HomeMy WebLinkAbout14656-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
zj~537
THIS CERTIFIES that the building Re-cons truct A.c.c.es .s.o.roY Ga.za.b.?
350 Br,iarwood Lane Cutchogue, New York
Location of Property/f/~O$~ ~/o~ ........................................................
Street Hamle~
County Tax Map No 1000 Section 1.36 Block 0 l Lot 5. . .
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
>'.eh r u ~.r.y.. 9 .......... 19. ~ ~pursuant to which Building Permit No ..... 14. .6 .5.6 z. ..........
dated .. gq~ ¢~.. [ ~, ............... 19 .~ ~, was issued, and con~rms to afl of the requirements
of the applicable provisions of the law. The occupancy ~r w~ch this certificate is issued is .........
~b a.s. ~??!~ ~ ~-.
~e-cpp. struc.t acc.eq~or~ ~a? o o
Th rtifi i edt FRED & MARYANN CARCICH
......... ;, ~;rdexo~ :~? .....................
e ce cate s issu o ................ (owne
of the aforesaid building.
Suffolk County Department of Health Approval [q / A ........
UNDERWRITERS CERTIFICATE NO ................ ~./.A. ..............................
Rev, 1/81
FOBM NO. ~
TOWN O~ $OUTROLD
BUILDING DEI~ART/~I~I~IT
TOWN HALL
SOUTHOLD, H. Y.
BUILDING PER. J~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
14656 Z
County Tax Mop No. ]000 Section ..... )...;~;:~.,~o ...... Block ..... .~.,..! ........... Lot No ........ .~;:~,-~,, ...........
pursuant to application doted ,..,~.~.~....~. ................... , 19..~.~2-- ~nd approv~ by the
Building Inspector.
Building Inspector
Rev. 5/30/80
FORM NO, 6
TOWN OF SOUTHOLD
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 ~a ~ 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 build ngs, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the bud ng.
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 p2*operty showing all property lines, streets, buildings and unusual natural or
topograph ic 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-
lion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy
2. Certificate of occupancy on pre-existing dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O, $5.00
5 .Updated C.O. $15.00 Date .. /~ ¢{~¢;~/~. , [¥,~..~, , ,
NewCons truc tion ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . .~,,~ .... ~:),~, dlx'/~,f4/~.~/~,,. , L~.. ~/. r~.~;~.~...,
House No. ~. Street Ham/et
Owner or Owners of Property , .~ .... ,/~:../~.//~//~.,, ~ ..................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision
................................. Filed Map No ...... Lot No
f
Permit No./.~.d. ~. ¢.-~ Date o Permit ~.(..~. ~pplicant .. (~,~.. ~... ~ .........
Health Dept. Approval ..... /Q'/./~ ............. Labor Dept. Approval .... ,/K~/~, ..........
Underwriters Approval ...... ~.//¢- ............. Planning Board Approval ..... ,/~,~ ............
Request for Temporary Certificate Final Certificate
Fee Submitted $. ~.~. ;~2~. .....................
Construction on above described building an~it meets al/app~ co,es and regulations.
Rev. 10-10-78
co '1553 7
7GS-XS02
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
REMARKS:
76S-1802
BUILDING DEPT.
INSPECTION
~ FRAMING
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FINAL
REMARKS:
INSPECTOR
F~IEI,~D .INSPECTION__ COMMENTS
FOUNDATION {1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
350 BriaDwood Lane
Cutchogue, NY 11935
3 March 1986
Town Hall - Southold
P.O. Box 1179
Southold, NY 11971
Attn: Building Department
Gentlemen:
I have enclosed a notarized application and three sets of plans
of an unenclosed outdoor shelter (gazebo) of approximately 154 s.f.,
proposed for my property. The structure replaces a like structure
which was destroyed in the hurricane.
I have enclosed $25 application fee.
V~er~]t ruly yours,
F'~Fr~d
FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.~. ~, ] ~.9.~ .......... Date ..... .~ p?. J:. .1. .7 .................... 19 .8.3.
THIS CERTIFIES that the building ................................................
Location of Property . .3.5. Q..B?.%a..p.~p. qd...L.a.n.e. ........................... C.u..~.c~h~u..e...
House No. Street Hamlet
County Tax Map No. 1000 Section . J .3.6. ....... Block ....Off .......... Lot .... 0.0.5. ..........
Subdivision.. [ ............................ Filed Map No. X .Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...A. p .p 5.1. . 6. .......... , 19 8..3. pursuant to which Building Permit No .... ~. 2. .2.3.~.Z. ....... ' ....
dated .... g. p.e.5.1...7 ................ 19..~ .3, 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 .........
a gazebo accessory structure.
