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Home My WebLink About14915-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20980 Date AUGUST 27~ 1992 THIS CERTIFIES that the building ADDITION Location of Property. 2725 SKUNK LA & 55 LESLIE RD. CUTCHOGUE~ N.Y House No. Street Hamlet County Tax Map No. 1000 Section 97 Block 4 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 16~ 1986 pursuant to which Building Permit No. 14915-Z dated MAY 29~ 1986 was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is ADDITION & DECK ADDITION TO EXISTING ONE FAMILY DWRLLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. WILLIA~ & JUDITH WURTZ (owners) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-0960057 - OCTOBER 5~ 1989 PLUMBERS CERTIFICATION DATED AUGUST 28, 1992 - WILL/AM WURTZ Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTFtORIZED) N°. 14915 Date Permission is herebt granted to: ..... ~~.~.....~.?~::...u..~..~~. ~ . ,o .~....~.....~~..~...,....~.~....~.;.~.~ ..... ~, ~,~, ,~,~ ~, .~.~,....~.~.~..~...~...~......~~ co.nv ~o~ Mop ~o, iaaa Se~,,on ...... C~..q ....... B,~k ..... .~..~ ......... ~ot No....L~. .............. pursuant tO application dat~ ...... ...~.~...)..~ ............. , 19~.~., and approv~ by the Building Inspector. Building Inspector Rev. 6/30/80 Form No. 6 ~ ' TOWN OF SOUTHOLD BUILDING DEPARTMENT ~'-~'~PPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation f[om Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2il0 of 1% lead. 5. Commercial building, industrial building, multiple residences an*d similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. . 6. Submit Planning Board Approval of completed site plan requirements.' For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1. .Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and'a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 · 4. .Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..¥ '!ew Construction ........... Old Or Pre-existing Building ..... Location of Prooertv:...~.?.~f>... 5~ ~ ~) ........................ ~, ~. "' House No. Street ~ Hamlet )nwer o~ Owners of Proper ......................................................... ...... .......... ..... ............ ;uhdiv~sion ' · ' Filed Map Lot ...... ..... ........... ~lann~ng goard Approval ........... ~ ........... :~quese for: Temporary CertSf~cate ........ Final CertScate,., '~ s~od: ,... ~..:.. /~~ . ~<. ~q~ ~z . .. . ............. Co~o~o .. .. ~'"." TOWN OF SOUTtIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. / ~/.3 Owner~ ~///~//~/ ~/ (please print) (please print) I certify that the solder used in the water supply system COntains less than 2/10 of 1%' lead. NOtary Public, County Notary Public 'CLAIRE L GLEW Notary Public, State of New York NO, 4879505 Qualified in Suffolk Cou~ ~'~ Commission E~pires Dec, ember 8,15~,,., 7GS-~.802 BUILDING DEPT. INSPECTION FOUNDATION ZST £ ] ROUGH PLBG. FOUNDATION ;ZND [~J~NSULATION [ ] FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION DATE INSPECTOR 7GS.'1802 BUILDING DEPT, INSPECTION FOUNDATION FRAMING []FOUNDATION ~.ST [] ROUGH PLBG. ZND [ ]INSULATION []FINAL REMARKS: , /'0 DATE P.O. BO~ 602 I,IC,ff1227 This certifleate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors ma~e'~i'de~tlfled by their credentials, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FIELD INSPECTION FOUNDA ) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL COi~MENTS ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [~, ] ~./TION FRAMING / ~[-~,INAL REMARKS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ,19 ¢. _ Examined Approved ..~.c~ .... ~ .., 19~{q. mermitNo.?..q/.~.!.~...'~ Disapproved a/c ..................................... ................................. ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. TNs 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 appliqation may not be commenced before issuance of Building Permit. d Upon approval of this appllcatipn~ 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 co~e, housin~-~Mq~k~ regulations, and to admit authorized inspectors on premises and in building for necessary inspectionpf..~ (Signature of applicant, o}/nfi~fie, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... [/:T.m .....~.~. '. ............ .'~.. ~ .~././7/~....'~.%. ~..M.g~.~..~z ......... (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 Nol ..................... ~S~t~O//~ ~//) Location of land on which proposed work will be done. ~..~..~.. ff~./~. ~/.~..~-..5.~./?~...~.e ,.~t. ?..~t:~. ) ..... .............................. Z// f .......... ..................................... /0. House Number Street Hamlet County Tax Map No. 1000 Section ... q.7...~'~ ........ Block ..... .0/.. .......... Lot.../~. ~ ........... Subdivision ..................................... Filed Map No ................ Lot .... : .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Ifitended us~ and occupancy'.'. ~,/.~'....~..~..~..~ ............................... '. '.": ..... - .......... '3. Nature of wor,k. (check which applicable): New Building ' Addition , j " ~Mieration ~, Repair ...... '.- ....... Removal .............. Demolition ..... ,. ....i · · · Other Work-. .............. ~ (Description) ~0 oo0 . 4. Estimated Cost ...................................... Fee ......... ~ .............. ' (to beI paid on filing this application) 5. If dwelling, number of dwelling units .......... /. .... Number'~)f dwelling units on each floor ....... i ......... If garage, number of cars ' ;~-... ................................ , ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..: .................. 7. Dimensions of existing structures, if any: Front .... .~.~.,.,¢...4.-.Rear ~,~ '~,~ Depth Height ,~,~ ,-o" Number of Stories ~---' ' Dimensions of same structure with alterations or additions: Front .,~.,8. :~.e. ~... i · · · Rear . ,,~...~. ..... Depth ........ 4f.~. :¢ .......... Height .... ./.E r ¢.'~. ............Number of Stories . ...... · 8. Dimensions of entire new construction: Front ............... Rear ....... J ....... Depth Height ............... Num,,b, er of Stories ........................... i ............... 10. Date of Purchase ............................. Name of Former Owner i ............................ 11. Zone or use district in which premises are situated ........................ i ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ¢~, .0. .......................... 13. Will lot be regraded ....... ~;;';'l'/>,'~'~:', ........ Will ex,.cess fil! be r%m,o,v~d from premises: yest~ No Name of Contractor .......................... Address .................. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, i He is the ............................................................. i ............................ (Contractor, agent, corporate officer, etc.i 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 ail statements contained in this application are true to the best of hi~ knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this of. ./ NOTARY PUU , /" - No §~'4311~0 SMfolk Countl'~ Commission Expires March,~y OCcU?ANC¥ OR suPPLY sYSTEM cANNOT' EXcEED2/10of1%LEAD' FEE ~ kO B¥~ ~ C.£~ NOTIFY BUILDING DEPARTM~T AT 7S5-1802 9 AM TO 4 PM FOR THE FO~OWING INSPEC~ONS: USE IS U~UL "~'~ ~ ~ , ~.~,o. ~o.~,.~ ~ ~ di~lb~n~ FOR POURED CONCREYE ~ ~a ~ ~, INSULATION 4, FINAL CONSTRUCTION MUST BE COMPETE FOR C,O. ON LEAD CONTENT SEFORE THE REQUIREMENTS OF THE N.Y ~ATE CONSTRUCTION & ENERGY CERTIFICATE OF OCCUPANCY CODES. NOT RES~NStaLE FOR ~IGN OR ~NSTRUCT{O~, ~RRORS, II Ph~ /~{ 6g- GREEN.PORT, N:¥. 1.1'944 ~0' 0~ r,4r J'l !l