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Home My WebLink About14670-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icate O[ Occupancy Date August 5 19.8.6 THIS CERTIFIES that the building ....a.d.d.~ .L .~ ?.n. ................................... roperty 103 Country Club Drive Cutchogue, N.Y. Location of P hS[~s~ ~o~ ....................... 'S't/a31 .................. Hamlet County Tax Map No. 1000 Section 109 .Block 03. .Lot 2.27 ............................... Filed Map No.6.7.3.6. .... Lot No. 6 Subdivisionlq/o Country Club gsts. . ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...5.~?.c.~...~.~., ......... 19 8..6. pursuant to which Building Permit No..3.6.6.. 7.0.z .............. dated . Iqa r c h 1 9, 19 $ 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 ......... addition to existing one family dwelling The certificate is issued to F r ~ n k C o s t a r i n (owner, of the aforesaid building. Suffolk County Department of Health Approval ....... .N/.~ ............................... N760976 UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 FOR~ NO. l~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOt. D, ~1. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~.o 14670 Z Permission is hereb), granted to: ~.~....~....~.~......~~.'..~.. ..a*..~.~......~.~..-~.,.~...~.....: ...... ~.., ............. ...~,~.-....~ :..'l.;....L!..~..~.~ ......... ~. ,o ....... ot premises loced ot .~...~.0..~1..~}l ~...u ~..~..~...l.~.~.......~..~...~...~...~.~..,.....~o County Tox Mop No. ]000 Section ..... )....~...~.. ......... Block ...... ..O.....~... ....... Lot No.....~.:...~....~ ....... pursuont to opplicotion doted ...... ~...q~....~...k~.. ................ , 19..a°.~, ond opproved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~ 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 sifnilar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Su bm it Plan n lng Board app reval of comp leted site p lan requ irements where app l icable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~l~perty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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: 1. Certificate of occupancy $5.00 2. Certificate of ~ccupancy 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 ........................ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ............................................................... House No, Street Ham/et Owner or Owners of Property . . .~'V~....~. , .C_~...~...~2~-5[~. ~, ,u~0 County Tax Map No. 1000 Section ...k~...~ ......... Block ...0.,~ .......... Lot...~.::..'?~. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..[.?.~.?.0.'.~? Date of Permit ...l~.,~.v. !~,...Applicant., .~C/~4~.I~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .... 1'~,;'~ ............ Construction on above described building and permi~l meets, all a/p~lic/~ble cqdes and regulations. Rev. 10-10-78 1OOlOe3 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~[[].~ ~,~ ~[~6 85 JOHN STREETtNEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment ~ ~scrlbed be~w a~ introduced by the applicant ~med on the above application number iR the prem~es ~f ~ ~st~rf~k 16 ~untry ~ub ~ve ~ ~ella, ~o~e, in the foHowlng location; .. ~ ~,~ ~ Ist FI. ~ 2nd Fl. Section Bl~k Lot was exatnined on d~.ty ~ [ ~ [}Y~ and,found to be in contplian 'e with the reqa rements qf tbis Board. FIXTURE OUTLETS I ~ FIXTURES SWITCHES NCANDE ENT FLUORESCENT 2 ]3 6 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E Electirc P~om Heaters: 1-1.51~v, 4-0651~v ! Gemy Doroski 42~ ~3onsell Lane CuteDo~ze.~ N.Y. 1].935 [&c. 29,~AE GENERAL MANAGER 11 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY_ FOR BUILDING~ DEPARTMENT. THiS COPY OF CERT F CATE MUSE NOT BE A~TERED IN ANY MANNER. F1ELD INSI~ECTION COMMENTS FOUNDATION {1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINd C~ 0 ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ;ZND [ ] INSULATION ~'/~FRAMING [ ] FINAL REMARKS: ..... (~-~/~' DATE /~//~/~/ iNSPECTOR./e~?~)~r3, 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [] FOUNDATION 2ND ~ ~.~IJLATION []FRAMING [P/] FINAL REMARKS: ....... ~),~ 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION AND ~.