The certificate is issued to ........ .E.D.N. 5..~.-.. ~9.B.g. ....................................
(owner, fear, e-or
of the aforesaid building.
Suffolk County Department of Health Approval ... B./.~ ...................................
UNDERWRITERS CERTIFICATE NO ........... r~/.O ...................................
Rev. 1/81
om~
~
I I
I I
×
~AP
FR.
R,
cOt~~
OF
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1802
Examined. ~'~.o~x~.l.q..., 19 .~.~.
Approved . .'."~....O_/~..../.qT..., 19~(~. Permit No..} .~./.f .~."~...~..
Disapproved a/c .................. . ...................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. Tltis 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 whate¢er 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 i,,spectors on premises and in buildh~g for necessary~ns~
(Signature of applicant, or name, if a corporation)
..... .ow.. q.v. ..............
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ... ~:O.~(-~.. ~C~.. / .~M/W~'. ~ ....................... (as'--on the tax roll or latest deed)
If applicant isa corporation, signature of duly authorized officer. (~~
(Name and title of corporate officer)
Builder's License No ..........................
CAMILLE PRELLI
Notary P~lblic, Stale of New York
No. 31-47~,2.327 Qual. in Now York Coltnt~/
Commmoion Expiro$ March 30, 19~..~'
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
..................... ¢rrx . .........................
House Number Street Hamlet
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:
a. Existing use and occupancy ..... f~,~././~/~.~ .................................................
b. Intended use and OCCUpancy ... ~,/dL/. '~/.~..~t,~.~z~d,,.,..~t'.~---Z~ .................
3. Natme of work (check which app!icable): New B tiding .......... Addition ..
i~- Repai,r .............. Remov¢l ............ Demolition ...........
· Other
(Description)
property lines. Give street and block number or
interior or corner lot.
4. Estimated Cost .... .n'.Z'(d~,~'z~.O,, ................... Fee ....................................
' ' (to be paid on filing this application)
If dwelhng, number of dwelhng routs .............. Number_of dwelhng umts on each floor ................
If garage, number of cars ...... ,:... I'~I'~['I II'DA[~[~..¥. (~. .......................................
6, If. business, commercial or m~xed 9cctlt~l~i~/~&if~t~l~re an~'exten, t.o,f each type of use .....................
7. Dimensions of exist, ins stmctures,lif alYttti _lgntiC..~',lil~ll. A~l~[~li .....~.~..: ..... Depth .~t4~ ............
Depth .... ' . S]...Fl: ........... i. Hel~[.[ lli~tli~l..Ul~,.% I} .~.l. ~%~r~f Stories
Hexght .. '..t~..d~./(....'. N,umbeJ' ofl0~ O~l;~l~fil~l~ .'[[ i.e .......................... 1, ...........
9. Size of lot: Front ..... ff-~, .l.e~/. ....... .'l'I~ . .· · .(~ : . ~ ........... Depth .... '[~.(t~ ............
10. Date of urchase ....... I ........... Name of Former Owner ................
11. Zone or use district in which premises are situated .... ~3t/2~,,.t~'14q.,. ..................................'
12. Does proposed construction viola~e any zoning law, ordinance or regulation: .~O ............................
13. Will lot be regraded ....... ~ .N.~. ................ Will excess fill be removed from premises: Yes
14. Name of Owner of premises i~,~l¢i~6~Cz.~ ...... Address $'$'O~.~.~../~.. Phone No. ff.3['{-..7~'.~ ....
Name of Architect .......... .. !;'T .............. Address ......... .'F. ........ Phone No ................
Name of Contractor .......... i.-7. .............. Address ........ .-'7 ......... Phone No.. ~ ............
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
ation according to deed, and show street names and indicate whether
APPROVi~'D AS NOTED
c, '-- C.
785-~802 ~ A~ 1'O ~ PM FOR THE
ALL COO;O ~UC'~ON SHALL MEET
HE REOth, ~..:, ,~{:NrS OF THE N.Y
STATE CO{~)~ rRUC'rION & ENERGY
CODES. NOI RESPONSIBLE FOR
~E8I~N OR CONSTRU~ION ~8RORS.
TATE OF NEW YORK,o ~'_ .., ,.,
... ~. ~1~..~. '.~'.~'. '. .................... being duly sworn, deposes and says that he is the applicant
(Name of individual signin~ contract)
above named.
(Contractor, agent, corporate officer, etc.)
*f said owner or owners, and is duly iauthorized to perform or have performed the said work and to make and file this
~pplication; that all statements contaified in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner ~et forth in the application filed therewith.
~worn to before me this ,' ~~4..~_~.~.~
{ ., CAMILLE PRELLI
! / ~ ] Commission Expires March 30, 19,0~.?'