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Home My WebLink About20735-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20827 Date JUJNE 24~ 1992 THIS CERTIFIES that the building ADDITION Location of Property 840 PINE TREE LANE House No. Street County Tax Map No. 1000 Section 104 Block 1 Subdivision Filed Map No. CUTCHOGUE~ N.Y. Hamlet Lot 11 Lot No. conforms substantially to the Application for Buildin~ Permit heretofore filed in this office dated JUNE 18~ 1992 pursuant to which Building Permit No. 20735-Z dated JUNE 18, 1992 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 (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ROGER & MADELYN STOUTENBURGH Bui/in~ InSpector Rev. 1/81 lvO~ NO. O TOWN OF SO~Ti'fOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N_oN? 207115'7 Permission is hereby granted to: ~' ........ ~..h..~.,..../.~_~_~,.., ............. ~~._~..~,.,~...z/.~?~- ....//~"~'"~:~. ............................... ~./.......~..~~i ............................. "'/"/" ................ ~ ........ ./../. ....... County Tax Map No. 1000 Section ...... /~...~.. ....... Block ............. ./.. ..... Lot No .... pursuant to application dated .....................~//.~.. ..................... ,19...~...~., and approved by the Building Inspector. Fee $..L~....~.~ ..... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,m~ 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 features. 2.Final approval of Health Dept. of water supply and sewerage disposal-{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 Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pzoperty showing all property 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. Data 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 -- BUSINESS $50.00 ACCESSORY $10.00 2. ?rtific.ate of.occupancy or) pre-existing dwell ng $ 50. 00 · ~opyoTcertiticateofoccupanc¥ $ 5.'00, over 5 years $10.00 4.Vacank ~.and C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ...~/./~./~..~. ............ NewC°nstructi°n ...... Old or Pre-existing Build{ng ........... . Vacant Land ............ . Location of Property ....... ~...1~..~.. , . ~', ~.-'"'~,mE- House No. Street Ham/et Owner or Owners of Property ~"~.. [.~.?.~...L.~..~/~, .~..o.~, ~-P,, ~-~'~ ~ ,~,~ ~ ~-(;,~ County Tax Map No, 1000 Section .... j..~.¥, ...... Block ,. ~ ............ Lot. ~,~ ............ .......... Filed Map No /, ./")..~. LotNo Subdivision . . . 'F I~ ~o_r~ .~ ~/~ f'$~ ~' ..................................... Permit No ........... Date of Permit .......... Applicant ..... Health Dept Approval '---- Labor Dept Approval Underwriters Approval Planning Board Approval -- Request for Temporarv Certificate ................... Final Certificate .... ~ .......... FeeSubmtted$ ~,~,~0, .. Construction on above described building an~_ it meets alL~licable codes and regulations. FOUNDATION (lst) FOUNDATIO~ 2. ROUGH FRAME & -PLUMBING (2nd) INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ~, ,, FORM NO. 1 -~ ' TOWN OF SOUTHOLD ' BUILDING DEPARTMENT ~ '1 8 199;~ TOWN HALL SOUTNOLD, N.Y. 11971 ,' -' TEL.: 765-1802 Approved ...... . .... , ]9 Permit No .......... Disapproved a/c ..................................... CALL ................... HAIL TO: · O'~uJlding Iuspector) APPLICATION FOR BUILDING PERMIT , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 at,.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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appIi- etlon. ¢. The work covered by this application may not be c~mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit lall 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 ~vhatever until a Certificate of Occupancy mil have been granted by the Building Inspector. APPLICATION IS HEREBY ),lADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zbne Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, and regulations, and. to Jmit authorized inspectors on premises and in building for necessary ins ct~ s. (Signature of'~pplicant, or name, if a corporation) (Mailing address of applicant) tare wl~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. amc of owner of premises . ~J~'}. (~T..