~I/INSULATION INSPECTOR'~~, CLUB Lo; .5 Examined...~¢4w ;-~ )..~. Approved · . .N~.~..~.[.%. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 ., ., Pe it No.! ?. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG DEPT TOWN OF SOUTHOLD Received ........... ,19... a. This application must be completely fiBed in by Wpewriter 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 ~t 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 f9%~moval or demglition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildi~/g:/6de, housing c.~o~d r~gulations, and to admit authorized inspectors on premises and in building for necessa,~ c~s. ¢ ~ 'N? .~ ;' ': · · · (Signature/6f gppdcant, or na e, it a o p ' ~ .. (] ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises .. ]~..~...~..~...~ ..... .~(]~~'~ .I.~....~..~ .~.. ~) .................................. (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... /.tZ~.! ~...'~...~. ..... Plumber's License No ......................... Electrician s License No ........... Other Trade's License No ...................... 1. Location of land on which proposed wg.[k will be done...~..~..~.....~.(~ .~t~... ~J/~... 52 ........... House Number Street Hamlet County Tax Map No. 1000 Section .... 1 .O..~. ......... Block ...... .~. .......... Lot .... ~--.,..~. 7 ....... 1 Subdivision .~(25L~...~. ~..t~.~.. ¢~.~..~ .~. ~ 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 . .~.~Y.~'~...~...0~ ............................................ b. Intended use and occupancy ...~. · *.~-..k.x~ .~.....~.....,-~......Q~.. ............................... 3. Nature of work (check which applicable): New Building .......... Addition ......... Alteratic ........ Repair .............. Removal .............. Demolition ............... Other Work ............. 4. Estimated Cost . .. Fee ............................. ' (to be ,~aid on filing this application) ....... 's o ch floor 5. If dwelling, number of dwelling units.. · I .... Number of dwelling uni~ nea ................ If garage, number of cars ............................................ i ............................ 6. If business, commercial or mixed occupancy specify "~*,,re and extent of eachty~e of use ............ 7. Dimensions of ex, jstingstructures, ifany: Front .... .,.c~.~. ...... Rear ..~'.~...~. ...... Depth .~..~. Height .... !.&...~.F. ....Number of Stories ..... [ ...................... i ............. ii Dimensions of same structure with alterations or additions: Front ....~ .0 .c~ .... i ..... Rear .. [ ~..~ ........... Depth . Height ~, ~t Numlzerof Starie~ .............. -'-8. Dimensions of entire new construction Front . L~'~ ~ ?.~ .... Rear ... t; .~..!..-'...,~. Depth ......... Height .... ~.~..~. ..... Number of Stories ..... ! ..................... ! ....... 9. Sizeoflot:Front...~.0.5....~.~ ....... Rear..c:f...~.~ .............. :Depth .iilg~.iiiiiiiiiiiill 10. Date of Purchase .................... , ......... Name of Former Owner .i ............................ 1 1. Zone or use district in which premises are situated ......................... ! ............................ 12. Does proposed constructio,~2r~Violate any zoning law, ordinance or regulation: .... j ................ ~ .......... 13. Will lot be regraded .... ~ ....... A' ........... Will exce~ss fill be removed from premises: ~e~ No 1 4. Name of Owner of premises .¥~-~ . .'¢o~3'~.~. Address . .~.~ ........ i .... Phone No..~.~;.fltT~(~ .~.-~,-~.. Name of Architect ............................ Address ............... i .... Phone No. Name of Contractor . [:ll~.v~ .~.. h~C~{~ .~"..~N~t:. Address 41,OB.~..lq0ta~:~,! .... Phone No ................ PLOT DIAGRAM 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. STATE OF NEW YORK, S.S co r_¥ OF .... /'t ........... ·..."~. ~......M'f~--C~...1 .......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above name~ He is the ~~0_~...~.. _ , (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to perform or have performed the shid 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 ....... ' · ..~.. ............ day of....~..)~'~,}:[ ........ 19 .~.~ (~ . ./ ,i 4 , , · :.,, d ¸,I