The URL can be used to link to this page

Home My WebLink About14200-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~3890 Date September q9 85 ................. · ................................ 19... THIS CERTIFIES that the building e~end e~c±s, ti.~.~ deck. Location of~toperty .. 3~.0.. West Creek Ave. Cutcho ue House No. Street Hamlet County Tax Map No. 1000 Section .... ~.0.~ ....Block ......... .~ ~....Lot 2 Subdivision ........... .X. .................. Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore f'ded in this office dated .... AL~&t. 9 ........ ,19~5. pursuant to which Building Permit No ...... ~..~.~.O.O.Z. ......... dated ... ~L~gLL~t..'1 .~- .............. 1~.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 ......... Extend existing deck. The certificate is issued to ..................... ...................... of the aforesaid building. N/A Suffolk County Department of Health Approval ........................................ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Re~. 1/81 FORM NO. ID TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, hi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED') N~ 14200 Z Permission is hereby granted to: ...... ............ ~.~......~..7 .......................................... ~. TO, .-/,/. '-/. /. .......... ,~.~.,:. ......... .~,L ....... , ................ ./..~ ..... ,o .......... ,~.~.,~,~....n;~.z ~.L,'..,,.~..% ...... .o.~,~L .......... .~,,::C.,.. ......... ~.x.,~..: ............. ~..~..~ 55-0 ~- ~g ~ o, premises ,ocoted at ............................. ~..~?.,..(. ......... ~..~..~ .............................................. County Tax Map No. 1000 Section ..... /..~..~. ........ Block ...../.~.. ........... Lot No ......~..~.g ........ pursuant to application dated ............ ..~.. ........................ , 19..~....~..., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu[Iding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted i~ ~ 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. Finat 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date .... New Building .... ~ ... Old or Pre-existing Building Location of Property...%~ ........ ~. ~, .~.. · .I~..¢~¢..~.-~ ....... .~.(~. ~ .~"¢~..~ .~/' ' Ham/et Owner or Owners of Property ....~(~.~' ' ' '~ ......................... County Tax Map No. 1000Section ../..¢73 ....... Block .. ~.'.'~. ........ Lot....~-~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept. ApprovaJ ........... ~ ............ Labor Dept. Approval . ....................... ~-' Unde~riters Approval ........................ Plannin oaFd FOWl ................ Request for Temporary Oertificate ..................... Final Certificate ...................... Fee Submitted $ .... ~.'~ ..... C~struc~ion on above described buildin~rmit~eets all. applicable codes ~d regulations. NOTIFY ~U~LDING DEPARTMENT AT DLLOW~N,G f-~S-ECTIONS: ~. FOUNDATION - ~0 REQUIRED FOR ~:3RED CONCRETE ~ ROUG~ - F~A, MING& PbUMBING 4, FINAL - CO7~'STRUCTION MUST BE CO~PLETE FOR C.O. ALL CON~RL'C~[ON Sk:ALL MEET THE REQU:RE~,q?~S OF THE N.Y. ~ATE CONSTRUCT]ON & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. I,'(jU[qBI[T]~ON ( 1 s t ) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY C,ODE COMHI,N 1 ,.~ FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHO~D~ BUILDING DEPARTMENT~, TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 . (Building Inspector) ... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Rece~ived ........... , 1 9 · · · Date ............ 19 i a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s~ts of plans, accurate plot plan to scale. Fee according to schedule. i b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cqtion. c. The work covered by this application may not be commenced before issuance of Building Permit. si d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit all 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 s~all 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 B~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or P~egulations, 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~blfil'~ng code, h~using code, and regulations, and to a(tmit author/zed inspectors on premises and in building for neces:~~ ~ _ (Signature of applicant, or name, if a corporation) .. (Mailing address of app ' t) 1.~-~ S~ate whether applicant is o.¢~ner, lessee, ag, e, nt, architect, engineer, general contractor, electrician, plumber or builder. l~ameofownerofpremises ~.~3~ ..~. ~ \ ~Q.~..~.~...~....~.~..~ ............................ ~ ................. (as ~n the tax roll or late;t ~;ed) It 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 .................................................. ..... ..... .............. House Number Street Hamlet County TaxMap 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 .............. . .~....o ........ ~. ....................................... b. Intended use and occupancy .............. '"'~I~. ~.....~.-- ........................ · .~..(~ .............. 3. Nature of work (c~eck which applicablel Repair .... ~ ....... 'Removal ... 4. Estimated Cost ....... .~:~ .~. 10. Date of Purchase ................. 1 1. Zone or use district in which premises ar~ 12. Does proposed construction viglate any i 13. Will lot be regraded ...... ,.....'~... 14. Name of Owner of premises Name of Architect ................. Name of Contractor New Building .. ......... 'Addition ........... Alteration ~, ......... ......... Demolitior/ .... ., ...... i' ' Other Work...~-~.. .......... .... , ........... .................... (to be!paid on filing this application) If dwelling, number of dwelling units ........... Number of dwelling un s on each floor ............... If garage, number of cars .......................................... : ............................ If business, commercial or mixed occupa :y, specify/~.ature and extent of each ~y~e of use ........ ............. Dimension} o~e~.~is, ting structures, if any: Front.· .~/./t ......... Rear . .~/.1t. .! ....... Depth..~ .......... Height . ./..~ · · · Number of S ofies ..... ~. ...................... ! ............................. D~ensions_of same structure with alterations or additions: Front . .~.~,..... ~ ..... Rear . ~Z ............ Depth... a~ ............... Heigtt...~ ..... Number o~Stories' .. l ......... D~mens~ons&f entire n~Fonstruct~on: I rent ~.. ~.1.~ ...... Rear ...~ ~..: ....... Depth ...~ ........... Height . .~.~.. ~mber of S' eries ......... Sizeoflot' Front ~0~ .. Rear Name of Foyer Owner Locate clearly and distinctly all building property lines. Give street and block number ~ interior or corner lot. STATE OF NEW YORK, S.S (Name of individual signing contr above named. ~k/~..~ ~d~?.( He:is the ................ Of said owner or owners, ~d is d~ly authofi application; that ail statements contained work will be performed in the m~ner set fortl Sworn to before me this ................ q~...day of. Nota~ Public, .............. fl... situated ......................... i ................... ; ........ ......... ' ss fill be. remove~t from premises: Yes No '- J('7. ....... Address ~,'a.~..~.·. ~dl.ea~'ol~a-g.,-Phone No ............ .......... Address ............... i .... Phone No ................ PLOT DIAGRAM whether existing or proposed, and. red,cate all set-back dimensions from description according to deed, and show street names and indicate whether ct) being duly sworn, deposes and says that he is the applicant 2ontractor, agent, corporate officer, etc.)I ~ed to perform or ha'~e performed the shid work and to make and file this his application are true to the best of hi~, t in the application filed therewith. knowledge and belief; and that the (Signature of:applicant)