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Home My WebLink About15265-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z14878 Date Sept. 16 ..................................... 19 86. THIS CERTIFIES that the budding .... D.e.c..k ........................... 375 Alvah's Lane Location of Property ....................... _. .... Cutchogue House No. ~'treet ................... ~t~mle~ County Tax Map No 1000 Section . 109 ...... Block .... .0.1 ...... Lot ....3.3_ ........... Subdivision .................... Filed Map No ...... Lot No ............. conforms substantially to the Apphcatlon for Bmld:ng Permit heretofore filed in tlus office dated ·.. Se. pt....3:..6 ....... 19 8.6. pursuant to which Building Permit No. 152657, dated S. ep .~ .. ]:.6. ........... 19.86., was ~ssued, and conforms to all of the requirements of the applicable provlsxons of the law The occupancy for which tlus certificate is issued is ......... .... Deck .~a~t,~.%iOTt 'qQ. f~,~-~.tbnq .o~.e ~. a.m~l.~, dee]:..]-~.~~: ............... The certificate is issued to . . (owner, X~v, tYc~ of the aforesaid budding. Suffolk County Department of Health Approval . . .N./.A ........................ UNDERWRITERS CERTIFICATE NO ............... .N./.A .......................... Bmldi~f~g Inspector Rev 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, I~. Y. BUILDIHG PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No 1000 Sect,on J C~.¢J, Block .... ?...J. ..... Lot No ..... ..~.l ..... pursuant to apphcatlon dated Bu~Idlng Inspector. .... , 19~..(19., and approved by the Building Inspector Rev FORM NO. 6 TOWN OF $OUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ~nk, and submitted m~ to the Budding inspec- tor w~th the following; for new buddings or new use: 1. Final survey of property w~th accurate location of all buddings, 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 F~re Underwriters 4. Commercial buddings, Industrial buildings, Multiple Residences and s~milar buildings and installa- tions, a cert~fmate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit PIanmng Board approval of completed s~te plan requirements where applicable. For ex~stmg buildings (prior to April 1957), Non-conform~ng uses, or buildings and "pre-existing" land uses. 1. Accurate survey of p~operty showing ali property hnes, streets, buildings and unusual natural or topographic featu res. 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- tion required to prepare a cert~fmate. Fees: I. Cert~hcate of occupancy $5.00 2 Certificate of occupancy on pre-ex~st~ng dwelhng 3. Copy of certificate of occupanc~ $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 Date .... $15.00 NewConstruction ..... Old or Pre-exmt~ng Building ............ Vacant Land ............. Location of Property ............... J~L,¢ ~cF_.~ /1 House No Street Owner or Owners of Property . ~..~. ~ ~ ~,..~'~. ~, ................. County Tax Map No. 1000 Section .... I ~ Block l Lot '~ / Subdlws~on .................... Fded Map No ......... Lot No ..... Permit No ......... Date of Permit ......... Applicant .................................. Health Dept. Approval ..................... Labor Dept. Approval ........................ Underwriters Approval ..................... Planning Board Approval ...................... Request for Temporary Certificate ................... Final Cert~fmate ....................... Fee Submitted $ ........................ COMMENTS I ~=- F1ELD INSFECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ~65-X802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL REMARKS: DATE INSPECTOR [_ TOWN OF SOUTHOLD Disapproved a/c ................ FORM NO 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 (Budding Inspector) APPLICATION FOR BUILDING PERMIT Recezved ........... ,19. INSTRUCTIONS a. This apphcatlon must be completely filled m by typewriter or in mk and submitted to the Budding Inspector, wit sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of buildings on premises, relatmnshlp to adjolmng premises or pubhc str._ or areas, and gtvmg a detailed descnptmn of layout of property must be drown on the diagram which is part of tlus ap cation c. The work covered by this apphcatlon may not be commenced before issuance of Bufldmg Permit. d. Upon approval of this apphcatlon, the Bmldmg Inspector will issued a Bufldmg Permit to the apphcant Such per shall be kept on the premises avmlable for inspection throughout the work. e No budding shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Oceupa shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MA~DE to the Budding Department for the issuance of a Building Permit pursuant to Bmldlng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buddings, addihons or alterations, or for removal or demohtlon, as hereto descrit The apphcant agrees to comply with all apphcable laws, ordmances, budding code, housing code, and regulatmns, an, admit authorized inspectors on premmes and in bmldmg for necessary inspections. (S~gnature of ap~cant, or name, if a corporation) ...... ,.. ...V ...... . .. ~mai±lng address or ap~plicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or buflf Nameofownerofprem~ses ~d~. ~q~'~' ~i/~ ' ~'(/~ .................. (as on the tax roll or'latest deed) If apphcant is a corporation, s~gnature of duly authorized officer (Name and ntle of corporate officer) Builder's License No d<,omjZ/~" Plumber's License No Electrician's License No Other Trade's License No .... 1. Location of land on which proposed work wIlI be done.. House Number Street County Tax Map No 1000 Section /C~ . . ............ Hamlet Block / Lot. 2 Subdivision ...... Fded Map No .... Lot (Name) State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction a. Existing use and occupancy . b. Intended use and occupancy 3 Nature of work (check which apphcable): New Bmldmg((~ (_.~c_~./' Addition ....... Alteration . ( .... Repair ...... Removal ........ l~emohtlon ........... O~h~r Work ......... '. ~g ~d, O~ (Description) 4. Est~nated Cost .} .~<~ ~-...r~..~.+ .~ r~ ,..4_. (. ,c>. ....... Fee (to be paid on filing thru application) 5. If dwelling, number of dwelling units ........ Number of dwelhng units on each floor .............. If garage, number o f cars ................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ 7. Dimensions of exmting structures, if any Front .......... Rear ........... Depth ............ Height ..... Number of Stones ............................................. D~menmons of same structure with alterations or addltnons Front ............... Rear ............. Depth ............ Height ................. Number of Stones ................. 8. Dnnenslons of entire new construction' 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 district in which premises are situated ...................................... 12. Does proposed construction wolate any zoning law, ordinance or regulatmn ....................... 13. Will lot be regraded ..................... Will excess fill be removed from premises. Yes 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 withznt~0 feet of a tidal wetland? * Yes ..... No ..'..-~--. · If yes, Southold Town Trustees Permit may be requzred. PLOT DIAGRAM Locate clearly and distinctly all bufldmgs, whether existing or proposed, and. indicate all set-back dnuenslons fr, property hnes Give street and block number or descnpt~on accordmg to deed, and show street names and indicate whetl interior or corner lot. STATE OF NEW YORK, S S COUNTY OF... (Name~[ individual above named. · being duly sworn, deposes and says that he ~s the apphc He is the ................................... (Contractor, agent, corporate officer, etc.) of smd owner or owners, and is duly authorized to perform or have performed the smd work and to make and file apphcatlon; that all statements contmned m this application are true to the best of his knowledge and belief, and that work will be performed ~n the manner set forth m the apphcatlon filed therewith Sworn to before me this NotaryPubhc, . ~../~-...4J£.~'..S~ ..... County ........... ¢ .ff . ....... (Signa~re of apphc~