HomeMy WebLinkAbout21716-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22669 Date OCTOBER 20~ 1993
THIS CERTIFIES that the building. ADDITION
Location of Property 4030 sTILLWATER AVE.
House No. Street
County Tax Map No. 1000 Section 137 Block 2
Subdivision Filed Map No.
CUTCHOGUE~ N.Y.
Hamlet
Lot 4
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated OCTOBER 4t 1993 pursuant to which
Building Permit No. 21716-Z dated OCTOBER 15~ 1993
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 ROOF OVERHANG OVER EXISTING PATIO "AS BUILT"
The certificate is issued to WINIFRED MITCHEL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FO~M NO.3
TOWN OF BOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y.
N£
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
...... .................................. ,m..
2~7~6 Z
Permission Is hereby granted to:
..... ~~...~,.....~.~ ..... ,
~....~ ...... ~.~.....~ ....... ~~.~ ....... ~......~ ................
...~..~~ .................. ~,L~ ...... ~ ................. ~ .................... , ........................
at premises located at .......... ~..~ ........ ~././...z,~..~...../~. A.~,~. ..............................................
CountyTax Map No. 1000 Section,,,. ,/..~..,~., ........... Block ...... ..'.~.,~m..'" . .......... Lot No ...... .~..../~... .............
pursuant to application dated .......... ...~..,~.....~...,..~ ............... 19.....f,,~......., and approved by the
Building Inspector.
Ee~*.,.~.,-~,.',.~, .....
/ ~/' Building Inspector
Rev, 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERIC'S OFFICE
SOUTHOLD. N. ¥,
C OP,Y,
CERTIFICAT~- OF OCCUPANCY
No. Z 10~+7 Date May 19 19 61
THIS CERTIFIES that the building located at .T..~..a..c...k....&.....S.~.J:~_~..~..a..t..~r.. ............... Street
Map No...~..~.H~D...d. ........ Block Bio..~..X. ............ Lot Bio. 9~&96
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........................ ~..~..~..e...m..b..~?......2.,019.~..0... pursuant to which Building Permit No....Z.]:..2.~.~ .....
dated ................. .~...a..~...~..a..~,¥........~ ........ 19..~..]:., was issued, and conforms to all of the require-
ments of tho applicable provisions of the law. The occupancy for which this certificate is
issued is ... ~P~..~.¥.p,..t..e....~.~..e.,...f.~.n..k....l.y...¢.l~.~.l.~.i,.n.g .............................................................................
This certificate is issued to ..J..O.~..~.p.]3...~:],.~..ch.e...Z.~. ..................... .O...w.n..~V. ......................................
(owner, lessee or tenant)
of the aforesaid building.
FORM NO. 6
TOWN OF SOUTHOLD
, Building Department
.' Town Hall
Southold, N.Y. 11971
76.5 - [802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted -. aa~a,aaeaa 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 featu res.
2. Final approval of Health Dept. of water supply and sewerage disposel-(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 Arch tact 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 properW 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.
C. Fees:
1. Certificate of occupancy $25;00 -- BUS[NESS $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.'00, over 5 'years $10.00
4.%Z~cant Land C.O. $'20.00
5.Updated C.O. $"50.00 Date October l, .].9.¥.
NewConstruction......x Old or Pre-existing Building ............ Vacant Land ............. 4030 Stillwat~r Ave Cutchogue
Location of Property ......................... .' .......................... ,v-. ............
House No. Street Ham/et
Owner or Owners of Property ....Wi .~.~ .f r~.d. i~;[t~(;[~ ~ ........................................
County Tax Map No. 1000 Section . ~$7 ........... Block . .2 ............ 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 ..................... F~ate . .X. ....................
Fee Submitted $...~.QQ ,' .................... . ~/..~/..//,, .
P. 0. Box 706
~, ~0~:~o~.78 Cutchogue, NY 11935
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] I~.UI;;ATION
[~INAL
[ ] FRAMING
DATE/~.?',/_~?~
/
o,.
GARY FLANN£R OLSEN
COUNSELLOR AT LAW
P.O, BOX 706· MAIN ROAD · CUTCHOGUE, LONG ISLAND, NEW YORK 11936 · PHONE 519-734-7666
FAX 5~6-734-77~
ti OCT - 4 1993
[[~ October ~, ~993
~u ~> ........ ,:.:' .i.~. ~,: ~ Mitchell to Shi~ell
TOWi~O~-.'u:~ ~,~ , Our File ~ 5644
L,2 .................. Re:
Dear Gary:
Enclosed please find an Application for a Building Permit
and a Certificate of Occupancy. A roof extends off the back
of the house over a patio. The owner winifred Mitchell
advises me that the roof has always existed and was part of
the original construction. However, the attorney
representing the lending insitution that is giving a
mortgage on the property is insisting that we obtain a
Certificate of occupancy for same. Mrs. Mitchell can be
reached at 734-5149.
I am enclosing my attorney's check in the sum of $75.00
the Building Permit and $20.00 for the Certificate of
Occupancy.
for
I am also enlcosing herewith a copy of the Certificate of
Occupancy, # Z1047 issued on May 19, 1961 pursuant to
building permit #Z1287, along with the survey.
GFO:lmk
Enclosures
Town of Southold
Building Department
Town Hall - Main Road
Southold, NY 11971
Attn: Gary Fish
Very truly yours,
/~ARY ~NN~F~ OLSEN~/~
Approved ..... X/~/~/../~.. ....19 .~.. Per,nit No..~./..~./.~..~..
