HomeMy WebLinkAbout21723-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22675
Date OCTOBER 22~ 1993
THIS CERTIFIES that the buildin~
Location of Property 1663 BRIDGE LANE
House No.
County Tax Map No. 1000 Section 118
Subdivision
ACCESSORY
CUTCHOGUE~ N.Y.
Street
Block 2 Lot
FiLed Map No. Lot No.
Hamlet
3
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 27~ 1993 pursuant to which
Building Permit No. 21723-Z dated OCTOBER 21¢ 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 ACCESSORY SHED "AS BUILT"
The certificate is issued to PUDGE CORP.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Rev. 1/81
FOi~M NO.$
TOWN OF SOUTHOLD
BUiLDiNG DEPARTMEI~
TOWN HALL
SOUTHOLD, N,Y.
N£ 21723 Z
BUILDING PERMIT
[THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLET ON OF THE WORK AUTHORIZED)
CounlyTax Map No. 1000 Section ...... .Z"../..~... ....... Block ....... '.~ ........... LotNo .......... ~ ..............
pursuant to application dated ......... ~...,~, ...................................
Building Inspector.
Fee $.,,..~,,,~,~..
19,, ,~'....'~... ..... and approved by the
Rev. 6/30/80
Form No. 6 ~v ;
" TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the f · ·
ollowzng, 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.
3. 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 natnral 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 tho
reasons therefor in writing to the applicant.
:. Fees
i. Certificate 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00
4. Updated Certificate of Occupancy~_ $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date October 22, 1993
Construction Old Or Pre existing B ilding '
ocation of Property,.. 1663 BRIDGE LANE CUTCHOGUE, N.Y.
House No. Street Hamlet
~Wer or Owners of Property PUDGE CORP .
ty 1000 118 2 3
Dun Tax Map No , Section .............. Block ................ Lot ......................
~bdivision ·
.................................... Filed Map ............ Lot ......................
!rmit No...21723-Z .Date Of Permit ........... -- 1 V LESSARD
............ 10/21/93 . .
~alth Dept. Approval ......................... Underwriters Approval .........................
anning Board Approval ·
~quest for: Temporary Certificate ........... Final Certicate ...........
'e Submitted: $ 25.00
APPLICANT
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
Disapproved· a/c ...................... '
...............
(Building ]¢fi~pector)
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH
3 SETS OF PLANS
SURVEY
ClIECK ........
CALL ...................
HAIL TO:
' INSTRUCTIONS
a. This 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 sti'eets
or areas, and giving a detailed description of layout of property mu~t be drawn on the diagram which is part of this appli-
cat/;~n. '
. 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 i~sued a Bu/]ding Pen'nit to the applicant. Such permit
shgll 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 ap, I/n~tble 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 laws, ordinances, builO,ff~g co~/co~t~, and regulations, and to
admit author/zed inspectors on premises and in building for necessary ir~ct,~p ~ ~ . ? ~
· . ' t ~gnature ot' a~plicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, generai ·contractor, electrician, plumber or builder.
I ~(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. Noo. ..................... .~ ........
I. Location of land on which proposed worl~will be done
Itouse Nulnber Street ~ Hamlet
County Tax Map No. 1000 Section ....'...~.4~ ....... Block : ...... ~. ~- ....... Lot...C)....~ ...........
Subdivision Filed Map No ............... Lot
(Nmfle)
2; State existing use and occupancy of premises and intended use and occupancy of proposed construction:
10.
11.
12.
1'3.
14.
Name of Contractor ........ ...................Address ..., ........ · /...~.~,.~'..Phone No ............ ' ....
15. Is thio property within 300 feet of a tidal wetland. *Yes...~T .... No .........
· If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions f~om
propqrty lines. Give street and block mmber or description according to deed, and show street names and indicate whe{her
interior or corner lot.
Nature of work (check which applicable) New Building ...gq. ..... Addition .......... Alteration .... : .....
Repair .............. Removal .............. Demolition ..... : ......... Other Work ...............
'"~ ' '" ". ' ~[ . (Description)
Estimated Cost . ~ ........................... Fee . .~.'. ..........................
(to be paid on filing this application)
If dwelling, number of dwelling units.. ' ......... Number of dwelling units on each floor.. ..............
If garage number of cars '
If business commercial or mix~d, occupancy, specify nature and extent of,each type of use ........... .... , .....
Dimensions of existing structurbs, if any: Front .... : .......... Rear ............... Depth ...............
Height Number of Stories '
Dimensions of shme structure With alterations or additions: Front Rear ....
Depth ' ' Height Number of Stories
Dimensions of entire new construction: Front : Rear
............... · .............. Depth ..............
Height Nurpber of Stories
Size of lot: Front , ~ ' Rear ' Depth
Date of Purchase .......... + .................. Name of Former Owner ........................
brai it d ....
Zone or use district in which pr scs are s uate ...................................... ~..
Does proposed construction vioiate any zoning law ordinance or regulation:
Will lot beregraded.. ..... '.,...................i Will excess fill be removed from premises: Yes No
Name of Owner of premises ' Address Phone No
Name of Architect .' .......... ' Address Phone No
' FOIJ..OW~NG ~iqSP~ONS:
1. FOUNDATION 'I'WO REQUIRED
FOR PO[IRED CONCRETE
2, ROUGH ~ FRAMING & PLUMffiNG
.3. ~NSUt-ATION
z,. FINAL COg8TRUCT~ON ~UST
BE COMPLETE FOR
ALk CONSTRUCTION SHALL. ',MEET
%HE REQU{REMENTS OF THE N.Y.
STATE CON~TRU~ION & ENERGY
CCDES.' N~ RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NF~;~-"YO~. //.~ ~,~
(Na~ne of individual signing contract)
above named.
being duly sworn, depose~ and says that he is the applicant
' : (Contracts(, agent>Zorporare Olllcer, etc./ . ' ·
of said owner or owners, and is duly authorized to perform~or have performed the said work and to make and file this
app catmn, that all statements contmned m th~s a hcatmn re t o
· ' ' ' '. ' ' PP ' ' a true to the bes fhis knowledge and belief; and that the
work will be performed in the manner ~et forth in the application filed therewith. '
Sworn to before me this
........ .day .... , 19...
· CLAIRE L, CLEW' ' \ / ~ ~ ·
Commission Expires Oeoem , ~ , .
(Signature of applicant) .