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Home My WebLink About20405-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20502 Date JANUARY 27~ 1992 THIS CERTIFIES that the buildin~ Location of Property 350 TRACK AVENUE House No. County Tax Map No. 1000 Section 103 Subdivision ADDITION CUTCHOGUE~ NEW YORK Street Hamlet Block 12 Lot 3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 27, 1992 pursuant to which Building Permit No. 20405-Z dated JANUARY 27, 1992 was issued, and conforms to all of the requirements of the applicable provisions of the lawo 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 COUN%5~ DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A DAVID A. & SALLY M. BLADOS B6ildin9 Ins~c~or - ' ~' Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMEN¥ TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N~ 20405 Z Permission is hereby granted to: ....... ..... ~.~..~....~~.,..~.,..... -__ _ ...~..~../......~..,...~.11~. cou.~ Tox Mop No. ~000 ~c, on .... /..~ ........ B,o~k ..Y...~.. ....... Lot No....g ................ pursuant to application dated .... ~ ........... ..~....-..~.... ..... 19..~.~,..and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN IIALL 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 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 Heaitb 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 i% 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. :J. For existing buildings (prior to April 9, 1957) non-conforming uses, or buiidings and pre-ex%sting 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. .' Fees ~. 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-e×isting Building - $i00.00 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 ate .../.'- ?:?.4-. ':ew Construction ~ ..... ' ................ .......... c-existing Building .............. · Old Or Pr ,.ocatxon of Property ..................... ; ................ ./-¥'-.~; .... House No. Street Hamlet ;,,wer or Owners of Propert . .b..Ift~.~,~ .~ 1~l.41o0£ 4-5',~/.~, ~,~.,,,~..~ :uunty Tax Map No 1000 Section. _/O~ /..~. ' Block .......... Lot .... ?. ...... ubdivision ..... · -- ' .............................. Filed ~ap ............ Lot ..................... oalth Dept. Approval . i4/d / /' ........ .......... ~ '"' ............. Underwriters Approval ....... ~/.~ .............. !;Inuing Board Approval cqucst for: Temporary Certificate ........... Fill Certicate...../~......, Submitted: $ ...... ~'~ -- ' .. .... ............. :.. FORM NO. 1 TOWN OF SOUTHOLD ' BUILDINt~ DgPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ................. 19 .., Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK ................. ~.. SEPTIC FORH .............. CALL ................... HAIL TO: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date~.~...7.., a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts 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 appll- ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit mil be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole orin part for any purpose ~hatever until a Certificate 0f Occupancy hall 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 .uilding Zone 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 taws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectom on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ;rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ame of owner of premises ./~.t~'./& ~ /~,/,~aOo£ + .~...x~././~. (as on the t.a:x roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...(~.~. ?.{ .~. ............... lumber s Lmense No ......................... Electrician's License No ....................... Other Trade's License No ................. ' ..... Location of land on which proposed work will be done .................................................. ...3YQ ...................... .................. %. :.:. × ............... IIouse Number '~ Street Hamlet County Tax Map No. 1000 Section ...... /.o. ~. ........ 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 . ./.../-~../Q..q~/... (~.../.~..././r?..5....t~,?.~.~..Z~.c~ .......................... 3. Nature of work (check which apblicable): New Building .......... Addition'.... Alteration .......... Repair .............. Removal .............. Demolition Other Work .......... I (Description) 4. Estimated Cost .... ,~]~:~...~ .cff..,~. ~ (to be paid on filing this application) 5 If dwelling number of dwelling ~nits Number · ' ............... of dwelling units on each floor If garage number of cars i ................ If business, commercial or mixedioccupancy' specify nature an.d. extent of each type of use ................... 7. Dimensions of existing structures,, if any: Front ........... ·. Rear .............. Depth;.. ~. .......... Height ............... Number of Stories ..................... Dimensions of same structure w alterations or additions: Front ................. Rear .................. Depth .................. i. Height .......... Number of Stories ...................... 8. Dimensions of entire new construlction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories . ....... .... .......... 9. Size of lot: Front ........... i' Rear .... De .............. pth ...... 10. Date of Purchase ....... ' ...................... .... · '.. . .... Name of Former Owner I 1. Zone or use district ,n which premises are situated ......................... ' .............. 12. Does proposed construction viola e any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .......... ! .................. Will excess fill be removed from premises: Yes No i4. Name of Owner of premises .... i ......... , ....... Address ................... Phone No ............... Name of Architect .(~.o4..~.e .z~.. q.~ .~)...u~. r./(TJ · Name of Contractor ... i.. · .. Address .................. Phone No ................ ..................... Address ................... Phone No ............. .5, Is this property within 300 feet of a tidal wetland? *Yes. Nod~-~t~O ''' · If yes, Southold i ....... . ........ ~qwn Trustees Permit may be required. ... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and+indicate all set-back dimensions from property lines. Give street and block number or descriptioia according to deed, and show street names and indicate whether interior or comer lot. FATE OF NEW YORK, i OUNTY OF ......... S'Si (Name of individual signing ~ontract) ,ore named. being duly sworn, deposes and says that he is the applicant · is the ~ - I (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly attthorized to perform or have perforzned the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the irk will be performed in the manner setl forth in the application flied therewith. ,om to before me this . ~ uo lc, ~tate ut ~em~ ~ork .... . ....... No. 4~22~63, Suffolk County~ ~ ~ (Signature of applicant) ~T HOLE PARTMENT-DATA FOR APPROVAL TO C061STRUC T lATER I~AIH..~.MI, e_ # SOURCE OF WATER, Pt~I'~4~TIE ~..~pu~t. IC ~ SURVEY FOR I:)/~VtD A.ESL/~,DO$ ~ Sb. LL"/ tv'l. G,L~DOS OCT. MAY .AT CUTCI4OeUE DATE: TOWN O~ SOUTHOLD SCALE:I SUFFOLK COUNTY, NEW YORK NO. ,~4"1l YOUNG S YOUNG oos .t RIVERHEAD1 1 ALDEN W. YOUNG~ PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S. UCENSE NO. 12:845 HOWARD W. YOUNG~ LAND SURVEYOR N.Y.S. LICENSE N0.45893 SONS INC. 1046