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Home My WebLink About14038-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. ~.1.4.4..6.2 ......... Date June 3 86 THIS CERTIFIES that the building ..... I)eck. ...................................... 37720 old Middle Road Peconic Location of Property ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section ...Q .6.9 ...... Block .... .0.4 ......... Lot 0 1 0 Subdivision. M...D£.cJq£~.oJq. ]3~37.n. ~. ........ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 5.une..6. ......... , 19.8.5 pursuant to which Building Permit No. 1 4 0 3. 8 7~ dated ..... ~une..1 1 .............. 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 is ......... Deck addltlon to ex~stlng dwelling. The certificate is issued to . ROBERT D. BURNS of the aforesaid building. Suffolk County Department of Health Approval ....... N./..-5 ................................ UNDERWRITERS CERTIFICATE NO ............... lq./..~ ................................ Rev, 1/81 Building Inspector 1~'01[~[ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N., Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14038 Z Permission is hereby granted to:_ .... ~.~..~.~.~...~..~.~.~ .............. .... ~z.~....~.....~..~.~.~. ........ ...~.. -~.~..,...~.,...~ ................................. ~o .......... ~.~.~.~ ...... ~ ...... ~.~/.Z.~.~ ....... [.~....~ ........................... .............. ~L~.9......~~.~.~ ............................................................................ of premises I~ated at ........ ...... ~..~[~.....,..,.~..; ................................ .................................................................................................. ~)~.~...~.~ .......... co~ ,~ u,p Uo. ~ooo sec,o~ ...~ .......... ~k ..... ~.~ ........ cot ~o..~Z~ ............. Building Inspector. Fee $.....~...~... ............. Building Inspector Rev. 6130/80 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 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, Approvat 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of p~'operty 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: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.Oo $15.00 New Building .v~.~,, .~,. ...... Old or Pre-existing Building . . Location of Property . ~.~. ~O...~)g,~../~./D~/~_. J~0~./~. ..... ~L,/~.. House No, Street Owner or Owners of Property ./~T.. ~..~.~ .A/3 .................... County Tax Map No. 1000 Section . .0~.? ......... Block ...~/. ........... Lot .......... Vacant Land ............. Ham/et Subdivision ~(~.~.~..E~. ~/..~,..~>~ .~.~. ........... Filed Map No.~.~.: .~....Lot No .... l .......... Permit No. 1 .~.~.~.~.'. .~... Date of Permit ~J.l~.l.~.~...Applicant ~.(~'0~.~.../d.4~..~Y~,'.-~....~..~ ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ~.~.~..~..~ .......................... 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~FINAL DATE ~-.~<~ ~ INSPECTOR 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION ZST [ ] ROUGH ~PLBG. FOUNDATION 2ND[ ] INSULATION ~/F~MI~G [ ] FINAL DATE /'//////7,,~ INSPECTOR // / FIELD PNSPECTI N COMMENTS FOUNDATION (2nd) 2 o ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C?DE FINAL ~IT%ONAL COMMENTS 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 E×amined. .... Approved .'~.q(~.....6t ...... 1 .. Pe~it No.. [ .... Disapproved a/c ......................... .~ ........ ............................. .... (Building Inspector) ~PPLIG~TIO~ FOB BOlLDING PEBMIT INSTRUCTIONS a. Tiffs application must be completely filled 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 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 inspections. · ................... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ~.o.,~£ .~. ~. D. . . B.o ~.~¢/-5 ....... d>~ ~.~.~ ........................................... Name of owner of premises .... '~.t. Z~.'7... ]'~..~.j'd~J~-~.. ...................................... (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 ...... ~.. ?.. ~ ............ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which p¥oposed work will be done .................................................. 2.0. .d)zz9 .... mmP . .fo,qz? ............. . House Number Street Hamlet County Tax Map No. 1000 Section .....~..~..~ ........ Block ...... ~. .......... Lot .... ZO.. ........... Subdivision..~.: .0./..~./(/.Jk/,~...~.L)~.~.. ....... 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 ....~..'/..Ad. ~...Z-.~....~-.~]?~/.~/... ~...t44.ff~..ZdAd'.~ ......................... b. Intended use and occupancy .... .~..~.t~..~....1~..I. (~ .°~.. ~. ........................................... 3 Natur of wok (check which ~pplicable): New Building ' Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work.. ~F-..C._~ ...... 4. Estimated Cost ....... i ....................... Fee.. ,.~ ..................... ! " (to be paid on filing this application) 5.If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... If garage number of cars,' 6. If bus ness, commercml or m~x~d 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 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height Number of Stories 9 Size of lot: Front Rear Depth 10 Date of Purchase Name of Former Owner 11. Zone or use district in which p~emises are situated 12. Does proposed construction viglate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ i .................... Will excess fillbe 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 lifies. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, , S.S COUNTY OF ............ ...... ',~ ............ : ........ being duly sworn, deposes and says that he is the applicant (Name of ~nd~wdual s~g~ng contract) above named. He is the ..................... ! .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is drily authorized to perform or have performed the said work and to make and file this application;that all statements coniained 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 .......... , I9.. Notary I' Y