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Home My WebLink About13772-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ....... A..d.d.i.~.5:..o.n ................................ Location of Property 2765 Wells Rd. Peconic House No. Street Hamlet County Tax Map No. 1000 Section ...0.8.6. ...... Block 02 ..... Lot 002 Subdivision ....... .X ....................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated March 12 19 .8.5pursuant to which Building Permit No. 13772Z dated ....... .M.a.r..c.h ..... .2.1. ....... 198..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 Addition to Existing One Family Dwelling The certificate isissued to CONDIT, RALPH & JOAN (owner, fe~= ~, reTlal~) of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ............... N/A Building Inspector Rev. 7/81 irO~,M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 13772 Z County Tax Map No. 1000 Section .... ~ ............... Block ~'~ Lot No. '~ pursuant to application dated ..... ~...~.~;~...~.~ .............. , 19..~....~..'~, and approved by the Building Inspector. Building Insgector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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 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 property 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 occupancv $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.., .~..~.¢.c..~../~). !.~?~i-. ..... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~.14; 0-- ~ ~./(~ /~c~, /~e~...~ ,'C__. House No. Street Ham/et Owner or Owners of Property .... .~,.. ,~, '. .......................... County Tax Map No. 1000 Section .... .~..~ ....... Block .... ~ ......... Lot...,~,, .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .............. ?..~..~.'. .......... 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 ~r'r~i:~ m~ets.all ap~icable co_des and regulations. ~ ~_~ ~.~- Applicant ../..~..c?_~-.. ~.. ~ .....~ ...................... Rev, I0-10-78 FIE~D INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .: J.~.o~,O/,~., 19 Permit No. Disapproved a/c ' · ......... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT. TOWN OF SOLm-IOLD Application No .................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 Occupahcy 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 alpdP~C;bul~ldl.alnW~Ss,foO~d~meca~sCseasl, bi~cng~d,e, housing code, and regulations, and to admit authorized inspectors on premises an ' ' ' g ...ry'.P~,~s~O.O ' ~'~_~'" /~''~- ''/y-X~%'''--'~'' '''-y'''-:''~x~'''~?''' (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, ~rchitect, engineer, general contractor, electrician, plumber or builder. ;2~'2[ 2;~ii of premises...~.. ~...t4..d~. ~ .... &/~...~...~... ,~.. dO c~..~[ .... (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 ...................... Location of land on which propo.~ed work will be done .................................................. ....... .... ................................. House Number Street Hamlet c~>unty Tax Map No. 1000 Section .. i...~.'.~. ......... 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 ................. ~ .................................................... b. Intended use and occupancy .................................................. 3. Nature of work lcl]eck ,w. hich at~plicable): New Building .......... Addition .......... Alteration .......... Repair ...~J~...~. ~..'~ :3.h RemOval .............. Demolition .............. Other Work .~..o.~. ~..PC .~.~.~. · ~ (Description) -' ' (to be paid on f'fling this application) 5. If dwelling, number of dwelling units ............... 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 .................... 7. Dimensions of existing structures, ifany: Front .... ~'..~.~ ........Rear ...~..~'. ........ Depth..~.O..~.8.~. · ' Height . ~.~ ........... Number of Stories '.. Dimensions of same structure with alterations or additions: Front . .~.%~..~ ........... Rear .?.ffv~...~. ........... D~nth ~t,~' Hei~,ht $,,-~- -- Number of Stories .~..o~,. % .... ...... 8. Dimensions of entire new construction: Front ..... ~ ........ Rear ..... ~-..~..~. .... Depth ../.~.~ ....... Height ...~..-v ....... Number of Stones .. ..................................................... 9. Size of lot: Front .../.9.°.; .............. Rear .... /..o?. f ............. D_~ept,h,.../. ~./..;9. ;..;...-,. 1 0. Date of Purchase ../.~/,'~./(..~..~. ................ Name of Former Ow~ner ..,~.o:..?.~. ¢.%~... ~: .,'7'~(,~.E.e~-..q. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..,n(.o ............................ 13. Will lot be regraded . .A(~. ........................ Will excess fill be removed from premises: Yes ~) ' - ~ ~ · 14. Name of Owner,,,~, ......................................................... Name of Architect a.~ ~...%.. . Address ."'... '~ . ~... Phone No ................ Nam fC a~ ~-~ e.._ .... Address ................. n o ................ e o ontractor .................... 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 comer lot. ,' t STATE OF NEW YORK, S.S COUNTY OF ................. "~tau[~. ~ ~ ~otc~,q being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said 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 , dayof..~. ,19.~.~__C0,~0 D ounty_ N0~R¥?U~LIC.~h~eo!~ew¥or~ ..... .~...c~...~....~.....~.......,,... ....... N0 ~?0;87~. S,-%I~ Ct~t,~V ~- ~ ' (Signature of applicant) 4emi E×,pl~eS M~r~.~ 30, ~ I-I.,. D. REF. sewage disposal and water supply ~f~ oili%ies for %his location have been be sa%isfac%ory. Chief of Gered?,! Engineering To AQDITJONAL JN$'[ITL3%JON$ OR 5UBSEQUENI~ I ALPN ~L:COLI iC tt AP~OVF. J) AS NOT~ _ _ M TO4 PM F~' s ~ RSQLJ~Z~/Z?;-S OF THE N. Y. CODES. NOT RESP~I~B~ 27'tt" II