~. ?.~..~..ff~....~. ~.~..~../~......~.~'..o..'vV..'~..?:../'~-. ~. (:' {~...~. {4..: .................. (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. APPROVED AS NOTED NOT, , "U,LD,NG DEP^RT E.T AT 765-1802 9 AM ~ 4 PM FOR THE FOLLOWING INSPE~IONS: 1. FOUNDATION y ~0 REQUIRED FOR POURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 3. INSU~TION 4, FINAL CONSTRUCTION MUST 6E COMPLETE FOR C.O, - ALL CONSTRUCTION SHALL ME~ (Name and title of corporate officer) Builder's License No ........ : ..... 0CC{}PANC¥ 0~ ............ USE I$ UNLAWFUL PI.,nber's License ~o ........ : ............... WI~NOUT CErTIfiCATE m~t~i~ian.~ Litany= ~o ....................... OF OC.CUPANCY O/her Tradc's License No ..... Location oflaod on which proposed work will be done..' ......... THE REGUI~MENT8 OF THE N,~ ~ .~ ............ STATE ' CONSI'~ON' ~' ENERGY ...... ~0 Pk~ ~ k~ &~~~__RESPONSlBLE FOR I louse Numbcr Street .... ~,' ' DE,SIGN OR C~T~CTt~N'ERRORS CounW Tax Map No. 1000 Section . .. ~ ......... Block ............... Lot ................. Subdivision .,~. ~.~.$g.~..~ $. .......... Filed Map No. (Name) - · · ~ l.~.q ..... Lot ..... . ........... Sla~e existing usc and occupancy of premises and intended use and occupancy of proposed construction: a. x~sting use and occupancy ... ~ ~,~ b. Intended use and occupancy · 3. Nature of work (check whichjaPplicable · j pcew .uuwa a Repmr . . . g ....... Add X.a it.. c.;., . ......... Remove ~. . {6n 3...:'..c-'..x'.--'.'-.%. ,]0tcrat on ........ ,. ! ............ ucmouUon ....... .x.,...~ . n the.~Vork .......... 4. Estimated Cost .......... , ......... Fee ........... ~ (to be paid on filing this application) 5. If dwelling, number of dwellinlg units..';": .-: ......... Nuraher of dwelling units on each floor ........... · If garage, number of cars ____ 6. If business, Commercial or mixed occt paacy, spec ~ ature . . .... 7. Dunensmns et existing stn, ctures if any: F d extent of each type of use , ............ He gtt ;..~-~_ ................ Rear ...... Depth ...... ........... au nber of Stori ; es ..--.. · ..... Dimensions of Same structure, vlth alterations or add~ mas: Front ....... Depth ___. I Ileight . .w--..... ....... · ............ ........... ' ................ Rear .... 8. Dimensions of entire new construction. Front ...... . Num bet of Stories ........ Hei,, ~t I ' ' .......... .' ' .......... ~.. ° ~. ''. ...... :'"cNumberofStories Rear ............... Depth ...... 9. a~ze otmt: Front ..I..O.O.:.. I ............................... ' ' ' ' 10. ate of Purchase . . . . . 'Q" ................ Depth .I .q'.~,.'l . . . ' ....... I 1. Lone or Use district in which m~e,',i,,~ · · ~.' · · .j .... rqame of Fenner Owner , ~ ............ 12. Docs proposed construction violate any zoning law etd 13. Will lot be regraded /','~ , mance or regulation: 14. Name of Owner of premises'g.ok..~.%r}?,,~.a,,,,~,' e. ~e~ss fill~be rem_Loved from premises: Yes No NName o~,. ~...,-_,- JJ,..;..', ............ ,q. aclress . . . n,_ ,., ............. 15. I$ l:h~,s property within ¢00 P,.c4~.~ ~t..~}... Addressee Oe~..'4t.q .'1.~..*~-.~..~'one No ?.90.-~;,~ .... teat: of a t:~'dal wetland? *Yes ...... ' ' ' ........ ' .....':' · If yes, $outhold ~o~n Trustees Permit may be requ:/.red. .. No ......... · .. i PLOT DIAGRAM Locate clearly and distinctly sill buildings, Wliether existing or proposed, and, indicate all set-back dknensions from property lines. Give street and block humber or descnptmn according to deed, and show street names and indicate whether interior or comer lot. rATE OF NEW YORK, 9UNTY OF ............... being duly sxvorn, deposes and says that he is the applicant · '" ' i' ( fflcer crc Salu owner~ or OWners, and is dui .... ~,,. . , ' ') ' ........... t e ne t ad Wor nd to~akeand file Ibis ti t all statements coat n a II ,heft)ct/otto rtl licat , ~reWlul, .............. County No. 48225~8, 8u~olk C~unW ~'~ (Signature of applicant) Term Expiroa December 31~ 1 ~ , ,, J