HomeMy WebLinkAbout17368-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217953 Date APRIL 18, 1989
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1760 CROWN LAND LANE & 1235 SPUR RD. CUTCHOGUE
House No. Street Hamlet
County Tax Map No. 1000 Section 102 Block 07 Lot 08
Subdivision CROWN LAND LANE FILED Map No. 6284 Lot No. 11
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUG. 16, 1988 pursuant to which
Building Permit No. 173682 dated AUG. 29, 1988
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 ONE FAMILY DWELLING WITH ATTACHED GARAGE.
The certificate is issued to JOHN & ARLENE SULLIVAN
(owner, xxxxxxxxxxxxxxxx) ,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-84 APRIL 14, 1989
UNDERWRITERS CERTIFICATE NO. PENDING 4{17/89
PLUMBERS CERTIFICATION DATED O`CONNOR PLUMBING 4/17/89
uilding Inspector
Rev. 1/81
Foam xo. s
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)
No 017368 Z Date .........F.L~ 19..~~
Perm~~ is her~grante to~ G ~~~~%Grirp'.C ~a~ '
!o ~o
.......~.......ay,~.~..~....~~...~/..,
at premises located of ...17~~..~....4~.~4 ~F!,.:G
:3:~.. aS~l....
County Tax Map No. 1000 Section ........,!~.~.2', Block ...........7......cuuLot No..........Q............
pursuant to opplication doted ~~~0..............................., 19.Q,Gl, and approved by the
Bui ldi ng~~/j'/l'nspector.
Fee $.../••l~~~.~// /
~uilnspector
Rev. 6/30/80
\ ~j FORM NO. 6 ~C,`,
cs~'" ~ ~
~~.~...,..o....... _
TOWN OF SOUTHOLD ~D ~ ~ ~ ' ~~2~~
Building Department ~ j i { 3
Town Hall ) ~ ~ l~
Southold, N.Y. 11971 ~ '
765 - 1802 p
pG. pE~~
APPLICATION FOR CERTIFICATE OF OCCUPA CY TOWN OF SoUTHn~,.
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~e~~.o to the Building Inspec-
torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa•
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
~ topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00
1. Certificate of occupancy New Dwellino,$25.00, Accessory~$10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 5 0 . 0 0
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00 ~/~y/~~
5.Uodated C.O. $ 50.00 Date... / /
NewConstruction,,,,,,OldorPre-existing Building Vacant Land .
Location of Property f.~...~
House No. / , / /~Streef Hamlet
Owner or Owners of Property I?':'!~!. g.. ~~?:'?:W~! . d?~.~`~ 4^a'
County Tax M No. 10000 S®ect~i°on(~f ~.L' Block ......7......... Lot g .
Subdivision ....Filed Map No/." /..........Lot No . .
PermitNo..Ud:73~.~. Date of Permit .~~Xj./vO...Applicant
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ .
Construction on above described building and per ppI1C ble cod and regul ions.
Applicant .
Rav. 10-10J8 Q~
l~ 3706
y~~~/~~ o zi~~.~_3
~ A t
TEL. 765-1802
~oS~FFUL/~CpG TOWN OF SOUTHOLD
y~ OFFICE OF BUILDING INSPECTOR
r P.O. BOX 728 ~,„„~,~,~~„A„,„,,„„ya
c°1'~ yc TOWN HALL ~ U
"O ~ ~ SOUTHOLD, N.Y. 11971 ~ ~
t I
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~3
BLDG. DEPT.
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
Date ~i
Building Permit N~~o~~.~~~ ~1
/~Z/`
Owner Q ~//GCEsu,liiG~i ~fYN
i (please print)
Plumber , ~ ~~~1'
(please p int)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
(plumber's signature)
Sworn to before me this T~~/,/,~
~3 day of ~ /`YwC~ f~ - Ui~-~.._
19 Notary Public
Notary Public, County
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ADDITIONAL COMMENTS: x'~.~
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765-1802
BUILDING DEPT.
f NSPECTION
[ ]FOUNDATION i5T [ ] R UGH PLBG.
FOUNDATION 2ND [ INSULATION
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[ ]FRAMING [ 7 FINAL
REMARKS: ~x2.t~c>"_tir~
DATE ~ ~ 9 ~ INSPECTOR
ld~~~
765.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND I~':NSULATION
FRAMING [ ]/FINAL
REMARKS: 1 c`.~ I"
DATE INSPECTOR .~/~.f1
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765-1802
BUILDING DEPT.
[ ]FOUNDATION iST [ ROtDGH PLBG.
' [ ] F UNDATION 2ND [ ]INSULATION
~RAMING [ ]FINAL
REMARKS: ~
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DATE ~ 3~ ~ INSPECTOR /
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST ( ) ROUGH PLBG.
[ FOUNDATION 2ND [ ] IN5ULATION
[ ]FRAMING [)FINAL
REMARKS:
a
DATE ~ ~ INSPECTO
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rss-isoz
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST ( ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
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[ ]FRAMING [ ]FINAL
REMARKS:
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DATE l~~ IN5PECTOR
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BOARD OF HEALTH G:~u........
3 SETS OF PLANS ,~•I`~2a~_.
D ~ FORM N0. 1 SURVEY y........ .
..6........
BUIOLD NG DEPARTMENT SEPTIC FORI~•,p~^3. .
