l ~ ~ ~ ~nle t Owner or Owners of Property .J~/~.~..~. ~',~.. County Tax Map No. 1000 Sect,on ...... /. d. Subdivision ................................. Fried Map No .......... Lot No Permit No ........... Date of Permit ......... Applicant ................................. Heatth 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 ail applicable codes and regulations Rev. 10 10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 August 6, 1986 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /~ An application is not on f~le. /-/ /-/ /_-/ for Certificate of Occupancy No Underwriters Certificate on file. The check is(~~not on file.)$50.00 Building Fermlt 5.00 C.0. 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 ~ L ~- ~ ~ Z Building Dept. ***/~/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) A FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Thru apphcat~on must be filled in typewriter OR ink, and submitted m~ to the Budding Inspec- tor with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographm 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, Industmal buildings, Multiple Residences and similar buildings and installa- tions, a cerhficate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed rote plan requirements where apphcable. For existing buildings (proof to April 1957), Non-conforming uses, or buildings and "pre-exmting" land uses' 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topograph m 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 buiIdmgs or premmes, or other pertinent mforma- t~on required to prepare a certificate. C. ~certlflcate of occupancy $5 00 2 Certificate of occupancy on pre-exmtmg dwelling $1 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.upda%ed C.O. $15.00 Date .~,4~....~. NewConstruction ...... Old or Pre-existing Buddmg .......... Vacant Land ............ House No. Ham/er Owner or Owners of Property . .~f-~. ~- ./~ .~'~,g~..~ ~ ..................... County Tax Map No. 1000 Section ......... Block .............. Lot ............... Subdlwmon .................... Fded Map No ........ Lot No ............ Permit No ....... Date of Permit ........ Apphcant .................................. Health Dept. Approval ....................... Labor Dept. Approval ........................ Underwmters Approval ...................... Planmng Board Approval ...................... Request for Temporary Certificate ................. Final Certificate ....................... Fee Submitted $ ................... Construction on above descmbed budding and permit meets all applicable codes and regulations. Rev 10-10 78 FIELD ILS~ ~zON DATE ~,0,~, * ~ FOUNDATION {1st) FOUNDATION 2. 12nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL COMMENTS: / ADDITIONAL ]65-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: DATE INSPECTOR ~C/~ ~,~ Examined Approve~.~ .~:~ .~" .'~- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL 765-1802 , 193 ~ Disapproved a/c .............. (Bufldmg Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF soUTHOLD . ;Rece:~ved .... .~..-~ .I..'~., ~ 98~ INSTRUCTIONS a This apphcat,on must be completely filled m by typewriter or zn ink and subm]tted to the Bmldmg Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of bmldmgs on premises, relatmnship to adjoining premises or pubhc stree or areas, and giving a detmled description qfilayout of property must be drawn on the d~agmm whmh is part of this appl cat~on. ~ ~ ~ t~J: ~ c. The work covered by fi:us apphca, tion may not be commenced before zssuance of Budding Permit. d Upon approval of this at~phc~i6n~ th~ Buffeting Iias~ector will issued a Building Permit to the apphcant Such perm shall be kept on the premises avattabfe~for mspectioff throughout the work. e. No building shall be occupied or used. in w~aole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Bmlding Inspecto.r. : APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances c Regulations, for the construction of bmldmgs, additaons or alteratmns, or for removal or demohtlon, as herein describe, The apphcant agrees to comply with all apphcable laws, ordznances, budding code, housing code, and regulations, and t admit authorized inspectors on premises and m building for necessary.~nspections~ ] . ~...-- - ' -...(~tgnatur.e o f apphcant, or nam..q~ ~ or~o~'°rp°ratl°n) State whether applicant zs owner, lessee, agent, architect, engzneer, general contractor, electrician, plumber or builder Name of owner of premises ~-~D~o~gff ,J-, /~A-t--Tkm'V/ %. ~.¢.~/~.~,1e-' (~...~..~.I~F. c ~--~'~r 1. ...... (as on the tax roll or latest deed) If apphcant ~s a corporation, signature of duly authorized officer (Name and t~tle of corporate officer) Budder's L~cense No. . ~. Plumber's L~cense No ........ Electrician's License No ......... Other Trade's License No ..... 1 Location of land on whmh proposed work wdl be done House Number Street Hamlet County Tax Map No 1000Sect,on l0 ~ . . Block ~. ..... Lot.. 2 Subdivision.. (Name) .... Filed Map No .. Lot State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy eJCaSt;~, q l.r ~. 'F -'~. .-~ {"'O~-.~. r./' ............... b Intended use and occupancy /~ .S .-~.. t°.°' ~..~ ~ .................... 3. Nature of work (check which apphcable) New Budding ....... Addition ........ Alteration )~ Repmr .. . Removal ..... Demolition ...... Other Work. 4 Estimated Cost ..... ,.~,OOO Fee '- (to be prod on fihng th~s apphcahon) 5. If dwelling, number of dwelhng units ...... Number of dwelling units on each floor ......... If garage, number of cars .................................................... 6 If bumness, commercial or mixed occupancy, specify nature and extent of each type of use ............ 7. Dwnenmons of exmtmg structures, if any Front .......... Rear ......... Depth. Height ...... Number of Stones Dn'nenmons of same structure w~th alteratmns or additions Front ............. Rear ....... Depth .......... Height ............ Number of Stones ................... Dnuenmons of entire new constructmn Front .......... Rear ............. Depth ............ Height ........ Number of Stones 9. Size of lot Front ............... Rear ................ Depth .................... 10. Date of Purchase ..................... Name of Former Owner ....................... 1 1 Zone or use d~stnct in which premises are situated .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation ......................... 13 WflI lot be regraded .................. Will excess fill be removed from premises' Yes N 14. Name of Owner of premises ................ Address .............. Phone No ............ Name of Architect .................... Address ............. Phone No ........... Name of Contractor ..................... Address ................ Phone No ........... 15. Is this property located wzthin 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permzt may be required. PLOT DIAGRAM Locate clearly and dlshnctly all buddings, whether existing or proposed, and. indicate all set-back danenmons fro property hnes. Give street and block number or descnphon accordmg to deed, and show street names and indicate wheth interior or corner lot. OCCUPANCY OR USE IS_ UNLAWFUL WilHOUI CERIIFICAIE OF OCCUPANCY ?ROVEO FEE ~'~ NOTI~ ~UI~NG uEPA~M~ FOLJ OW,NG iN~C~ONS' 2 ROUG~ ~RAMING ~ ~UMBING 3. tNSULArlOr; ~, FINAL CoN.RUCTION ~ COMmiE FOR C O ALt CONSTRUCTION S~[ MEET TH~ MEQUI~MENTS ~A~ CONS~U~ION & ~ERGY cOD~ NOT ~LE m~IGN OR CqNS~ON ~RRORS STATE OF NEW YORK, S S COUNTY OF.. · .]'~.0. Ad (d/1,(. O. '~-' '.' '~'a~' ~.F C~' T T- ...... being duly sworn, deposes and says that he m the apphc (Name of individual sigmng contract) above named. He is the 0 0~. k/..~...~ ........................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and m duly authonzed to perform or have performed the said work and to make and file , apphcatmn, that ail statements contained m this apphcation are true to the best of his knowledge and belief, and that work wdl be performed in the manner set forth m the application filed therewith. Sworn to before me this Notary Public, ~ ..... day of .... ~ ........ ,19.ff.~. ~. ~:..,~)..L~'~,...((. .... County ,.~"' ' (~lgnature of applim