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Home My WebLink About19559-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19669 Date JANUARY 22, 1991 THIS CERTIFIES that the building ADDITION Location of Property 1480 FLEETWOOD ROAD CUTCHOGUEr N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 137 Block 5 Lot Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 28~ 1990 pursuant to which Building Permit No. 19559-Z dated DECEMBER 3~ 1990 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 CHIMNEY ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to EDWARD HANSEN (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED z~JFiding Inspector Rev. 1/81 FOBM NO. 0 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) N"_ 1 c3559 Z Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 i ~ APPLICATION FOR CERTIFICATE OF A. This application must be filled in by typewriter OR ink and submitted to the inspector with the following: for new building or new use: 1. Final survey of property with accurate 16cation 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 farm). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn state,eat from plumber certifying that the solder used in system contains } less than 2/10 of I% lead. 5. Commercial building, indue, trial 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. : B. 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 o£ 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, 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, Con~aercial $15.00 Date .. ~.~.~..~. ~.~.~ ........................... New Construction ........... Old Or Pre-existing Building ................. House No. ~treet Hantlet Onwer Owners of Property ~ ~...C~ ~q.~.~.~..~. ' County Tax Map No i000, Section .... ~.$.7 ..... Block ....... ~ ...... Lot.../~ ................ SubdiVision ' .................................... Filed Map ............ Lot ...................... Realth Dept. Approval ..................... Underwriters Approval... ~../..~. ............. Planning Board Approval~. J.~. Request for: Temporary Certificate ....... Final Certicate ...... ./... 'OUNDA~ION (1st) OUNDATIO:~ ( 2nd ) OUGH FRAME & .PLUMBING NSULATIO}! PER N. STATE E}JERGY CODE FINAL < FORM NO. ] TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 1'197"1 · ,~.~,b . TEL.: 765-1802 ,an,toed.. 'Y'''i ........ ', ,,)proved,. ,/, .... , ,sapproved a/c ................. : ................... APPLICATION ~OR BUILDING PERMIT BOARD OF ItEXLTH 3 SETS OF PLANS . .,.. , o · o .... SURVEY .................... · SEPTIC FORH ' ;'''*''".. ........ .... BLDG, DEPT. TOWN OF SOUTHOLD Date .......... .8..., INSTRUCTIONS a. Tld~ application must be Completely filled in by typewriter or in ink and submittcd to the Building Inspector, with 3 ,s of plans, accurate plot plan to scale. Eeo ahcording to sd~cdule. . b. Plot phJn showing location of lot and of buildings on premises, relationship to adjoining premises r public streets ~areas, and'giving a detailed description of layout of property musi: be drawn on the diagram whtch ~ part of th.is appli- c. Thc work covered by this"application may not b~- commenced I~,'fore issuance of Building Permit. ' ' d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant, Such per'nit dl be kept on the premises available for ins"ection th--'--~ ....... e. N° building shall ,be occupied or used in whole or in part for an ur-ose wha' \ .. dl have been granted ~ the Building Inspector ' y p P ' [evtr untn a uerhficate of Occ. upancy APPLICATION IS HEREBY MAr,~ ........... ddmg Zone Ordmanco of the Town of Southnld c:-cc~,iP-,"' . ~r tl?j~.suance, of a Building Permit pursuant to the ......... , .*,,,urn ~.ounty, rqew ¥,~r. 1<, aha other applicable Laws, Ordinances or gulations, for. the construction of buildings, additions or alterations, or f removal or ' ' e applicant agrees to cOmply with all aonlicab]e law~ ~--" ............. 9{ , . . dentohtmn, as herein described. nit authorized insnectors o ,.ten '= ..... ,h';2 ~..:~.,:_~ ~' u~u,-,~n~.ua,.uuualnglcooe nousmg code, and regulations and t . ~,~gnatur, e et appdcant, or name, if a corporat~l~n')' (Mailing address of applicant) t [.c~5' ~ , ~te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .meo wnero remises .. .., . as on thc tax roll or latest deed) tpplicant is a corporation, signature of duly authorized officer. ~. (Name and title o~'corporat(c.~fficer) - Budder s L No ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade% License No 'r Location of land on which pi'oposed work will be done ' ' CountyTax Map No. 1000 Section ...... I.~..'~ ..... : B¥ck ....... ~ ....... ' Lot .... Subdivision ...................... , .............. F~lcd Map No Lot (Name) ............................... State existing u~e and occupancy of premises and intended nsc and occupancy of proposed construction: 3. Nature of work (check which ~pplicable): Ne~v Build n, . . . Repair .............. Removal .. ... g,~, · .. .... Addition ...... : · · · Alteration ......... , ~. Estimated Cost ~.~ ...... .~ . ~ ' (Description) $,, Ifdw~ lng, number otdwellin units ....... · Uo b~ paid on fihng tlu~ appiicat on) , If garage, number of cars..... i ........... '..· Number of dwelling units o; each floor, ' 6. If business, commercial or.'mix~d occupancy, , I lensless O~lStlllg Structures any:.Front . ,. It N lb~ro o De · unHeHslo~so entire new const finn -- '''*'''~''''''. .... NumborofStodus N hb erst ear ............... D ~th e ''''''. ....... . ut er ori 9. Size oflot: Front ; ......... ~ .......... ;. Rear .......... Depth .... W~llot be regraded /.~,. .... ~'~'~ ............... ~ ~ ' v. ' .. u~a '~' t~'~' ~t~WOP.~hone No ...... , ......... N~o of, Architect ....... ,' ' ~ ................. ' ..' { ~IUIAG~M . '~ ..... ' i ''" " ATE OF NEw YORK . i f ........... · ,jr.,~,.~.,,,... LL,/.t. t~. O.~. - ' ,(Name of individual signln ~ cont t{ .......... being ~uly Sworn, deposes ~d says that h? is ~h.e, 5p, p![,ca, nt Public .... . ........ County LINDA d. COOPER Notarv Public, 8tale of New York,% ~ No 4822563, Suffolk County L.({/ ) Term Expires December 31, 19.~t''/ ' ~ - (Sig f ppil t) nature 0 is tit,,. ' ,, ?: ,~ ~ · ((Tnn* ............. 'F~'r ' ' * ' "; r"~'" "'"-" ', c. ', ,% , , · ,,,.u,,.auwr, ageot, C~oratc officer, crc,) ...... * ' ' ' ' ' ' ' ' ' ' ' ;aid owner or owners, ~d is dulya,uthonzed to p~rform or have performed tim said mvork and to m~o~hnd file hearten; that all statements containqd in tills application are true to the best of his knmvledge and belief; and that the k w~l be perfo~ed in the ~ner se} forth-in the apylication Qled therewith. ' ,, m to before me Ufis , d y of 19