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Home My WebLink About22110-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCy No: Z-26380 Date: 04/16/99 THIS CERTIFIES that the building ADDITION Location of Property: 24635 MAIN ROAD/ROUTE 25 CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 109 Block 1 Lot 16 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 19, 1994 pursuant to which Building Per, it No. 22110-Z dated JUNE 6, 1994 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 AS APPLIED FOR "AS BUILT" The certificate is issued to ANNA BARISIC of the aforesaid building. (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A Building I~ / FORM NO,3 TOWN OF $OUTHOLD BUll.DING DEPARTMENT TOWN HAJ,.L SOUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE: KEPT ON THE P~EMIS£S UNT~t. FULL COMPLETION OF THE WORK AUTHORIZED) ~te..~.....~ .................................. ,~..~..y... 221~.0 Z Permission is hereby granted to.~ ~ ' ........ ~"~;'~'"~ ................ '/~7'"'~ ....... ....... i~.~.~.~.~../.....~/..:.....Y.....'... ~..~ .......... ~.~..~ ........... ~~ ....... ~....~ ............ .~ ..................... ..~...~....,-,. .......................................................................................................... Count~Tax Map No. 1000 Secflon.Z...~,...~'. ........... Block ............ ./ ........... Lot No. .,/,...~,. ................... pursuant to application dated ....... ~..,,~. ....... .,,,~,.,, .................. 19....~.../...,, and approved bythe Building Inspector. ~ ...... 7~........'~:. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. ~. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing'~ land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. ~ertificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ....... . .~Z'?.~./. ~...~. ................... New Construction~..~/_'_'~. Old Or Pre-existing Building.: ........... Location of Property.. ~.~. ~..~..?~.. .... /.~?.~.g..~...z~....z.~..~.. .........'" ~;~. .. ..~..?...~. House No. Street Hamlet Onwer or Owners of Property .... ~..~.~'....~...~....~.~.~.. ............................. County Tax Map No 1000, Section..J~..~. ..... Block ..... ./. ......... Lot ..... .z~....~.. ............ Subdivision............... ...... ...............Filed blap............Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .................... .... .. Underwriters Approval ........................ . Planning Board Approval .................. . ... .. Request for: Temporary Certificate ....... .,~..~nal Certicate ........... Fee Submitted: $ ......... ~...~-----~ ~-? / ..... ........... CO ~--~ ~d .. APPLICANT 765-Z.802 BUILDING DEPT, INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING FIREPLACE [ ] ROUGH PLBG. [ ] INS~ULATION [ ~INAL CHIMNEY REMARKS: DATE / /'/ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMI~IG [/-~INAL [ ] FIREPLAc~E-~ CHIMNEY REMARKS: ~~j)' ' DATE OUNDATIO.~ ( 1 s t) OU~'$DATIO:! (2nd) ,0UGH FRA~-IE & -PLU~BING 21;SULATIUU ~. y. STATy:;ERGY //CODE Fi:;AL ADDITIO~;A'L CO:-~.[-~E~TS: N-55'0Z'3Cr'E. ~ 63.1 '-1 k4AP OF PF...OPE~TY ,SURVEYED F'O~' MILTON r,., DOLL'Y' MELTZEI:P-. ,A'[' CUTC~OGMI~ · TOWN· OF' $OUTHOI-D..N.~'; ~' I TOWN OF SOUTHOLD ~A¥ ( 9 ~ [ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ . I TOWN Of ~)i~{{~_D , TEL.: 765-1803 Disapproved a/c ..................................... // (Building Inspector) BOARD OF HEAL'TH ....~..... 3 SETS OF PLANS ......... SURVEY .................. CIIEC~ .................... SEPTIC FORH .............. CALL ...... HAIL TO: INSTRUCTIONS , a. TbJs 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 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 daws, ordinances, building code, housiffg code, and-regulations, and to admit authorized inspectors on premises and in building for necessary insp~ions...~-_ ' ,- , (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of ow,,e .................................. (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 .... ~ O d) '~ -~ /'-/~- '~- Plumber's License No .......... ~...~. .......... Electrician's License No ....................... · Location of land on which proposed work will be done .................................................. cou.ty Ta~ ~,ap No. ,o0o Section /.~.~ ........... BIoc~../. ............. ~ot..../¢ .......... 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 ...................... ~'.r.; 2,.. x c,.,,;u ~ 9'.'::? .... 3. ............ 3. Nature of work (check which applicable): New Building .......... Additio~,. Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ~ - · ~.~.._ ~>o ~, (Description) 4. Estimated Cost. ~. ~ ........................... Fee. ~ .~ ........................... (to be paid on 5. If dwelling, number of dwelhng units ............... Number of dwelling units on each~'C~fl~}q~ .......... . If garage, number of c~ ........................................................................ 6. If business, commercial or m~ed occup~cy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, ifany~ Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... HeiSt ........... =.. ~ ...... Numbe~of Stories ............ ~ ........ '~8. Dimensions of entire new construction: Front ...... ~.~ ..... Rear . {.~ ........... Depth ./~ ........... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... I0. Date of Purchase .................... · ......... Nme of Fomer Owner ............................. 11. Zone or use district ~ which premises are situated ......................... ~ ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~..: ......................... 13. W~I lot be regraded ........................ :... Will excess fill be removed from premisem, Yes No 14. )l~e of Owi,ci of ~c,ti~e~. ~,t.~ ./.~Address~ ~~ Phone No~~ Nme of Architect . . . ~ ._.¢1 ~ .... Address~-O'~ ~ [3~ [. Ph~e No ......... ~,/v,~ Nme of Contractor'. ~ ~~;~ ~ Addre~l~ifl~:~~.6..~..t.~ ti, Is this property within 300 feet of a tidal wetland] *Yes ........ No.~ ..... · If yes, Southold Tom Trustees Permit may be required. P~T DIAG~ Locate clearly ~d distinctly ~1 bu~dM~, whe~er existMg or proposed, ~d. indicate ~1 set-back d~ensions from propeay fines. Give street ~d block number or description accoMMg to deed, and show street nines and Mdicate whether Mte~or or comer lot. APPROYED AS NOTED NOTI~' BUILI)iNG DE--AT 765-1B02 9 AM ~ ~ FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSUt ATION ./L. rqNAL CO:'JSTRUCTION MUST ~E COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REC)UIREMENT$ OF THE N.Y. STATE CONSTRUCTION & ENERGY ('()DES, NOT RESPONSIBLE FOR DFSIGN OR CONSTRUCTION ERRORS STATE OF NEW JfORK, ~ ~ r~ county ......... ;7~7~...~?.~-... --,~::~, ,_~.' ~. ~_~- ...... being duly sworn, deposes and says that he is the applicant (Name of individual si~ing contract) abcve named. He is the ............ ~ ..................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authored to perfom or have peffo~ed the said work ~d to m~e ~d file thil application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ner set fo~h ~ the application filed therewith. Sworn to before me this ...... ~5.~~ .......... day of..~ ........... , 19~ ' Residing in Suffolk Coun~ . . No. 52-5895~ a. / ....... C~misai~ Expires Ami130. 1~ (Si~atu~e of app[~c~" P- OAD MAP OF PIZ. OPEF-.TY SURVEYED MILTON ~, DOLL'Y' MELTZE~ CUTCHOGU~ TO~,Jb4 OF 50L.~TI--tOL~D. N.h'~ VAN HAY 1.9 1994 BLDG. DEPT. TOWN OF: SOUTHOLD