HomeMy WebLinkAbout15190-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No Z14823 Date .August 21 .,1986
THIS CERTIFIES that the bmlding ... De, ck. . ................................. .
Location of Property .....6.4.5 S. 9....C.R..O.S.S.R. 9.A?. ......... CUTCHOGUE,N.Y.
i~ouse No Street Hamlet
County Tax Map No. 1000 Section . 1.1.0. .... Block ...5 ............ Lot . ...2.7. ...........
Subdivision ........................... Filed Map No ......... Lot No ..............
conforms substantially to the Apphcahon for Building Permit heretofore filed in this office dated
.Hgy..2.7. ............. , 19 ~.6. pursuant to which Bmldmg Permit No...1.5.1..9 p.Z. ............
dated ...A~q....~ 0 ................. 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 .........
.Deck .~dd/~.t~ov..t,q ~cj~t~g..Qn.e.f..am.il~..d.we.ll..zng.. ................ -~ .......
The certificate is issued to INEZ D. MORRISON
of the aforesaid building.
Suffolk County Department of Health Approval ......... N/A ...........................
N/A
UNDERWRITERS CERTIFICATE NO ...............................................
R~v 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING P EP~,~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15190
Permission Js hereby granted to
............... ' .P..,.~. . /.Y.~. .z ~. ,,~... ....
.....................................
County Tax Map No 1000 Sect,on /./ ~.. ..... Block ...~ ........ Lot No ..~... ~ ....
pursuant to a pphcahon dated .~'~ ~ W .... , 19.~, and approved by the
Building Inspector
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
A. Th~s application must be filled ~n typewriter OR ink, and submitted ~ ~ to the Building Inspec-
tor w~th the following; for new buddings or new use'
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natu raj or topograph[c featu res.
2. Final approval of Health Dept of water supply and sewerage d~sposal-(S-9 form or equal)
3. Approval of electrical installation from Board of F~re Underwriters.
4. Commercml buddings, Industrial buddings, Multiple Remdences and simdar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responmble for the building.
5. Submit Planning Board approval of completed rote plan requirements where applicable.
For ex~st~ng buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting"
land uses'
1 Accurate survey of property 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 buildings.
3. Date of any housing code or safety ~nspect~on of buddings or premises, or other pertinent informa-
tion required to prepare a certificate.
C Fees'
1 Cerbflcate of occupancy $5 00
2 Certificate of occupancy on pre-ex~stmg dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
4.Va~cantdLand C.O. $5.00 ~-/-- --.
5.U. date C/ $15.00 Date.../..~.~/. ~..~. .......
Hou~ No. Strut ~ -- ' ' Hamlet~
Owner or Owners of Prope,y ..~~.~..~~ ................
.. 1. ....... ......... .....
Subd~ws~on ................ F~led Map No ......... Lot No ..........
Permit No .......... Date of Permit ....... Apphcant .................................
Health Dept. Approval ..................... Labor Dept. Approval .......................
Underwriters Approval ...................... Planmng Board Approval ......................
Request for Temporar)/Cert~hcate ................... Final Certihcate ..... ~. .........
Fee Submitted $..'~.~/~,~ .,.~. ~. ...............
Constructlo n o n above desc rlbed bu ildln~~ ~~/bl_,Le.~,~?es~,gu lations.
Appl ca~ ~ ~ ~ ~% ~ ~ ~ ~ ~ ...............
R~ 10 10-78
,t
765-1~
BUILDING DEPT.
INSPECTION
FO/~NDATION XST [ ]ROUGH PLBG.
]/~OUNDATION ZND [ ]INSULATION
FRAMING [ ]FINAL
REMARKS:
DATE
FORM NO 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
£OUTHOLD, N Y 11971
TEL 765-180:3
., i4 Pe t No. /
.... TOWN OF ~OU'T~OLD
Rece3. ved ........... ,19..
