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Home My WebLink About21206-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z~22134 Date FEBRUARY 4{ 1992 THIS CERTIFIES that the building ADDITION Location of Property 2575 STILLWATER A~E. CUTCHOGKIE~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section i03 Block 8 Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 28, 1993 ~pursuant to which Building Permit No. 21206-Z dated FEBRUARY 1~ 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS BUILT The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWEITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A -- / ~ Bui]~ding Inspector Rev. 1/81 leO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-°N? 21205Z Permission is hereby granted to: ~i~.(..,....~.~.~...~~. , -~. .,.~.,~,.....~..~... ........................................ _ _ ..... ~.~...~.~..~.~...~..~.~.-- , County Tax Map No. 1000 Section ...... ./..~..~ .....Block ........ ~ .........Lot No ......~ .............. pursuant to application dated ...... ~.. ................................ , 19...~and approved by the Building Inspector. Fee $..~..~.. Rev. 6/30/80 Form No, 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 Upre-exist~ng" 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 i'nspect 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, 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 - $I00.00 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 FEB. 3, 1993 ~ew Construction ........... 01d Or Pre-existing Building ................. ,ocation of Property ..... ~7~. ~i~f..A¥.e.. .......... Cutchogue, N.Y. House No. Street Hamlet )nwer or Owners of Property ALMEDA R]~LESKII :ounty Tax Map No 1000, Section .............. Block .... 8 6 103 ............ Lot ...................... :~bdivision .................................... Filed Map ............ Lot ...................... ermit No. 21206Z .Date Of ~ 2/1/93 ...M~..'L. ROLLINS ............. . .... Applicant. ealth Dept. Approval .......................... Underwriters Approval .............. lanning Board Approval ........................ equest for: Temporary Certificate .......... ~ Final Certicate ........... me Submitted: $ 25.00 CO'~ 3m013 Li~ APPLICANT ~OUNDA~ION ( 1st)- ~OUNDATIO:~ ~DUGH FRAME & iNSULATION f2nd) ADDITIONAL COMMENTS: -PLUMBING PER N. STATE ENERGY CODE FINAL Lof 8~ 200,00 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ............ , 197.? Approved ¢ 19~dPermit No. ~.,~. ~6 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLA,N'S .......... SURVEY ................... CHECK .................... SEPTIC FORH .............. hot a FY , CALL ................... HAlL TO: Date .................. , 19... 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 sca!e. 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 constructioh of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applj~cant, or name, if a corporation) .... ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner Of premise~ ........... : ..... ¢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 No ...................... 1. Location of land on which proposed work will be' done.~..~. . '; · .............. ............................................................... ' ". .... House Number Street County Tax Map No. 1000 Section ............ d~.?.. 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 cc property lines. Give street and block interior or corner lot. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem{vel .............. Demolition .............. Other Work ............... ?Z ~~ion) 4 Estimated Cost ./'~.~-~-'- Fee .. .~..~<..?.~ ........................ (to be paid on filing 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 structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ~. Height ...................... Number of Stories ............... 5 ...... 8. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ...... ' ......... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... '. .......... Rear ...................... Depth ...................... 10. Date of Purchase ........... [ ........ . ......... Name of F0rmer Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ~ .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone Nd~. .............. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......... 15. Is this property within '3b'0 'f'e'e't ;'f' 'a ..... Address .......... Phone No ................ tidal wetland? *Yas'~'.'.'.'.'.'.'.' No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from umber or description according to deed, and show street names and indicate whether AF/PR~_ ED A~ NOTED' NOTIFY Bl.fl~lNG DEPAR~T AT 765.1802 9 AM ~ 4 PM FOR THE FOLLOWING INSPECTIONS: '1. FOUNDArloN * TWO R~QUIRED t:OR POURED CONCRETE 2, ROUGH ~ FRAMING ~ PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST B~ COMPLETE FOR C,O, ALL CONSTRUC~ON SHALL ME~ THE REQUIREMENTS OF THE N.~ STAT~ CON~TRU¢ION & ENERGY CODES, N~ RESPONSIBLE FOR DBSIGN OR CONS~U~ION ERROR8 STATE OF NEW YO~I~% ,. COUNTY OF ......... '~.~.;~w-~.. S..S ....... ~..,..a:ff'. ! .~....Ir..: .~pJ~ ~ being duly sworn, deposes ~d says that he is the applicant (Name of individual signin~ contract) above named. He is the .......................................................................... corporate officer, etc.) of said owner or owners, ~d is duly ~uthorized to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements contaified ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith· S worn to before me this ............ ' ........ d~Y of~.. ~.. Nota. ~ubhc~, 'r~~ kL; ........... of applicant)