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Home My WebLink About20038-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20152 Date AUGUST 15~ 1991 THIS CERTIFIES that the building. Location of Property 165 PEQUASH AVENUE House No. County Tax Map No. 1000 Section 102 ALTERATION Street Block 3 CUTCHOGUE, N.Y. Hamlet Lot 6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 22~ 199~ ......... pursuant to which Building Permit No. 20038-Z dated JULY 22, 1991 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 ALTERATIONS TO EXISTING DECK AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED WILLIAM GILDERSLEEVE N/A Rev. 1/81 ~ // /~uildin~ Inspector 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) NM 200~8 Z Permission is hereby granJ~ed to:, /~ . County Tox ~op ~o. 1000 S~ction ...... ~.~ ....... 81~k ~ ~t ~o. ~ pumuant to application dat~ ...~ 19~., and approv~ by ~e Building Inspector. Rev. 6/30/80 Form ~o. 6 TOWN OF SOUTIIOLD BUILDINO DEPARTMENT TOWN I~LL 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 instal, lation from Beard 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 C~pliance from archiuect or engineer responsible for the building. ~ 6. Submi~ Planning Board Approval of completed site plan requirements. ;. For existing buildings (prior to April 9 1957) nOn-conforming uses or buildings and pre-ex~st~ng land uses: , 1. Accurate Survey of property showing all p~eperty lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to iospect signed by the applicant. If a Certificate of Occupancy is denied, the Buildieg Inspector shall state the reasons therefor in writing to the applicant. · . Fees i. Certificate of Occupancy - New dwelling $25.00, Additions to dwellieg $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 guildJng - $100.00 3.Copy of Certificat~ of Occupancy _ $5.00 over 5 years ~ $10.00 &. Updated Certificate of Occupancy _ $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ._ . '. ate .... -~ u~nstructlon ....... ~... Old Or Pr~-existing Buildine..~ W ...................... ocatzon of Property...~.¢.~. ....... t/.~r~.....~.' ~ ,,onse "V:: .... ......... ....... ' ,,er or o,$,rs of Proporty... . . :unty Tak Hap Mo 1000, Section..~.~.~. ...... Block .... 3: ......... Lot , ~... bdivision ............ ~ ..................... Filed Map .... ~ .Loc.....'~. .. rmit No. . . ace Of Permit.. ... ~licclnt. ' lth D pt App oval ~- ' .... ~ ................ U der riters Alproval ~nning Board ~pproval . ...'~. 'u Temporary ~..~. est for: Certificate. ~ Final Certicatc. , Submitted: $- ~ .%~ ~{l~J.. ~ ............... ~. ~aq/.~ " ,.~ ~..~.., APPLICANT ..... ~ Ol5~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & -PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ANDERSEN CORPORATION GEORGE A. PULLIS PORT JEFFERSON STATION. N. Y. 11776 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: INSPECToR~. ?~~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1803 19~'].. Permit No...~...~. ,~..00. .~ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ' NOTIFY CALL ................ MAIL TO: 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 6f 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. ¢. 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 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 auth°rized inspect°rs °n premises and in building f°r necessary i~~ (~~,~.~ ......... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether ap?cant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises...~..~__~ ~,-...~~ ............................. (as on the tax roll or latest deed) If a~plicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) ALL CO~TRACTOR'S MUST BE SUFFOLK COUNTY Builders License No .... 1' '3' '~' 5' '~" ~]~ "~' Plumber's License No ~ LICENSED Electrician's License No ......... '-T. ............. 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 ....... ./f?..~. ..... Bl;ck ... 5~.. ............ Lot .4 Subdivision,. ................................... F~Ied Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended hse and occupancy of proposed construction: a. Existing use and occupancy ....Q~:....4~..~....~7. .......... :.~ ....... X,~ ........... i ............. ". b. Intended use.ana occupancy ........... : ..... ~, , ....t ......................... l 3. Nature of work (check which apElicable): New Building ..... ' ..... Addition ........ ~ .~ ,~. Alteration . .X ..... i .. Ct · (b scnp3 on) ttt5 be paid on filing this application) 5. If dwelling, number o f dwelling u!nits ...... ~ ....... Number of dwelling units on each floor ................ If garage number of cars i -- 6. If business, commercial or mixedloccupancy, specify nature and extent of each type of use '. ............... · ''fa y Front Rea D pth 7. Dimensions of existing structures!, ~ n .......... ... . . . r .............. e ................ of Stories Height ............... Numl~er ............ ............................................ Dimensions'of same st.m. ~.~{)w,!~ alterations or additions: Front ................. Rear .................. Depth./0.¢~h4~. ¢~Jo-J~.(,~,~ Height ...................... Number of Stories ...................... Dimensions of entire new constrgcfion: Front .......... . ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Si oil t: Front R ~ : Depth 10. Date of Purchase ........... i ................. Name of Former Owner ............................. 11. Zone or use dmtrlct ~n which pre~mses are s~tuated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. 13. Will lot be regraded ......... i · ~ ................ Will excess iii1 be removed from premises: Yes No 14. Name of Owne. r of premises ~..~! ~. Address .~.~....O_..~... Phone No .... ~ .......... Nmne of Architect .r-~.~ ....... ,q ...... ~ ..... Address . .~,~. .............. Phone No .............. 15. Is thio property located vithin 300 feet of a tidal wetland~ *Yes .'.... No ..... · If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and distinctly all ~buildmgs, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block fiumber or description according to deed, and show street names and indicate whether interior or corner lot, RP/PROYED AS NOTED NOTIFY 8UIEI~NG DEPARTM~,.~'P'AT 765-~802 9 AM TO 4 PM FOR THE . FOLLOWING INSPECTIONS: ~. FOUNDATION - ~0 REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL CONSTRUCTION MU~T BE COMPLETE FOR C,O. ALL CONST~CTION SHA~ ME~ THE REQUIREMEN~ OF ~E N.Y. STATE CONSTRU~ION ~ ENERGY CODES. N~ RESPONSlB~ FOR DESIGN OR CONSTRU~ION ERRORS STATE OF NEW YI;~,I~¢,-_, I/ ir, ~ i .... ~. ~.-~ .... i ....... being duly sworn, deposes and says that he is the applicant (Name of individual sign:ing contract) above named.~ ! I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy at~thorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ' · ..... d.~..~. · ........ / .~.day ode,.."~..~..~. ............. Notary Public .... --// ~"~ ~ "--~'---~ ~. ~..'~...~..__... '. ,~..~r~tl:~ ~ County /'"~[[] ~