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date~a~ 7 · , 19~t~
a Tins application must be completely filled m by typewriter or in ink and submitted to the Budding 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, relationship to adjoining premises or public stre~
or areas, and giving a detailed descnphon of layout of property must be drawn on the diagram which is part of this app
cation.
c. The work covered by tins apphcatlon may not be commenced before issuance of Building Permit
d. Upon approval of this application, the Building Inspector will issued a Budding Permit to the applicant Such pern
shall be kept on the premises avadable for mspechon throughout the work
e. No budding shall be occupied or used in whole or in part for any purpose ,whatever until a Certificate of Occupan,
shall have been granted by the Bmlding Inspector ' ~
APPLICATION IS HEREBY MADE to the Bmldmg Department fot. the ~s-'snl~c~ of'q~'~t~ ~l~lih~ ~Omr~it'p~rsuant to t
Smldlng Zone Ordinance of the Town of Southold, Suffolk County~,i~l.~//~Or.~~ a~a~[ o~ther_~ptJhLab]~e%[,~!vv~, Ordmances
Regulations, for the construction of buddings, additions or alteratl6j~s~o~fol;_r~m~(~l 9~c.-do. naokta*¥~s hereto describe
The applicant agrees to comply with all apphcable laws, ordmanceg ~lj~lr!kng[~_de[ ~b~n~r~ regulations, and
admit authorized inspectors on premises and m buddmg for necessarv~/[~l~ca['~lo~l~ ~ "j' - '
rporat~on)
State whether applicant is owner, lessee, agent, architect, en~neet,
general contractor, electrician, plumber or bmldc
Name of owner of premises '-~blS Z- D~ fi40/'~ [~ [50 ~ ....
(as on the tax roll or latest deed)
If apphcant ~s a corporatmn, signature of duly authorized officer
(Name and t~tle 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
b frS- .c/e -ss
House Number Street
County Tax Map No 1000 Section [ /t
Hamlet
lock 37
Subd~vis~on Fded Map No Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of p, roposed construction
b Intended use and occupancy .~ ..........
3 Nature of work (check which applicable) New Budding
Repmr . . Removal ..... Demohhon ~
5 If dwelling, number of dwelling units.
If garage, number of cars ..
Addition ./," . . Alteration ...
..... Other Work ......
~/. (Description)
.... Fee.. ~.~.~..~. ~. ............
(to be paid on filing th~s apphcatlon)
..... Number of dwelling umts on each floor ...........
6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .............
7 Dunenmons of existing structures, if any Front .... Rear ......... Depth ...........
Height ........ Number of Stones ..........................
Dwaenmons of same structure w~th alterations or additions Front ..... Rear ........
Depth ...... Height .... Number of Stones ...............
8. Dunenmons of entire new construction Front . ./q.~ / ..... Rear ./.~ .Q .. Depth .../~2./...
Height 5/9 ,t ..... Number of Stones ............................
9. Size of lot Front ....... Rear .............. Depth
10 Date of Purchase .......... Name of Former Owner ....................
1 1 Zone or use district in which premmes are mtuated ....
12 Does proposed construction wolate any zoning law, ordinance or regulahon .......................
13. Will lot be regraded .............. Wtll excess fill be removed from premises' Yes No
14 Name of Owner of premises ......... Address ............. Phone No ......
Name of Architect ........... Address ......... Phone No ..........
Name of Contractor ............ Address ........... Phone No ..........
15. Is thzs property located wzthinl00 feet of a t~dal wetland? * Yes ..... No
· If yes, Southold Town Trustees Permit may be required.
PLOT D1AG RA~
Locate clearly and distinctly all buddings, whether existing or proposed, and, indicate all set-back d~rnenmons from
property lmes Give street and block number or descnphon according to deed, and show street names and mdmate whether
interior or comer lot.
APPROVED A6 NOTED
N~ ~I~iNG DEPARTM~T AT
7~1~2 9 A~ TO 4 ~ ~R THE
~LOWING I~C~ONS:
~UNDA~ON ~ REOUIRED
FOR ~ED CO~E
2 ROUGH FRAMING & ~BING
3, INSU~TION
4 ~AL CONSTRUCTION MUST
~ COMPETE FOR C 0
ALL CONSTRUCTI~ SN~.L A~rET
T~ REQUI~MENTS ~ TH~ N ~
~D~ HOT ~S~S~[[ ~g
~IGN O~ Ct~S~OA~ ~aCRS,
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
STATE OF NEW YORK,
COUNTY OF
SS
(Name of lndiwdual slgmng contract)
above named
being duly sworn, deposes and says that he is the apphcant
He ~s the .....................
..... (Contractor, agent, corporate officer, otc
of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file this
application, that all statements contained m this application are true to the best of his knowledge and belief, and that the
work will be performed ~n the manner set forth m the apphcatlon filed therewith.
Sworn to before ~ne this
...... ~ L ' day of .... ~...6¢~ ..... 19~'~
Not ublic,.
County
l~~----ff~ (Signature of applicant)