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Home My WebLink About13760-z FORM NO. g TOWN OF $OUTHOLD Building Department · Town Hall '~ Southo~d, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter 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 natura~ 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 similar buildings and installa- t/OhS, 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. B. For existing buildings '(prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of pgoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancv and condition of buildin§s. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- t/on 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 occupancv $1,00 4.Vacant Land C.O. $5.00 ._ , ,~_ 5.Updated C.Oo $15.00 Date ,,(~/./~..J'~ ............... New C OhS trhc t i on Old or Pre-existing Building Vacant Land Location of Property.. ~ 2../.'?~ .... ,....~.. ?.,%..~./z~...f/.~..x?...~..,~... .......~..~, .~.~ .~,~.~ ~ .... House No, Street Ham/et Owner or Owners of Property ...,~..~"~../.-/~'~?.....~..~-...~..~'.~. .................................. County Tax Map No. 1000 Sgction .../..~, ,~ ....... Block ....~.. ......... Lot....~. ?../ ........ Subdivision ..... ~. Filed Ma o. .Lot No. Permit No. /..~.?.~..o..Z. Date of Permit~/./.~.~.?7.Applicant .~.~.~././?-. ?'. ~ (,'~-7.'~..0.- ?.? Labor Dept Approval Health Dept. Approval ..................................... /Y' ?~'/~ ~ ~;~"- Planning Board Approval Underwriters Approval ....................................... . . .. Request for Tomporary Certificate ..................... Final Certificate .. ~'.~"~.~ Fee Submitted $ ............................. Construction on above described building and permit meets all applicabl/~ cqdes and regulations. A l/can[ ~ .~/~-~.~; ~/. ........ .~.~?r. .... ~ ................... Rev. 10-10.78 co ,s TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~y~d owner (please print) Plumber ~Ii)~i~£ ( ~/~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this .~ ~-~ day of 19 ~ Notary Public, ~ ~OB£~q' £ DOE~~ N~ARY PUBLIC, ~tate ~'~ York ' ~ual. in Suffolk Co. 52-466~944~ Commission ~p~res M~rch County Notary Public / ~IEbQ INSPECTION FOUNDATION (1st) FOUNDATION ( 2nd ) COMMENTS ROUGH FRAME & PLUMBING e INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 76S-Z802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/] ~U~ATION [] FRAMING [~INAL REMARKS'- THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK~ NEW YORK 10038 ..t..~ugu~,t ~. 198e .~pp,ic.,~o. No.,,.~,,e 37373=/Bs N 766465 o~y the electrical ~uipment ~ ~scribed belo~ a~ intmdaced by t~ applicant ~med on the above application number in the premhes of Daniel Weber~ 1215 Com~t~ Cl~ Drive, Lot 10, Cu~cho~e,N.Y. '~ the follo~,i~g loca~Jon; ~ ~as,e~ent ~ I~t Ft. ~ 2nd FI, Sec~io. lO9 Bilk 3 Lot 231 ~s exa~n~ned on A~st 21 t 1986 and found to be in co.tpliance u,lth the req~ire~nents ~f this Board. FIXTUEE i RX~URES 55 59 38 55 DRYERS FURNACE MOTORS I FUTURE APPLIANCE FEEDERS SERVICE DISCONNEC~ RO. OF S X Panelboarde: 1-Toir., 100a~p~ 8-G o F. C · I · l-~oke Deteotor NO O~ CC COND. A W, G PER ,e~ OF CC, COND 1 1/0 Daniel Po Weber P. O.Box 331 CoreyCreek Lane $outhold,N.¥. 11971 This certificate must not be aJtered in any manner; return to the office of the 8oard if incorrect. Inspectors may be identified by the COPY FOR LDING DEPAI THIS Y OF CERTIFIC IN.ANY ~ ,lEE, RANGES COOKING, DECKS OVENS DISH1 WASHERS1.2 EXHAUST FANS TIME CLOCKS BELL UNIT HEATER MULTI-OUTLE1 DIMMERS R V I C E SURVEY FOR HELEN WEBER LOT IO,"¢OUNTRY CLUB ESTATES AT: CUTCHOGUE TO~ItN OF: SOUTHOLO SUFFOLK COUNTY, NEW YORK D.~TE: JAN 4, 1985 · SCALE:I"= 50* NO. 84- !3,2.1, ~b 96 y, cOUNTRY GLOB · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 . Pc,mit No.). ..'%. pproved isapproved a/c ..................................... .............................. ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT NAil II 1985 i TOWN OF $OUTHOLD Received ........... ~19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s 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~ ~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bnilding Inspector will issued a Building Permit to the applicant. Such permit 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 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 Jilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations,,anc~ to lmit authorized inspectors on premises and in building for necessary in~p~ions. · /.) 1 / .... ....... (Signature of applicant, or name, if a corporatiod) (Mailing address of applicant) iate whether applicant is owner, lessee, agent, architect, engzneer, general contractor, electrician, plumber or builder. ~rne of owner of premises ..