HomeMy WebLinkAbout15075-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z16629 Date Feb. 2, 1988
THIS CERTIFIES that the building ., .A..d.d.i.r.i. 9.n ....................................
Location of Property 33780 Main Road Cutchogue
House No. Street Hamle'~
County Tax Map No. 1000 Sectiou 097 .Block ... 9.2 .......... Lot 12. 1
XX XX XX
Subdivision ............................... Filed Map No .......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... J..u..1 .y..8. ,...1.9.8. 6.... pursuant to which Building Permit No...1.5.0,7. .5 ,Z .............
dated . .J.u.l.y..1.0.,.. ! .9.8.6. ............ 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 .ad O.i.t. io.n..t. 9..a.n..e..x.i,s.r./..ng..d.w..e.l.l.in.. g.. ...............................
The certificate is issued to JAME,S H, & KAREN F. WYCHE
.................... .....................
of the aforesaid building.
Suffolk County Department of Health Approval I'I/A
UNDERWRITERS CERTIFICATE NO... lq/A
PLUMBERS CERTIFICATION DATED: N/A
Building Inspector
Rev. 1/81
· OJB,~ NO. B
TOW*N OF $OUTHOLD
BUILDING DEPARTN~ENT
TOWN HALL
SOUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PER.MiT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15075
Z
Permission is hereby granted to;
..~..o....~ ...... ~..~..~ ...................................
..~.~.~.%..~...~.,..~.~......~.t..ql.~
,o .... .Co.~..~.~..~..Q.c..~.. ~L~../~....~.-~z~....~.o.~ ...~.~-.~..,~.O. ..........
....... ~........~ ........ ~..~..~ ........... ~.x./..~ ........ ~ ............................................................
at premises located at ......... ..~.....~....~.,.~- ......... ~T~....~. L~......~'~.~"~ ...............................
................................................................... , .......
County Tax Map No. 1000 Section ...~.....~.....~.. ..... Block O ~ Lot No...C~..L..~...' I
pursuant ,o application dated ..... .~.~.~.~,..~............~.. ................. , 1~.,.~., and approved by the
Building Inspector.
Building Ir~pector
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ,- ~ to the Building In~ec-
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 applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre.existing"
land uses:
1. Accurate survey of ptToperty 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.
C. Fees: Additions $25.00 POOLS $25.00
1. Certificateofpccupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00
2. Certificate of occupancy on pre-ex isting dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00 '1 l'~''~'
5.Upd~,ted C.O. $ 50.00 Date. ) ?.
New C o~. ~ b t~ u c t i on ......Old or Pre-existing Building ............ Vacant Land .............
Location of Property .............................. ; ..............
Nouse No. Street Ham/et
Owner or Owners of Proper,y ' .... ,...
CountvTax Map No. lO00Section ,....,~,.?, ...... t~lock .. ~ ......... Lot...!..~.i
Subdivision ................................ Filed Map No. , .Lot No,
Perm tNo. Pe · .LO o ...........
ateo, rmit .1 . . . 1~.. ~,Appllcant .... . .~. J'~....~,~ .
Health Dept App.'oval ' Labor Dept Approval
Underwriters Approval ........................ Planning Board Approval ......................
Request .... Final Certificate
for ~ emporary Certificate ............................................
Fee Submitted $..~...~. ~..O..(~. .................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant...'~..~.. ~ .........................
R~. 10-10-78
FIELD INSPECTION
1.
FOUNDATION
FOUNDATION
2.
(2nd)
ROUGH
FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
ADDITIONAL COMMENTS:
BUILDING DEPT.
INSPECTION
[] FOUND~I~T [] ROUGH PLBG.
[ If ~i~ATION 2ND [ ]INSULATION
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved..'7.il ..(~. ....... ,1 .9~.. Permit No. t.~.O.."7. ~-~ ~
Bisapproved a/c .....................................
....~.
(Bmldmg Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
8LDG, DEPT.
TOWN OF SOUTHOLD,
Received ........... ,19...
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 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 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 ~ 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, ordinanc~er,~building code, ]dOUSing code, and regulations, and to
admit authorized inspectors on premises and in building for neces~,~/n/;pections~/~~ ~~
State whether applicant is_owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized 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 ..................................................
f~;~e' ~'l~;r .............. "' Street .......... Hamle; '-- ......................
County Tax Map No. 1000 Section .. ~.~.. Block ...... ~ Lot
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
~/..~. ~.~ 1/~ .~0~. ................ :~j~ ,,~...,.. ~ ¥,., ....................
a. Existing use and occupancy .... ~.C[.. .~...
b Intended use and occupancy .S.~b.,f,~.~.. ~'C.! .'"?h ~)~.C~....¢.;~.~.~;2:4'.:..,..' ..............
3. Nature of work (check ' ~ ' ' ~..
which apphcable): New Building ...... Addition ...... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
(Description)
4. Estimatea'Co}~t ................................ Fee ...
' (to be paid on filing this application)
5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................
If garage number of cars '
6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ..............
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ............ . ............................................
Dimensions'of same structure with alterations or additions: Front Rear
Depth , Height Number of Stories
Dimensions of entire new construction: Front .......... ~... Rear ' Depth
Height ............... Number of Stories ........................................................
Size of lot: FrOnt · ~ ·. Rear.. . ' Depth
[)ate of Purchase j Name of Former Owner
Zone or use district in which pr&mises are situated ......................................................
Does proposed construction violate any zoning law, ordinance or regulation: ...................... ; .........
Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No
fp
Name of Owner o remises .................... Address ................... Phone No ................
Name of Architect .......... ................. Address ................... Phone No ................
Name of Contractor . Address
....................... Phone No
15. Is this property located iwithin 300 feet of a tidal wetland? *Yes ..... No .....
· If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM ~.-
Locate clearly and distinctly alli 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 show street names and indicate whether,
interior or corner lot.
10.
11.
12.
13.
14.
STATE OF NEW YORK,
COUNTY OF ................. $.S
................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signihg contract)
above aamed. 1
He is the
.' (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manneriset forth in the application filed therewith.
Sworn to.before me this
· ~' . .day of'. ~ ........... ' 19'~'~' /
~ti RMv- ~?Po/O' pog7
DV[R ~1~ VtE~
2Ol ¢¢
./~tF~RO/VED AS ,NOTED
FOLLOW
1. FoUN -
FOR pOURED CONCRETE
~, ROUGH - FRAMING & pLUtC. BING
~ ' ~0~
OP~
8CCU?~I~CY OR
§F OCCiJNi',ICY
(o,'16r~0c77~, N~r7- i~
~ 47v1~,/ llou~e)
.4R£A 'TO 7E LINE
· tRE4 O? 4EAO0
I. YZJ Ac.
0.73 §
2.661 Ac.
/,/IF
TOWN O,C' $OUTHOLD
SUFFOLK COUNTY
NEW yORK
5 75: 3°"-O0"E
SurVege,t by
,SCALE: t'=40'