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Home My WebLink About15163-zFORM NO. 4 TOBIN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Haii Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18194 Date JULY 18, 1989 THIS CERTIFIES that the building Location of Property 11900 OREGON ROAD House No. County T~xMap No. lO00 Section 083 Subdivision Filed Map No. ADDITION TO ACCESSORY Street Block 03 CUTCHOGIIE~ Hamlet Lot 5.3 Lot No. conforms substantialiy to the Appiication for Building Permit heretofore filed in this office dated JULY 31, 19SS pursuant to which Building Permit No. 15163-Z dated AUGUST 2~ 1986 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 AROUND AN ACCESSORY INGROUND S~IN14ING POOL AB APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A AT,V.~ C. ZUHOSKIr JR. Rev. 1/81 Building Insp~tor FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. No. BUILDiHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ls~ z ~o,e ......~..~....~ ............. ,,.~' County Tax Map No. 1000 Section .....0.....~....'~... ........ Block ...... ..~.....~.. ....... Lot No..~.,...~. ........... Building Inspector. Fee $...~......' ............. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY bATE. 7 ./.C c~ ? .. NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ Location of Pro err .~-au~-~M'~-~ ~' ~ ~// ~~ P Y - . .~.~.'.~..~.~.~ .... HOUSE NO. //~0 ~ STREET HAMLET County Tax Map NO. 1000 Section .~..~.. Block ~-~ Lot' .~..'.~. Subdivision ....................... Filed Map ........ Lot .......... Health Dept. Approval .................. Underwriters Approval .............. Planning Board Approval ................ Request for Temporary Certificate .; ..... Final Certificate ................ Fee Submitted: $ ....... -.~. ,o. ......... APPLICANT-.-~-~-~~ rev. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS'. 765-1802 BUILDING DEPT, INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING ?/~INAL · REMARKS· DATE '; '~,"" ,,: · ,,-' ' ' ·FORM NO. 1 ';<~'~; ,...F, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined~.~...:~-..., 19 ~..~ Appr;ved .~.. 3.., 19~.~. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date ................... 19... 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 public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applk- 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},lk~e~.ti0~,s. (Signature ~cant(,or name, if a corporation) .... ,'~·~ ;'~ ~" ~.'?..~,:~¥ ~, ,~¥~ ~' ~'~'3,' ........... .. , ~m?mng aoaress ozapp~can~) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~"7~' '~ .... ~e'~a'x'r~'' '~ ............................ ( or atest eed) 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 ...................... Location of land on which proposed work will be done~..~.w.~...~... ~.....~~ ........ ..//. q.' . :.o. ................ ' . . .................. House Number Street Hamlet County Tax Map No. 1000 Section .................. Block ~ 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 . . . .~. ............................ 3. Nature of work (check which applicable): New Building ' Addition 'I ........ Alteration ........ Repair .............. Removal .............. Demolition .......... i' . Other Work ~...a4-2~...'(. ~.' .o~ ~[~ (Description) 4. Estimated Cost Fee ~ ............ (to bi paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling urlits on each floor ................ If garage, number of cars ........................................... I ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .... ! ..... Depth Height ............... Number of Stories ........................... i ............................. Dimensions of same structure with alterations or additions: Front .......... ~ ..... Rear .................. Depth Height Number of Stories 8 Dimensions of entire new construction: Front ' Rear ! Depth Height Number of Stories 9. Size oflot: Front ...................... Rear ................... .. ~ Depth ... ............ .. . .... 10. Date of Purchase ............................. Name of Former 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 ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address .............. i .....Phone No ................ Name of Architect Address ~ Phone No Name of Contractor .......................... Address .... : ......... ..... Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLO-T DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ ihdicate 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. D e, TE: NOTIFY FOR 2 ROUGH 4, FINAL ALL CODES V.¢,L. OEPARTMfiNT AT TO '~ PM F-OR THE NSPECTIONS: *'~/O REQUIRED CO~B~ E FRAMING a PLUMBING O~,~ MUST FOR C.O, S~L, MEET :N,Y & ENERGY OCCUPANCY OR USE IS UNLAWFUL CERTIFICATE OF 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. He is the ' (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to perform or have performed theisaid 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 manner set forth in the application filed therewith. Sworn to before me this ............. ....... ..... Notary Public, ... ~... ~.. County ~fi" ' (Signature of apphcant)