' TOWN HALL
BIDG.DEPT. SOUTHOLD, N.Y. 11971 NOTIFY
TOWN OFSOUTHOl.O TEL.: 765-1802 CALL
GG MAIL To: ~Ls - l33.~
Examined ~..a''Z, g 19 9.~
Approved 19~SPermit NoI ~,3.6.~.~ ~ ~ ~
Disapproved a/c ` ~ ~ C / 1 ~0 D
(Bu' ing Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~Lt 19~~
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 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
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 authorized inspectors on premises and in building for necessary insp ti ns. ~ r
(Sig/nature of /pplicarwt,nor name, if ~orp~ aeon)
(Mailing address of applicant) I
State whether app]icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises o~wti . :'~!'v ~,Lv/•' •%.`~iS?Al.!
. .
(as on the tax roll or latest deed)
If applican a r ation, si at e duly authoriz~ficer.
(Name and title of corporate officer)
Builder's License No. • •
Plumber's License No. / •J~~
~j~~
Electrician's License No. ~G~~..~0~
~ ~G ~ ia.3 s-'
Other Trade's License No . .
1. Location of land on which proposed work will be done. ~ ~ ~"n•''
House Number Street Hamlet
County Tax Map No. 1000 Section f • • • • •JJ• • Block ~.........G..... Lot ~
Subdivision Yr ~ . L./~'~~J...`~iled 1•tap No. ..~~•4r(....... Lot .
. • .(Name)
2. State existing use and occupancy of premises and in [ended use and occupancy of proposed construction:
a. Existing use and occupancy ` ~ sF.... i .
N~ri. ~l~ /~aJ~Y~/
b, Intended use and occupancy • • • • s~•--
•~•,r_, • . ,
3, Nature of work (check which applicable); New Building Y....... Addition .Uteration .
Repair ,oval . . . Demolition , Othe r)~., . , .
Rent
~~tscripti~or))
f~~...t Fee
4. Estimated Cost ~CJ. 4
,~l l (to be paid on:filing this'applicat7on)
5. If dwelling, number of dwelling units V'~!....... Number of dwelling units on each floor : .
s g
6. If business, con mere alror mix ~ .
' gd occupancy, specify nature and extent of each type of use . , . , .
7, Dimensions of existing structures, if any: Front . s........ Rear Depth' , .
Height ...............NumberofStories............,............................,..............
Dimensions of same structure with alterations or additions: Front Rear . , .
Depth IIeigltt Numke~ 9f Stories .
8. Dimensions ofy entire new construction: Front ~ 7 Rear . Depth . ~ , . , .
Height Number of Stories t/.3~..r~ . , .
9. Size of lot: Front Rear ......f .1.-t? Depth .`~.3.......'.
10. Date of Purchase . . . . Na~rie of Former Owner , .
' 11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: . ° .
13. Will lot be regraded i.... ,Will excess fill removed from premises: Yes ' 'o
14, Name of Owner of preJnt~ys~ y~gtt~C'~e.,l[l;?,p;-; Address ..2:1 lyyf/¢~?.~:~:. Phone No.Xl~~'.~'s~,~i, ,
Name of Architect ~atS.:1 GaaQrnS- , , , GJn~~g OrYNr1A ~ q/~~ 4~-~ phone No..
~j.....
Name of ContractorlK7,if~J.fj~N*f.~i/d4 .Addressf~~~li~~Y..~ ~~7PhoneNo.?43^:J.~:~3:j:.
IS.Is this property located within 00 feet of a tidal, wetland? *YES....NO....'
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
.I
Locate clearly and distinctly alb buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block, number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF N Y ~B.S
COUNTY /j
,III
(Name o~i~idual si n'(~! 4°~~?4-.'Cr..... ' ' being duly sworn, deposes and says that he is the applicant
ng contract)
above named.
1
He isttte
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contdined 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
dayof~~~.. .,CrCL,?,•••.,,19.40
Notary Publ' , . ounty
JUDITH L TERRY ~
NotsrY Pu011c, Stets of NeW Yqk . .
No. 82-0344988
ttnetlfiad in SuHdkt~ (Signature of applicant)
~ -::,awn Expires May 81,
SUFFOLK CO. HEALTH DEPT. APPRQV~1,
;,r 88-50-
-'--y-~--- ,r
f .~T`'lf'fr7~t21' i~~ii4L6~*if?-.LS:i.~'S~ _ 1 1 ~ BLDG. DEPT.
~ _ _ TOWN OF SOUTHOLD
o, r ' ~ cxa.v r.~.>~~r ~A7E'M~ r~
O ~ ~ i C~°sI~GL 7 ~ ~k1P THE WATER ~9tIPlk.Y AN DtSPF)SAL
BYSTEM2 FOR THIS RESIDENC>r WILL
I `~1 ~ ~ .r...r,_...,.,..:....._._..„,.....,,._...~....._ CONFORM TO THE STANDARDS OF THE
1 - 5.~~~ E. ~ ~ 8t1FFOLK GO. DEPT. OF HEALTH SERVICES.
AiM~:K:ANT
„ ~ ~ SUFFOLK COU>s?TY DEPT. OF HEALTH
c'd, _WELtr ~~31 ~ SERYICBi - f.OR APPROVAL OF
_a k 4
i i ,c Ci~lidt`IEUCtiDli CiN1.Y
~ r t . + O \ DATE:.
S? j I f
~ F ,
.t,,., r ~-S ~ ~~6, ~ _ ~ APPROVED:
_
~ ~
. ~ = SUFFOLK CO. TAX MAP DrSI~NAT~N`.
_ ! - _ ~ ~ D1ST. SECT. BLOCK P+GI.
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L__yl"i't 6~ICK. NOC15E~-- - ~ ~ ~^"'`,C ADDRESd:
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