//.~.Z.~..'Z...~'..O..'~..'~../7.~/~. ·...I.. ·.~.~. .''?I~./7. · . .OJ.~.~..~.*~. ....................... (as on the tax roll or latest deed) 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 .... & .~..../.~ ...... .~.~..%~. ~ ..~...'Jr.~. .~-~.-~.. '. ....... '- ~ ' .C.~ '~v~~tTM..~f~.., ' ...... H~ '~' '~' ~'%''kJ~-J~' . ........ ...( ,')--~ .I...'~...., .... .... 7' Stree--C'< ' -'-amlet House Num bet County Tax Map No. 1000 Section ..... /.?. ~. ........ Block ....~. ............. Lot...~.: .~./. ........... Subdivision ~a~4~v.~. (d~ot~ -/2:--~t, qJ-~,~ Filed Map No. ~7.'?~ Lot ./.0 (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 1//4 e ~q ~ ~ /~ ,-' d b. Intended use and occupancy .... .°7~. .~... .~.., .... ~."! .~. ................................... 3. Nature of work (check which ap'plicable): New Building .......... Addition .......... Alteration ........ .~. Repair ..... ~..~ ....... Removal .............. Demolition .............. Other Work ............... i (Description) 4 Estimated Cost ' ' ' ~ ; *" (to be paid on filing this application) 5. If dwelling, number of dwelling Units ..... l ......... Number of dwelling units on each floor... / ............ If garage, number of cars ......................................................................... · 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...z///.~ ................ ..... if any: Front ~ Rear .. ~- Depth 7 Dn'nenslons of existing structures Height: ~ Number of Stories --- . Dimensions of same structure w!th alterations or additions: Front .... ..-TT .......... Rear Depth ---- Height .~-.. Number of Stories · · . ! · ~ ~ t ~r 8. Dimensions of entire new constructton: Front ..... Lq ? ....... Rear .. ~.~. .......... Depth . .~.~7 ........... Height ..../.~, ~ ~..t... Number of Stories.. Z ........................................ ~ ........... 9. Size of lot: Front ...... ./~:q.? ........... Rear .... I.~.~.: 7.7. '. .......... Depth . ~,~.7.,./.7. '...~...,~.d?: ?.7.' 10, Date of Purchase .. ,~./.~..o~/..g~ .................. Name of Fo~mer Owner .~.^.~.,,.~/~..~?Aee(":.. 11. Zone Or use district in which promises are situated.. ~.~.? (a/..~.,~/.t.~..L ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . N.o .................... 13. Will lot be regraded ...~.o....: ~::...,. :_.. C::. :¥:'4) Will excess fill be removed eom premises: 14. Name of Owner of pre, raises ,, ,//ff,~:-,'Y,, .1~,~,~,~,~,,,, Address ,g,o, ~, ?, ,3,/ ........... Phone No.7A~. (/..7 ? ....... Name of Architect . ff... )/ .................... 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 block[number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, c0u~rr¥ OF...~.e.~..~i +.~. ..... P. ~'/ '~'~ "vi'~': T.~. being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named· He is the ...... ¢ ~N.~ .' ........................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is duly authorized to perfo~ or have peffo~ed the said work and to m~e and file this application; that ~1 statements conthined ~ this application are true to the best of his knowledge and belief; and that the work wal be perfo~ed in the m~n~r set forth ~ the application filed therewith. Sworn to before me this ........................ day o .......... 19 ...................... CO~ ~y PUBLIC, ~tate icl New Y~ ~mmission · ~ L.: t89.50 N.79° 55' IO"W ~ qg, ~ /~_R:25.OO o ~ ~ SURLY FOR HELEN WEBER LOT IO,"COUNTRY CLUB ESTATES" AT: CUTCHOGUE D~E JAN 4, 1985 ~aX ~ ~ / ~WN ~: SOUTHOLD ~¢~ ~ L~ //,~ t1~?1 SUFFOLK COUNTY, NEW YORK NO. ~[ALTH DEPARTMENT-DATA F~ APPRO~L TO C~STRUCT mi ~n~ FOrt WHO~ r~[ su~tY *s YOUNG YOUNG NOTES: ~=MONUMENT~ ~=STAKE SUSDIVIStON MAP FILED IN THE OPFICE OF THE CLERK ALDEN WYOUNG~PROFESSIONAL ENGINEER OF SUFFOLK COUNTY ON OCT 17, 1978 AS FILE N0.6736 ANO LAND SURVEYOR N.Y.S. UOENSE N0.12845 HOWARD W. YOUNG~ LAND SURVEYOR SONS INC. 1046 L.- tS9 50 N.79° 55' lO"W ~INGLE FAM;LY DWeLLiNG OH :~UR~Y FO~ ~~ HELEN WI[BER H.D,R~F. NO. LOT lO(C( UNTRY CLUB ESTATES" , MAY 9,1985 ~ATE AT: CUTCHOGU OATE dAN " ~U]'HOLD SCALE' f'= ~0' THE S~AGE DIS~SAL AND WA~R $UPF, LY FAGt I~U~F~ ~OUN TY, NEW ~RK NO 8 4 - LOCATION HAVE BEEN'IN . ~ ~..%? ' TO 8E8ATISF~TO~y. su.v~v ~ A VI~ATIOM ~ SECTION 7209 ~ THE / ~v / ' ~' ~ ~~ ~ ~ OS~NDER AVE~E SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK ALDEN W. YOUNG, PROFESSlONAL ENGINEER OF SUFFOLK COUNTY ON OCT 17~ 1978 AS FILE N0.6736 AND LAND SURVEYOR N Y_S. UCENSE N0.12845 HOWARD W. YOUNG~ LANO SURVEYOR ~ L~T~ ~ W~L(W),~PTIC TAHKJST)a CES~OLS(~) ~ ~E~ N.Y S. LICENSE NO 45893