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Home My WebLink About21938-zFORM NO. 4 TOWN OF SOUTHOLD BUILDIN~ DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF O~CUPANCY No Z-22892 Date MARCH 10, 1994 THIS CERTIFIES that the building ADDITIONS Location of Property 630 FLEETWOOD ROAD House No. Street County Tax Map No. 1000 Section 137 Block 5 Subdivision Filed Map No. N.Y. Hamlet Lot 3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 8, 1994 pursuant to which Building Permit No. 21938-Z dated MBRCH 9, 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 TWO PLATFO~DBOKS pLACED ON GRADE "A~ BUILT" A~APPLIED FOR The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ELIZABETH J. LANGHANS N/A N/A N/A Rev. 1/81 WT~ull ~ i~ Inspector FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPAR'iMENT TOWN HALL SOUTHOLD, N.Y. 21938 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .................. : .......................................... 19._ ...................................................................... ..~.~ ~ ....................................................... Countc Tax Map No. 1000 Section,.,g..'~.,.7., ........... Block........~,,~ .......... LotNo ........ ..~..~.~, ............ pursuant fo application dated ......... ~.,/~.~i....?....(.,..: ............. 1 9......(~..../;~,..., and approved bythe Building Inspector. ..... Rev. 6~30/80 Form No, 6 TOWN OF SOUTMOLD BUILDING DEPARTMENT 765-1802 ~PLICATION FOR CERTIFICATE OF 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, Str¢ets, and unusual natural or topographic features. 2.- Final Approval from Health Dept. of water Supply and sewerage-disposal(S-9 form). 3. A~proval 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 i% lmad, 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. Certificate of Occupancy ,- New dwelling $25.00, Additions to dwelling $25,00, Alterations to dwelling $25.00, SwimmSng pool $25.00, Accessory building $25.00, Additions to accessory building $25,00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100,00 3, Copy of Certificate of Occupancy - $5,00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy ~ Residential $15.00, Commercial $15.00 Date ..... ~q~,~.l~?~ ....................... Deck which has been built New Construction ........... Old Or Pre-existina Building ................. Cutchogue Location of Property~ ....... ~.~pp~..RP~J ............................................... House No. Street Hamlet Onwar or Owners of Property ..... ,E~.z.a~.e.t,h. ,J.e.r.e.m.z' .L.a.n.~h.a.n.s. ................................... County Tax Map No I000, Section..J~,7 ......... Block .... ~ ........... Lot...} .................. Subdivision .................................... Filed Map ............ Lot ...................... Owner Permit No ................ Date Of Permit ................ Appticant.....~3~X...~..~...~.~.~.~..~...X.f~.~.~k~kwnK .... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate .... ....................... ')55" ....... <' 3- ... 2,. Nature of work (check which applicable): New Building 9~, ........ Addition .......... Alteration .......... Repair .............. Removal ........ ? :.,.~-~ Demolition .............. Other Work.. aec~. ........ : ,'~. , , .,: (Description) 4. Estimated Cost ...... .$..6.0. r. ~.45 .............. ' ....... Fee ....... .$.75...0.D ......................... ' "' (to be paid on filing this application) $. If dwelling, number of dwelling unitS .......... i .... Number of dwelling units on each floor ................ If garage, number of.cars ................... "' ~ture and exten't of each ty;e ofuL . · .': ........ i ........ 6. if business, commercial or mixed occupancy, specaY n '7. Dimensions of existing strUctures, if any: Front ............... Rear .............. Depth ............... Height .............. Number of Stories ........................................................ Dimensions of same strUcture with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... ,$. Dimensions of entire new constrUction: Front .......... Rear ............... Depth ............... Height ............... Number of Stories i '.iii ................................................... 9, Sizeoflot: Front ...................... Rear ...................... Depth ...................... ~10) Date of Purchase Augusi:. 1953 ............ i ' ' ' i Name of Former Owner ............ . .... i'1. Zone or use district in which premises are situated ...................................... osed construction violate any zoning law, ordinance or regulation: ................................ 12. Does prop . Will excess fill be removexi from premises: Yes No 13. Will lot be regradea ............................... !3u e~eetX~o,o,a,,~oaa v~^~o ~ 73~6~56 ...... 14. Name of Owner of premises · ~.;L~i~b~:h. l~/~!agla~. Address l,;~lt-chogue~, l~.x ................. Name of Architect ........................... Address ................... Phone No .............. ~- Name of Contractor ........................ Address ................... Phone No ................ PLOT DIAGRAM " Locate clearly and distlncfly 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, S.S ~Y~l~ ~'~'~" < ~ ' ........ ~. ~LlZ~. J~R~. L~S. being duly sworn, deposes ~d says that he is ~ applica (Nam~ of individual si~g con.act) above named. ~~ o,~ ,~ha has .alsead~ .oons~r,~ad..~he. deck.. ...................... SHe is th~ ...... ' (Con.actor, agent, co.orate officer, ~tc.) ~~~x~d ~ duly authored to perfo~ or have pe~o~od ~e ~id work and to m~e ~d f~e t application; that ~l statements cont~ed ~ this application ~e t~e to the best of his ~owledge and beUef; ~d that ~ work w~l be perfo~ed in the m~nar set fo~ ~ ~ app~ca~on filed therewith. Sworn to before me this 7'" Elizabeth Jeremy ~an~hans Qualified m Suffolk Coun~ Commi~ion Expnes June 30.1995 Examined ...... Dhapproved a/c ..................................... TOWN'O~ SOUTHOLD ' BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y, 11971 TEL.: 765-1803 (Bu?dir~Vinspector) ' APPLICATION FOR BUILDING PERMIT Date . Mfi~h~s~: 19 2,6. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 silts 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 axeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- . cation. e. The work covered by this ~pplieation 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 BuildingI 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 deseflbed. The .applicant agrees to comply with all applicable laws, ordinances, b~qing code, ho~sing pore, and regulations, and to admit authorized inspectors on premises and in building for necessary(ffisp~ctiqfs..Zz~--ff / / ... i. ~.~44~..//~..~...r, .~.. ...... : ...... . ~Signature of apl~ilcant, or na~he, if a corporatmn) ~I~1 0;~ 24 st:lgz~ ~;a [.~,:~ X,~x Owner (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, 'pi~e~i:'~r builder. · . . (~l~z.a.b,e.t.h .~e.r.e~y. ,I~qgha.~s.) ................. ~/~0~.~ ~'[~0t£[~ .... Name of owner ofp~em~es ..... ~,~,~,,,,,,~,,,,,~, ;.~.~.~.m.~..~.~,~.~.~.~.~. ................. ,A,~: ~~,~ '~/?J? (as on the tax roll or latest dee~?' ~53/00" SY: ~ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) OCCUPANCY OR NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING &~ PLUMBING Builder's License No .......... ........ USE' IS UNLAWFUL 3. INSULATION Plumber's License No ......... .... 'WITHOUT CERTIFICATE, OOCUPANCY ~.~ co.,T. UCT, O. Electrician's License No ...... ~ ......OF' THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY Other Trade's License No ..... ; .............. CODES. NOT RESPONSIBLE, FOR Hous~ Number ; Street Hamlet County Tax Map No 1000 Section 1.37, Block . . .5. .... , ....... Lot .3 Subdivision ' Filed Map No Lot (Name) 2. State existing use and ~ccupancy ~f premises and ~ntended use and ~ccupan~y ~f pr~p~sed c~nstructi~n: a Existing use and occupancy .R.es.$4.en.q.~ 7 2-~.tgry hqu.~e b. Intended use and occupancy .R,~:!-4 .e~3.e9 .v$.t:h.. 4e. e.k. ..... (p.e.ck.S'~.ap. g~r~!a~ty. ~3. '~v$:l-l;]. i"'V '' "'· ,.[1 ..... _- f..3L..;