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Home My WebLink About14954-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. z14~37 Date .,. ?.u.¥.u.s.~..2.~. j ................. ,19e.~.. deck addition THIS CERTIFIES that the building ................................................ ; ty ~P ~¥[~f~Pi~ Lane' Cutchogue, N.Y. Location of Proper House No. Street Ham~ County Tax Map No. 1000 Section 1 ? ? .... Block 07 . .Lot 6.3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 14.95. q z M.aT..2.8., ............... 19.8.6. pursuant to which Building Permit No ................... dated..........June 7 . ............ 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 i~ ......... The certificate is issued to .......... .J.a.m.e.s.. ?....&.. p.a. ph..n.e..H, qF.tp.n' .................... (owner, le,ss~aa~lx of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N/g UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 FORM NO. 0 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 AUTHORIZED) ~77 14954 Z Permission is hereby granted to: ~..~.....~...¢..~ ............... ...~..~~,.....~.:..ff.,....L<..~...~.~ . ro ~ ~ ' ~o ' ~.~m.~ ...... ~....~.~ ............... ~.....=~ ................... ............................................................ ................ ~o~ ~; ~~ ~o. moo ~,,o~ ...... L~.~ ....... ~t~ ..... ~ ......... ~o, ~o.....~...........~ .... '~ Fee $.~.....,"...'~,.. ........ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 AU$ 2 1 1986 ' - FJLgG. [.~EPL APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~I 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 app~cable. 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 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 buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ............. Old or Pre-existing Building $15.00 /~te,..'.~?. ~...~./. ~ .4~..~. ......... ........... Vacant Land ............ Location of Property ~.~..~. .............. .~y.~r..~...~.~,.~..~.~¢.~. ~/./~.~..~. ............ ~?. ~.,~.~. ~...~.~' House No. Street Ham/et Owner or Owners of Property ............................................. CountyTax Map No. 1000Section . /~ ~' Block ~"7 Lot, ,.~,.,...~.~, Subdivision ................................. Filed Map No ........... Lot No .............. · . . Permit NO ~fCY..~ate of Permit ¢...7. ~.App,icant .................... ~ .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Bequest for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. Construction on above described building and permit meets ~11 applicable codes and regulations. Applicant. ~/~..~..-~/~~~.. ................. Rev. 10-10-78 3 ol c0% FiE~D ~NSFECTtON FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION ?ER N. Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: o~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved...~.,IM-"/D~..~...., 19 ~{~. Permit No..~.~..~.~..7~ ..~. Disapproved a/c ..................................... Received ........... , 1 9 · . · t 77 (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 punic 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 inspections, n g>. ............. (Signatur.e of applicant, 6r r~me, if a cprp.oration) Ntane of owner of premises..~. ~ ~:~.~~~. ~ ....... 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 ...................... 1. Location of land on :rich proposed work will be do. ne...,.~ ............................................. ...................... ~treet Hamlet ~ House Number County Tax Map No. 1000 Section .../. ~.~ ........... Block '7 Lot ~/~ ~ Subdivision ..................................... Filed Map No ............... 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 ~~.~..~..~ .......................... I 3. Nature of work (check which applicable): New Building .......... Addition ......... Alteratiofl ......... Repair .............. Removal .............. Demolition .............. Other Work.. ,~ .......... escription) F 4 Estimated Cost .................... ee ... (to be paid on filing this application) 5. If dwelimg, number of dweiling units ............... Number o f dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each tyEe of use 7. D~menmons of existing structures if any: Front ..... ~.~ ....... Rear ....~..~..: ....... Depth . .~;~'..~. ......... · ~d r N mb fSt ties'.. ~ ' Height .............. u er o o .' ....................... , ..... Dimensions Of same structure with alterations or additions: Front ..... ~4/ / i Rear ~ 4~.' Depth. ...... . '7../.t. . . . Height. ;~).'. ,~ ...... Number/ c of'~tories. Tv. ........ ,, ......... . 8. Dnnenmons ofentlro.new construction: Front .~.~'~ .......... Rear ... ~.. .......... Depth ;~'~. ........... Height a~[~,. , . ~. ...... Number of Stones.. ,~7~. '~ .... i ..... 9. Size of lot: Front . .[~..;tr.C .............. R~'ar..J.'~,9,/.g~ ........... D_oepth ..~...~.~.r. ~'. ~. ........... 10. Date of Purchase .. i ............. ./.~. ~.'~ .......Name~of Foe.._meg Owner .~. ~ ............ 11. Zone or use district in which premises are situated ~ ~... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ...................... 13. Will lot be regraded . .~'tx~T. ..................... Will excess fill be removed from premises: Yes 14. Name o'f Owner o£premises~Ja~,~.. ~... Address .~... i'" Phone No.?.~.~..--.~'~.~.... Name of Architect ..................... n ...... Address ............... ~... Phone No ............. ~... Name of Contractor ~,~O~ ~[.,~,~. Address. ~[... Phone No..~J~. · .-.~..~'.~.'.,~-.. 15. Is this property located within~L00- feet of a tidal wetland? * Yes ..... No ~ ~ If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM I Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and sho~ street names and indicate whether interior or corner lot. o*~16 c.C.., STATE OFNEW~'ORK, , , COUNTY OF ..-~~.... S.S .......... m... (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the .... G ~..0 ~- (Contractor, agent, corporate officer, etc.) of said owner or owners, aad 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 of his jknowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this, C~. ~. · .~. ......... day of....c/7~,fl.c,o~.'. .......... 19 ., :: ........... ~d.~ ~ (Signat~ ~ tm~-~+ure ofapplic~t) ~. 4~2~63, 8u~k ~u~ : Term Expires ~cem~r 31, 10~