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Home My WebLink About19650-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP/MR~EI~ Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20210 Date SEPTEMBER 12, 1991 THIS CERTIFIES that the building. Location of Property 8305 COX LANE House No. County Tax Map No. 1000 Section 84 ALTERATION CUTCHOGUE~ N.Y. Street Block 3 Lot 1.1 Hamlet Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY it 1991 pursuant to which Building Permit No. 19650-Z dated FEBRUARY 1, 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 OFFICE ROOM INSIDE STORAGE BUILDING 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 PRIME PURlr~YOR8~ INC. N-192274 - JUNE 18, 1991 N/A Rev. 1/81 FO~M NO. ~1 TO~VN OF SOUTHOLD BtJILDIt4G DEFARTMEHT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne- 19650 Z Permission is hereby granted to: ..£~..o..~..P~.~.......~..~ ........ ..~.~../...~....~...Z/..~_za ~o~.~ ~o~ Mop .o. 10oo s,,tio~ ..~..~ .......... ~,o~ ..... Y.. ............ ~o,,o ....... /..,..../.. ....... pursuant ,o application dated .......... ~...~..... ............... /. ........ , 19..~.../, and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTI[OLD BUILDING DEPARTMENT TOWN RALL 765-1802 APPLICATION FOR CERTIFICATE OF(occuP~i~Cy This application must be filled in by typewriter OR ink and submitted to inspector with the following: i. the building for new building or new use: Final survey of property with accurate location of ali 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 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 C,~pliance from archiuect or.engineer responsible for the building. 6. Submi~ Planning Board Approval of COmpleted site plan requirements. i. 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. ~. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accesaorv 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 $15.00 , . Date .. · Street Haml~ ....... ' ' ' nwer or Owners of Property....~.p~d.~ ~¢~ ~ - - /-~ - :bdivision .................................... Filed Map ............ Lot ......... .. alth Dept. Approval ...... ' ............. ...... ndorwriters Approval.A/ Z Z..Z'/ arming Board Approval .... ' ...... quest for: Temporary Certificate·. ~ ......... Final Ccrticate... CO~.,°'~0~ I0 APPLICANT ................... FOUNDATIO:! (1st) FOUNDATIO:~ (2nd) ROUGH FRAME & .PLUMBING iNSULATIO~ PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS 'oo 1025104 THE NEW YORK BOARD OF FIRE UNDERWRITERS SURE^U o~ ~L~CTR,Crr¥ 8E ,.JOHN STREET. NEW YORK, NEW YORK 10038 ~/U~, ~L~,~9~_ AppticationNo. onfile 72~8~ 891/~J C~ ~O~ ~,C., 8305 COX l.~,~, CUTCHOG,)E, t4.Y. .{ 2 L3 2 rolliNS I RXTUR~ RAGS TIME CLOCKS S E R V OVENS ~-~-I~ WASHERS { EXHAUST FANS~ ~C. ROON [{RATERS:4-].5 K.W. B&RBATO & RUCIMSKI 61 DIBTZ AVE. P.O BOX 23 bAKE GROVE, NY. 11755 blC.13054~ 11. Per !. ~ , ~ must ~af be olfe~'ed in any manner; return to the office of the ~oQrd if incorrect. Inspectors may be identified by their COPY FOR BUILDING DEPARTMEHT. '1111S COPY OF CERTIFICATE MUST NOT BI= ALTERED IH ANY ktU'lNER. FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPAflTMENT TOWN HALL ~eOUTHQLEL gL'f_ tlq7 TEL.: 765-1802 Exanfincd ................ , 19... ^ppro,,ed- 4.... , 7./Perm,t No. Disapproved a/c ...... . ...... ................................ (Building Inspector) BOARD OF HEALTH 3 SETS OF PL.%.$ ''' CtlgC~' - ............... ;gl ................ MAIL - APPLICATION FOR BUILDING PERMIT INSTRUCTIONS I9. a. Th/s application must be completely filled in by typewriter or in ink .;,nd submitted to the ufldmg In, patter, witt sets of plnn% accurat~ plot plan to scale, l~ee aCcording to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sire: or areas, and 0' ' . olvm= a detailed description o£ layout of property must bc drawn on the diagram which is par~ of ti~s apl: cation. . · c. The ~vork COvered by this application may not be Commenced ~. Upon approval of this application, before ~ssuance of Bu//d/ng Permit. the Building Inspector will issued a Building Permit to shall be kept on the premises available for inspection throu,_hout the Work. the applicant. Such pen-r e. No building shall be occupied or used in whole or i-n part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector.. · APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe.wn£t punmant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws Ordinances Regulations, for the construction of buildings, additions 6r alterations, or for ~:cmoval or demolition, as herein descr/ber Thc applicant aerees to comply ~vith all applicable law'- . ' · admit anthonzcd inspectors on premises and ' b ' . , s, ordinances,, building code, houmn~ code a . · m ufldm~, for necessary irl~ections. (~gnatureotapphcant or am~ :r-- ''' :~'~"¢~''-, // ~ . ,,.