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Home My WebLink About19219-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAi{TMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z19615 Date DECEMBER 27, 1990 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property. 645 FISHERMANS BEACH ROAD CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 111 Block 01 Lot 33 PECONIC BAY subdivision PROPERTIES INC. Filed Map No. 786 Lot No. I0 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 17, 1990 pursuant to which Building Permit No. I9219Z dated JULY 23, 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 ADDITION AND ALTERATION TO SEASONAL DWELLING. The certificate is issued to JANE B. GOELLER (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N161091 NOV. 15, 1990 N/A /Bu~lding Inspector FORM NO. $ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERI, AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Building Inspector. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OC( This application must be filled in by typewriter OR ink ~nd .~.~J.~!.~,.9~.~p~ inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, [lding 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 uhe 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. F, ees 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...~ .~ .~..~.?../...~...~. .......... New Construction ........... _~Old Or Pre-existing Buildin~ ..... House No. Street Hamlet Onws or O ners property.....--J77. .... ..... ............ County Tax Map No 1000, Section .............. Block ................ Lot ...................... Subdivision Filed Map Lot . . . Permit No~.~.~..~..~...Date Of Permit ............... . Applicant..~.-.~F~/.~...~.~.. Health Dept. Approval ......................... . Underwriters Approval ....................... .. Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~....... Fee Submitted: $ ....... ~ ........... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~<~?' ~ '['('~:~+:~t~'l'[ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK '10038 Dote Jppllcation No, on file THIS CERTIFIES THAT in the following location; ~ Basement ' ~ Ist FI. ~ 2nd Fl. O[~T Section Bilk Lot ~sexaminedon ~0~[~ 0~''{(~{~ andfoundtobeincompliancewiththerequ retnentsqftt sBoard. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT OTHER DRYERS MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DI/~MBRS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R OTHER APPARATUS: }>~l~;hBO~RIffl: I'~/O C I'R, 1 O0 OF CC, COND C OF NEUTRAL GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF: CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FOUNDATION__ __~(l~t) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION 1ST ~ j ROUGH PLBG. j FOUNDATIoN ZND [ J INSULATION ~FRAMING [~ REMARKS: DATE, ~b~/~) INSPECTOR., ~ 765-1802 BUILDING DEPT. INSPECTION [ F~OUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL REMARKS. DATE _~~/~/?'? INSPECTOR ~, _/'~/'~Z~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 2ND [ ] INSULATION FRAMING ,r. ] FINAL DATE ~/~/~ ' INSPE. CTOR ~ TOWN OF SOUTIIOLD OFVICE OF BUILDING INSPECTOR P,O. BOX 728 TOWN HALL SOUTIIOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. /_~// An application for Certificate of Occupancy is not on file. ~ /Z/ No Underwriters Certificate on file. /Z~/ The (:hack is(e~+d~/not on file.) /Z/ No Health Dept. Approval on file. /Z/ No final ins,pection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Vermin # / _~ ~ / 7 g Ja4~_~ Building Dept. ***/~/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 Approved ........... Pc=it Disapproved a/c ..................................... pccto Al: [ FOR BUILDING PERMIT INSTRUCTIONS BO^RD OF HEALTH . survey ......... '"': :' C.F.C~ ./.~..175.2.11'i .. SEPTIC FORH ................ a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according tc schedule. b. Plot plan showing location of 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. 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 sh, all 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 shi~ll 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 applicab'~e laws, ordinances, building code, housin~ code, and regulations, and to admit author/zed inspectors on premises and in building for necessa~y~ · . pphcant, or name, ~f a corporanon) ~3 ~.~.¥ov-& (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general ~ contractor, electrician, plumber or builder. ~//~: Name of owner of premises .~..c~.~.~. [~.... ..... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ....... Fg..v.~.~.5~....~. :. ~y.g.O~x¢. .... .%.~.~,~ ~ (Name and title of corporate officer~) ' Bu.der'sL~ecnse No .... I~t.~.~...d.T. ..... Plumber s License No Electr cian's L cease No..~.t~...O~.f .... - Other Trade's License No ' I. Location of land on which proposed work will be done; . . tlouse Number Street, ' ": ...... l~a,nl~'t' ...... '" c tyT M Noi~OOOS ti ././.Z " ' ' oun ax at) ec on ............ Block ... ............ Lot ........... .. . .... Subdivision Riled Map No (Name) 2. State existing use and occupancy of premises and intended use and OcCUpancy of proposed construction: ~. ~.