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Home My WebLink About14404-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NO. ~1.5.1.3.7 ' Date December 29, 19 .8.6 THIS CERTIFIES that the building .Acl4it. iqr~ ' Locati of Prop rty I980. B.R. ID. GE LANE CUTCHOGUE House No. Street Hamlet~ County Tax Map No. lO00 Section . .~5. ........ Block 2 ...... Lot 27 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Se. pt.~.2.0. ..... 19.8.5 pursuant to which Building Permit No . 1.4.40fi. z. ......... dated ..... Qql~, .3. q ................ 19 .8.5., 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~ ......... ...... cons e- ruer .a .deck. add LI; ior~ .CO .ce~c .of .dwq ].]. ~,rlg .................... · ......... SHEARIN The certificate is issued to ............ %HOMAS R.: ....... g. WAND, A S, ~ ..... ............................ of the aforesaid building. Suffolk County Department of Health Approval ........ N./.A. ............................... UNDERWRITERS CERTIFICATE NO I~/.4 · / ~,ilding Inspector Rev. 1/81 lroF~ NO. ~ TOWN OF $OMTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14404 Z Permission Is hereby granted~/: ..z~.~..~,,~....~..~ .~..._.~...~.~.....~...~.....~~.. . · ~. ............ ~.:....:::...::; ........................ ~ ...................................................................... o, ,,,,, ,=, o, .......... ~.....~.~:~......~.~....~.~ ....................... ............................................ .............................. ~oun~, To~ Mop No. lO00 Sec,,o. ~..~ ......... ~,o~ ..2.:- ............. ~ot,o...~.::..~ ..... Building Inspector. Rev. 6/30/80 TOWN of SOUTHOLD Receipt No. 5 ~ .~. Southold, New York 11971 Fee for ~ Yard Sale [] [] ck ~,11 ................ .................. Fee for Fee for Fee for ~_TiC~ficate I [] H.l.C. ['-']Building Permit L--Urof Occupancy [] Misc, i Ila- Building Inspector ~1 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: 1. Certificate of occupancy $5.00 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 NewCOns truc tion ...... ~J~ or Pre-existing Buildin,g ............ Vacant Land ............. House No. Street ! Ham/et County Tax Map No. 1000 Section .... ~.~-~'~. ...... Block ... ~-~ ........ Lot..~....'~.. ~ ..... Subdivision ................................ Filed Map No ........... Lot No ........ i ..... Labor Dept Approval Health Dept. Approval ............................................... Underwriters Approval ....................... Planning Board Approval ..................... Request for Temporary Certificate .................... Final Certificate ............. Fee Submitted $.. ~,.d~Q .................... Construction on above described building a~R~rmit meets al~lica~_~c~s al~d.d.d.d.~egulations. A licant .."~-,~..?"~7..~ ~'~' ~ Pp ............ ;-.. '; ................... Rev, 10-10.78 FIELD INSFECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: -'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (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 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 0 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 c6de, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) 1. (Mailing address of applicant) 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 duty authorized officer. (Name and title of corporate officer) Builder's License No ...... .~'L~. ~ .......... Plumber's License No. '"FT/""-- Electncmn s L~cense No ...... .'.~ ............ Other Trade's License No ..... .~ .... ' ...... 1. Location of land on which proposed work will be done. · .~B~7']. ~. l&~.. ~/~6.~.. ~¢~'. ~'~qO~ House[ .~. ~ .~ . . . '. ~r((.~. ~a~Number~ -- .................. Street ' ..... '~namlet~'~ ...................... 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 ......................................... b. Intended use and occupancy ......... ~ ............... ~,.;7.,..' .r.. ,i .',... O~;'i~ ............. 4 '~ 'Addition Nature of work (check which applicable): New Building .......... Repair .............. Removal ............ Estimated Cost~lll~ .Oa~.,~ If dwelling, number of dwelling units ............. ..... Alteration .......... Demolition .............. Other Work ............... ....... Fee'~ ./~.. ~...~t..~t. ~.. ....................~Delcripti°7). (to be paid on filing this application) Number of dwelling units on each floor ................ If garage number of cars ..... ~' ~-; If business commercial or mixed occupancy specify nature and extent of each type of use · --- Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stones ....................................................... Dimensions of same ..... Rear structure with alterahons or add~tmns: Front .................................. Depth "~ Height Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ....... N~mher of .qt~r~eq ............. . ....................... 9. Size of lot: Front ......... i ............ Rear ...................... Depth ...................... 10 Date of Purchase ,' Name of Former Owner 11. _ Zofie or use district in which premises are situated ..................................................... 12. Does proposed construction viplate 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 ................... Phone No ................ Name of Architect ........ ~ .................. Address ................... Phone No ................ Name of Contractor Address 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 bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. ; STATE OF NEW YORK, COUNTY OF ......... ........ S.S (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ................................................ . ......................................... ' (Contractor, agent, corporate officer, etc.) of smd owner or owners and ~s duly authorized to perform or have performed the said work and to make and file this apphcat~on; that all statements contamed m th~s applicatmn 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 , ............. ~..Q .~.c~]. .... day.?f/... ~ ........... 19 ?..S'- m.*,,,,o, .~,,~,'~t~'- '~$J'~'tlf ~;k ~1;'* (Signature of applicant)