Disapproved a/c '
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 766-1802
APPLICATION FOR BUILDING PERMIT
BOARD OF HEA~TH
3 SETS OF PLA;~S
SURVEY ...... ' ............
CII£CK ...................
SEPTIC FORH
N O-T I FY ~
CALL ..................
HAIL TO:
Date . ! ........ 19.9.3.
INSTRUCTIONS ,~--
a. This application must be completely filled in by typewriter or in ink and submitted to thc 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 st?eets
or areas, and giving a detailed description of layout of property must be drawn oil tile diagram which js 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 thc applicant. Such permit
shall be kept on thc premises available for inspection throughout tile 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 Bulldog Department for the~ issuance,iff a Bt~lding Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, anti' otherfl'pplicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for re/la'oval or/den~olition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building c9~de/,/~ou/s(n,~ode, and 'regulations, and to
admit authorized inspectors on premises and in building for necessary inspectiog~(~/55<,
.... .....
~'- (Skg'~nature of a'fSpli'~ant, or name, if a corporation)
Main Road, P. O. Box 706, Cutchogge, NY
........... iiI'ailiJ~ ~tfi;e;~ ~'a;,bii~;~;)' '~935 .....
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No ............... .......... '
Electrician's License No .......................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Attorney for owner
Name of owner of premises Winifred Mitchell
(as on the tax roll or latest deed)
If applic.ant is a corporation, signature of duly authorized officer. APPROVED A~OT£D
F E: ur::
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: & PLUMBIbIG
3. INSULATION
Oilier Trade's License No ...................... 4. FINAL ; CONSTR~JCTION MUST
BE COMPLETE FOR C.O.
I. Location of hind on which proposed work will be done .................. .A.LL...C[3)~S.T.R.L~QTJON..SHALL.MEEoT ....
THE REQUIREMENTS'OF THE
....49.39, S,t i 11.w.a.tpL .Ay,e.....C.u.t.c.hp~.u9:' .N.Y. } } .9.3.5., .' ............ ~y~..c.o..~,ST.RU¢7~O~. & .ENEBG¥ ....
llouseNumber Street CO~IetNOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
County Tax Map No. I000 Section 137. Block 2 ' Lot 4
St bdivis on ............. . .: ...... Filed Map No. Lot
(Name) .
2. Sta~e exisdug use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . .R p. .o.f. .o. .v .e r, .h .a p ~' .J...n, ne.ar..of. ..............
cons~:ruczea when zne originat nouse waga'ui,l~:,. ' ~
b. lnlended use and occnpancy ..................... · ............. ~'k':~'.~;L.,~. , . .:~;~ ~,u~*~,,~' ...............
/roof overhang
· 3. Nature of work (check which appiicable): New Building ......... Addition'. ......... Alteration ..........
Repair .............. Removal .............. Demolition
.............. Other Work
i '"" (Description)
4 Estimated Cost SS. Off..13.0 i
(to be paid on filing this application)
5. If dwelling, number of dwelling ufiits ............... Number of dwelling units on each floor ................
· If garage, namber of cars ...... [ ..................
6 Irbusmcss tl or m~xed 9ccupancy s>ecffy ...............................................
· , commerch natnre and extent of each type of use
7 D mensions ofexistingstructures iifany: Front Rear .....................
· ' ............................. Depth ..............
Height Number of Stories
Dimensions of shine structure witl! alterations or additions: Front ................. Rear ..................
Depth ............ ~ II igl ' N
' ' ' b fSt i
8 Di i f ti ti F ......
· mens OhS o ctl re llew construe o11: rent ............... Rear ............... Depth ..........
l-I igl N b4 of St i .....
e ~t ............... tun r or es .....................
~,. Sizeoflot: bront ............. i. Rear ...................... De~th " "
10. Date of Pnrchase ............. ...... . ......... Name of Former Owner .....................
11. Zone or nsc district in which ' itua e ........
premmes are s t d
12 Does proposed ' ' ' law ordinan'ce or regulation:
· constn CtlOn wo[at~ atly zolling
13. Will lot be regraded ·
........... ................. Will excess fill be removed from premises: Yes No
14 Name of Owner of premises ' Address
· · ...................................... Phone No ................
Name of Architect ............ i.. Address Phone No .....
Name of Contractor ........... 1 ............... Address ................... Phone No .......... ......
[5. I.s this property wlthin 300 feet of a tidal wetland? *Yes ........ No .........
· If yes, Soutbold To~n Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all btiildings, 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.
Sele annexed survey
::)UNTY OF ................. S.S '
· ~.a.r.y. ff.l.a.n, ner 01 sen · · · ~ ................ being duly sxvorn, deposes and says that he is the applicant
(Name of individual signing c]ontract)
ove nanled.
is the gttor, neY. for Winifred Mitchell
: (Coutractor agent porate officer crc) '
· ,o v~er or owners ami m duly authorized to pcrforn or have pcrforned t ~e sak work and to make a '
phcat)on, that all stat.cmcnts containcdl in this application are true to the best of his ,..,--x~.,,,.,,,_ ....... nc! file tilts
~rk x~tll be perforated m the manner set forth m thc application filed therewith. /--,-.,] , nd that the
'omtobeforcmethis i / /
tary Pu bl~~~~ County
Oualffie<llnSIdfolk~-.~ /. (Signature of applicant)