~sting Use and occupancy... ~.~.,~4..~...~. ~ ....... ~..e¢ ..--. · nten e Use and occupancy ............................ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 Exami'ned .~. ~/..~. ....... 19 fq TEL.: 755-180:2 Approved . .7.~' · · ....... 19 -~.~. Permit No ........ Disapproved a/c ..................................... INSTRUCTIONS SURVEY C.ECK ./.~..1~3:: : : . SEPTIC FORM ................ NOTIFY; c^LL .. 73q :.(~ 2 7.0 ....... DO O~PT ~ a. Tiffs application must be completely filled in by t3, pewriter orin 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is pan 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 sh~all 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 shkli have been granted by the Building Inspector. ' ~' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pemnit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appIicable Laws, Ordinances or Regulations, for the construction of buildings, a~ditions or alterations, or for 3emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and reguiations,.and to ..... ....... ~ ~a~.~e-~ (Mailing address of applicant) .......... State wh~ther applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Same of o,v.er ofpremises . .~..~V.~....~.... ............................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. itle of corporate officer) ' ' ' Plumber's License No .................... Electric art's License No .... 6x~, ,'~. ........ Oliver Trade's License No ' I. Location of land on which proposed work will be done: · .-.5 ~f.v~x~...s.. . o .c.. ~. }louse Number Street, Hamlet .... tyra ,~ o'.IO0os //./ " ' Q./. Coun ;': apN ection...... ... ....... BlOck ..... · · · ,,.. Lot Subdivision ..................................... F, ilcd Map No. , ............. Lot ............ (Name) · · ~-. State existing use and occupancy of premises and intended use and occupancy of proposed constrt~ction: a. Existing Use and occupancy ...................... ~ ..--7 , b, Iht en d e d ,-..-,, -~ ,'C','5', - ~ ...... 3. Natur~ of work (check which applicable): New Building .......... Addman ....... Alteration ....... Repai~ .............. .R~moval.. 'i ........... Demolition .............. Swimming pool ............ '. Tennis Court ......... Accessory Building .......... Fehce ....... Other Work; ........... 4. Estimated Cost a. · ./ ............... ee ..................................... ' ' (to be paid on filing this application} lfgar~.ge, number of cars .......... 4 .......................................................... 6. If business, commercial or mixed occupj'an~y, specify nature and extent of each type of use .................. 7. Dime!nsions of existing structures, ir an~,: Front.., ............ Rear ...... ~ ........ Depth ............ Hmgl~t-r ............... Nun bet o f IS tones . 4-'~. '. ..................................................... D mOnsmn~ of ~ara~.?~fqotzqre wtth alteratmns or addmons. Front ................. Rear ............. ; 8. Dimensions of entire new.co~structior~j: Front ............... Rear ............... Depth ...... Haietxt ~.~.!~ .~lJk..' L~umber otl Stories ....... ; ............................... 9. S~ze/ofl'6~ll*ront ..... ,~i.~. ...... ~' ...... ~ear .................... DepJb~ ,~. 1 0. Da t~ of Purchase .../'.~,~------~. ...... i ............. Name of Former Owner . .tf4. t lh.°'.~..5~.,&3..a... 1 1.' z. one or use dtstrtct m wb3.clwpremmesj are sttuated ...................... ','t ......................... 12. Doe; proposed Construct/,~n vie ate a~y zoning law ordinance or regulation: .J~.~ ............. ~ ............. '.'/ 13. Will lot be re-~raded . .ffl::k.. .. ' .............. W 1 excess fill be removed from premises....,_,t~Ye~, .m/No. · 14. Nan e of Owner of premises ~]~.*~.~ E..~..+[/P-.C.. Address~.-.%. J'Jf,[a$..v'T~.$.~.% · · Phone No. Ax>....~O../~.~... Nm e of Architect . .~.: . . ~_~.2'_' le ...... 42f iA~' ...... Address ................... PhOnePhone Ne.N° ............ ....... ~ ?~ ~.. Nm · of Contractor . .I;:~-~.7 .... ~ .l~Oi ~ .,~-~....w.. Address ....... : ........... '. IS.Is this property located within lO0 feet of a t~dal wetland? *YES-.-~--NO .... ~It yes, Mouthold Town Trustees Permit may be required. PLOT DIAGRAM , Locate clearly and distinctly all bud,'dings, whether existing or proposed, and; indicate all set-back, dm).enslons, f[~m nro~ert9 lines. Give street and block number or description according to deed, and snow street names aaa inmcate wne er interim or corner lot. ST/~TE el : NEW YORK, S.S COUNTY OF ................. [ .'~[~)4 ~.L~5.. ~ .-. ~ .~.~'~'J~.. being duly sworn, deposes and says that he ~s the applicant ~ · (Name of individual sign ng contract) above named. ~is the ) ' (Contractor agent corporate officer crc oflsaid owner or owners, and is dully authorized to pe,rform or have performed the said work and to make and file this aplplication; that all statements con!ained in this application are true to the best of his knowledge and belief; and that thc W~rk will be performed in the manner set forth in the application filed therewith. ' S?om to before me this i i/ · i ............ :/. ........ day r.. ............ (Signature of applicant~ 0 0 m~Zz i"11 Z