~ n ....... a corporanon) ....(~..~ ~o / W~.o~) .. [Mailing address of applicant) State whe'ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ,;:Z:'2';:;;::" :;": ........... - ...... ::;:;5:::::-'"-': ............ . (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. ........ }/Y Ja:i' ~e'~j~ titl ................. a e rp officer) Builder's License No ..... ~ < Plumber's License No ................... Electrician's License No .................... Other Trade's £icense No .............. · LocatioR ofland on which proposed work will be doBe; . · ...... ' ....... .. ,,,', ~' ....(~,~ .. ,-r.-.: .~% ....... llOuse Number Street. ' ' ' ' ' ' Hmnlet ~ ..... ~ ......... C°un'YTaxMapN°'1000Sect/°n "/F'¢ .......... Block .~. Subdivision ...... · · . .... . .... ............................... F..ilcd/lap No. ' "' ' ' (Name) State · .' · . . . . c.x~Shng Usc and occupancy of premises and iutcnded use and occu_a ......... · .... Lot ........... ... · ./___ . ney of. proposed construction: A. Exxstang use and occupancy ......... ~" B. Intended use. and occupancy ........~ ..... ~~:~:~ ......... .... ....... Locate cleaxly and distinctly all property lines. Give Street and block r interior or comer lot. 3. Nature of work (check which ' apphcab e): Ne~v Building ........ Additian .......... ,Lltcration ......... Repair' . ............. RpmoVal . .SwL'ming Tennis Court '''..'''.'''c?~ ............. Demolition ............. pool .......... ~,~ .~.,~,/.,~.CCessory Building .......... Fence ;.: .... OCher Work .... 4. Estimated Cost... . ......... / '.~..~..~..~. ::.'.'.''. (to he paid on filing this application} S If dwelling nUmber of dwclling units Number of dwelling onits each floor ' · lfgaraee n'umberofcars ! ............... on .............. 6 If busineSs .................................................................... · . COmmercml or mixed occupancy spccifynatureandextentofcachty~eofusc 7 Dimensionsofexistingstructurei £any Front Hei-.bt .... :..- ....... :. Rear ...... : ........ Depth. . Number of Stones ........ Dimensions of Same structure wflh alterations ...................................... ' Depth , or additions: Front ... Rear Height ..................... 8 .................... ~ ....................... Number of Stories ............. · Dimensions of entire new constniction: Front Rear ' ' .... Hci-ht Number of Stories ........................... Depth ........... 10. Date of Purchase .... ! ' " · ..... ! ..... Zone oruso a: ...... '/.':'" ~.. ...... : ......... Name of Former Owner .................... 1 I. ,- ~-~,uct m wmcn prermses are mtuated .... ; .............................. 12. Does proposed Construction violate any zoning law. ordinance or r'e-ulatio' ' ' . .. ' .... 13. Will lot be re,,raa,,4 I . ~, n: ..................... 14, lq~.,-,,~ ,-,r n ....... ~ ............ . ...... Wdl excess fill be removed from prerw~. Ye: ....... Name of Architect .... ' t ................ ~aarem ................... Phone No .............. Add ' Ph N Name of Co ...... ~ ................ ress ................... one o ............... ntractor ......... ~ ....... Add 15. t.h.i t¥ 1. d £tL'i';" .... Tess ............ , .. onL o .............. ..... Ph N . .I.& ~ proper ocate w 300 feet of a tidal wetland? YES .... NO .... ~If yes, Southold Town Trustees Permit may be required~ PLOT DIAGRAM ~uildlngs, whether existing or proposed, and. indicate all set-back dimen:!or.~ :': umber or description according to deed, and show stree~ names and indicate w;::::. STATE OF ,','EWC~:~RK~J? /.~ cou~.T¥ OF...~2A~L,~YO...I.~, S.s . .... V,4-.I above nam'ed(flame of individual signi~ig con'tract} ... being duly sworn, deposes and says that he is the applied: ~ is the ~ ' : (Contractor, agent to.) · of said Owner or owners, and is dulviant ~orized to · v ,,urm or nave perfOrmed tile saltl ~vork and to 1 1 application: that all statements contaitmd in this applicatJo, arc true to thc best of his knowledge and belief; and that u: work will be perfommd in the manner eec forth in thc appl cat on qlcd therewith. Sworn to before me this ........... ..... a,.or .... CLAIRE L. GLL~ . .. . ........... Quallfl~in Suff~-k-Coullty /,D -, (Signature of applic:m' ~.m~. ~-~