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Home My WebLink About21115-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21193 Date DECEMBER 3¢ 1992 THIS CERTIFIES that the buildin~ ADDITION Location of Property 870 SCHOOLHOUSE ROAD CUTCHOGUE~ N,Y. House No. Street Hamlet County Tax Map No. 1000 Section 102 Block 5 Lot Subdivision Filed Map No. Lot, No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 2~ 1992 pursuant to which Building Permit No. 21115-Z dated DECEMBER 3, 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 ATTACHED DECK & FIREPLACE "AS BUILT" TO EXISTING ONE FAMILY DWELLING. The certificate is issued to BRUCE B. & PATRICIA STEWART (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FO~ NO. ~ TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°-N.° 2111~Z Date ..~..~....~.. ............................. Permission is hereby granted to: ~.~...~../~....~..~ ..... . ..~.~-r.~~.x..2Z,...~././...~.~ , ,o ...... ........ ~.....~ ............................................................................. .~ ........................... at premises I~ated at ..... ~...~.~~~....~.~. ........................... ........................................ ........................................... co~ ,~ ~ uo. ~0oo s~,~o~ ..~.~ ...... ~ ...~.~. ...... to~ uo...~.~...~ ..... Building Inspector. ~uilding mspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-i802 APPLICATION FOR CERTIFICATE OF OCC BLDG. ~EP'ir. . I 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, ~maltiple 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 Vpre-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. 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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Location of Property..~...~.....~~.~...]. ] House No. Street Onwer or Owners of Propgrty..~~. ~..~ ........... County Tax Map No 1000, Section.../~.~...Block...~.~.~. ....... Lot..O./...Z'/. ........... Subdivision .................................... Filed Map ............ Lot ...................... Permit No ~.. ~ L/.~M~....~-v...Date 0 f Permit ~..?~.~. ~JT~pplicant~.~.~..~.~~. Health Dept Approval ~ Underwriters Approval ~' Planning Board Approval Requesg for: Temporary Certificate ........... Final Certicate....~....... Fee Submitted: . RF. NSSELAER G. TERRY· A~I'ORtlEY - AT. LA'~. ~ . i BLDG. DEPT. Examined FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. CALL ................... HAIL TO: (Building Inspector), APPLICATION FOR BUILDING PERMIT Date. J~.".~.... 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 streets or area~, 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 wbrk. 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 construction 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 applicant, or name, if a corporation) " ?.c', .&?. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth~orized officer. (Name and title of corporate officer) ~ Builder's License No...~../~-..~. ~' / Plumber's License No ~' - Electri.cian's License No.. ~ ' - Other Trade's License No. 1. Location of land on which proposed work will be'done ............... oo. O.~g ............... .ff .................................... House Number Street Hamlet County Tax Map No. 1000 Section ./.~..~. ........... Block ' O ,~ Lot. Subdivision ..................................... Filed Mhp No ............... Lot ............... (Name) !. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ..... -: Existing use and occupancy ,; ' b. Intended use and occupancy .............. ..4-. property lines. Give street and block flumber or description interior or corner lot. 3. Nature of work (check which a'pplieable). New Btl~lind~ . Ada=,: Repaar .............. Removal .............. Demolition .............. Oth~: yo~.. 4. Estimated Cos&.ff~...~..: ................. 'Fee .~. ~..~., ~'~5:?')~" ' ' (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 0rmixe'd specify ........................................... 7' Dimension's of existing structures occupancy, nature and extent of each type of use ..................... · , if any: Front ............... Rear .............. Depth ............... Height ............... ~umber of Stories ........................................................ Dimensions of same structur,, with alterations or additions: Front Depth Height ................. Rear .................. ................... ~ .................. Number of Stories 8 Dimensions of entire new construction: Front ..... ' .................. ............ '... Rear Depth Height Num bar of Stories .............................. 9 Size of 1~: ............. ' ............ ~ ............................................ Front Rear 10' Date of Purchase ........................................... Depth ...................... ' Name of Former Owner 11' Zone or ............................. ' ............................ · use district in which pr4mises are situated : 12 Does proposed construction viollate 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 No · Name of Architect ....................................................... ........................... Address ................... Phone No ................ Name of Contractor ......... 1. · · · ·.. Address ......... Phone No.. 15. Is this property within 300 feet of a tidal wetland? *Yes.' ....... No ......... · If yes, Southold ~own Trustees Permit may be required. ... PLOT DIAGRAM Locate clearly and distinctly ail ibuildings, whether existing or proposed, and, indicate all set-back dimensions Ir, om according to deed, and show street names and indicate whether ;rATE OF NEW ~,OR~ _ . (Name of individual signin~ 9ontract) .bore named· · · .' ....... being duly sworn, deposes and says that he is the applicant le is the ................... ¢).,-,,o.O~. ................................................... (Contractor agent corporate officer etc ) .......... f said owner or owners, and is duly aluthorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner s~t forth in the application filed therewith· worn to before mc. this /,~.~ ' . .. )~.~.. ' ' ~,~,,~ ~?)~ l&~' · ·.; ....... ~ · ~ 7.',- County , - . ............... Tern ~i~ ~Y 31,19 ~ (Signature of applicant)