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Home My WebLink About21110-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21186 Date DECEMBER 3~ 1992 THIS CERTIFIES that the building Location of Propert~ 1355 House No. County Tax Map No. 1000 Section Subdivision DECK ADDITION COX LANE CUTCHOGUE 96 Block 3 Filed Map No. Street Hamlet Lot 8 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 23~ 1992 pursuant to which Building Permit No. 2ii10-Z dated NOVEMBER 30, 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 AN EXISTING ONE-FAMILY DWELLING AS APPLIED FOR. The certificate is issued to Eo HANSEN & WIFE (owNers) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED .N/A Rev. 1/81 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) NeN? ~1110Z Permission is hereby granted to: ~ -?~,~....,~. .~.~,..~,...~ ...~......~~ ............................ ,o ..~~_~....~~...~~...~...~~..~ .... ~.~..~.~~....~-...~~..~. ~ ~, ................................... ~ ................. ~.~7,~,~.,~T~, ...... ~=~.~ .................................................................. County Tax Map No. 1000 Section ..... .~'..~. ............ Block .......... ~ ....... Lot No .....~ ............. to application dated ..... ~/.,//~......~.... .................................. , 19.~.....'~, and approved by the pursuant / Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL' 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPA~ 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 "pre-existing" 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. 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 - $100.00 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 ..//..~/.~ ~ ~Z_ ................................ New Construction..._....g .~ .~. ~ld Or Pre-existing Buildin~.~ ~..~..~.~.~ ......... Location of PropertY''l?.~ ~__~0~7 ~ ~0~0~ ~/f House No. Street Ha~et ro :r y - Onwer or Owners of .................................................. County Tax Map No i000, Section...~ ....... ................... n~ock ~ Lot ...................... O~O Subdivision .................................... Filed Map ............ Lot ..................... . Permit No..~//~...% ..... Date Of Permit.. .Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate.,. Final Certicate. ~ Fee Submitted: $ ..... ?.~7 ............... ~~...~.~~ ~f,~ :',":'..: ......... , ..... , ............. OUNDA~ION (1st) 'OUNDATIO}4 ~ 2nd ) :OUGH FRAME & .PLUMBING :Z~SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS Examined . ~.~.? ....... Approved . ).~//,~..O .... FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19 ... Permit No.. ,~//,(e~. ~ BOARD OF HEALTH 3 SETS OF PLANS .......... SURVEY ................... ClIECK ..................... SEPTIC FORH .............. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT CALL ................... HAIL 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 ;ets 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 appli- :ation. 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 :hall 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 ;hell 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 ~ullding 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 all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary i~gspections. · .?~...~..27.... ~.,/.~.~..~.~.... ,z.~..c..: ...... -- (Signature of applicant, or name, if a corporation) · ~ ~:. ~ .0 ~.. ¥.v. 'ZS-......~.q.o?../¢.,. ~ .......... (Mailing address of applicant) ]tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· qame of owner of premises ~.~... ~..~.~..'.~..~..~..'~..: .................................................... (as on the tax roll or latest deed) f 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 ...................... · Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map NO. 1000 Section .... ~ ~ ..... ' ..... "loc~ '.~'. ......... Lot~.g~ ....... Subdivision ..................................... Filed Mbp 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 3. Nature of work (check which ap'plicable): New Building .......... Addition ... Alterati n .......... Repair .............. Removal .............. Demolition .......... ~ ~??~.. ..... ~{~ ption) 4. Estimated Cost ............................... Fee . ~..O. (to be paid on filing,this application) 5. If dwelling, number of dwellin nits .............. Number of dwelling units on each fl~)r.;... If garage, number of cars . ~ o ........... 6. If business, co..mmercial or mixe4 occupancy, specffz, na~ure and extent of each tvve of use ~ O. 7. Dimensions ol existing structurei if an,,' From .6.3 ,)-.- ~ ,/]g ....... d.' '~.. ........ ne~gn~ .... ~-¥. ....... Number of Stories ...?'-.. ' ....... Dimensions of same structure. ',vRh alterations or additions: Front ............ - ..... Rear ..... ii i i."... Depth .................... i' Height ...................... Number of Sto.riTs ............. 8 Di f fiti tru R ' ; ...... · mensions o e rene. wcons ction: Front .......... ~... ear ............ Depth .............. Height ........... ;...~Number of Stories ........ .,-.. .... 10. Date of Purchase f/.Zf/~O. ..... ~r~n6 ~.k"7".' ....... ........ _ l~ .o. rm er uwner ..................... 1 I. none or use restrict in which premmes are situated.· .~.Z.~?.t ~'..0-.~.. 7/~ - ' ....... 12. Does proposed construction violate any zonin~ law ordinance o~ ~.'~'~]-"~'-' ' ~'~'~ ........................... 13. Will lot be regraded ,~..o, ......... Will e .... ' ............... .............. XCeSS Illl De removed from premises: Yes Name of Owner ofnremises ~. ~ 2c~l~/q~ ,q~.~o~ r,~c r,a~c- 15. Is this property within 300 feet of a tidal wetland? *Yes~'. ...... No....~-~%~.... *If yes, Southold Tgwn Trustees Permit may be requi=ed. 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 description according to deed, and show street names and indicate whether interior or coruer lot. ;TATE OF NE'~fg[I c ,~ :OUNTY OF...~L'W...':.l. J .¥. '. ~ ~'~ ..... ..... (Name of individual signingl contract) bore na~ed. being duly sworn, deposes and says that he is the applicant gent, corporate officer, etc.) ............... f said owner or owners, and is duly aUth"~i3*]5~rform or have performed the said work and to make and file this )plication; that all stMements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. Yvoru to before me this otary Publ Count Qualified in Suffolk Count*/ C~,~.. (Signature of applicant) Commission Expires Deeembe~ ~, 11~ .L~