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Home My WebLink About17457-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17553 Date NOVEMBER 30, 1988 THIS CERTIFIES that the building Location of Property 955 MASON DRIVE House No. County Tax Map No. 1000 Section 104 Subdivision ALTERATION CUTCHOGUE Street Hamlet Block 06 Lot 19 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 21, 1988 pursuant to which Buildin9 Permit No. Z17457 dated SEPT. 22{ 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 ALTERATION & REPAIR WORK ON ONE FAMILY DWELLING. The certificate is issued to F~_RY E. BELZ (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FOIIM NO. 2 TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ...~,.~.,...~.~.......~../~..................,., - ~ ....... ~~~_~,~.~.~./../..~ a, premise, located/ at ............. ...~....~....~.~...~...-.~-d/~....~...~ .......... [i ........... ...................................................... .................. County Tax Mop No. 1000 Section .?.t...~.... ,~.. ..... Block ....... ~. .......... Lot No ...... ~'.....~'... ......... pursuant to application dated ..~/~... .............. ,~.../.. ............. , 19.~.~A~ and approved by the Building Inspector. Fee $ · .~.~/~....~.. ~ · ~... - .~. · Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec- tor with 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 p~operty showing all property lines, streets, buildings and unusual natural or topograph ic 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 POOLS $25.00~LTERATION $25.00 1, Certificate of oceupancy New Dwelling $25.Q0, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ I00.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 5.Updated C.O. $ 50.00 Date ......................... .//. ~- ~ NewC°nstructi°n .....· Old or Pre-existing Building ............ Vacant Land ........ Location of Property ................ . ..................... House No. Street Ham/et or Owners of Property /~.~/~..qt....~..~.~.~..~. ...................... Owner County Tax Map No 1000 Section .............. Block .............. Lot . .. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No Date of Permit cant .... "ealthDept. Approva, . ....~..:~.~/t~.~.. Labor Dept Annroval TOWN OF SOUTtIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 7654 802 ~Wi\I O~ SOUT~,~OLD To Whom This May concern, We are unable to complete your Certificate of Occupancy because ,of the following reasons. /? An application is not on file. -/ /-/ for Certificate of Occupancy No Underwriters Certificate on file. The check is(outdated/not on file.) No Health Dep%. Approval on file. NO final inspection has been made. Please contact our office on Thank you for your cooperation. ~uilding Permit tl : ~ ~ ~ ~ Z Building Dept. this matter. No Plumber Solder Certificate on file. all permits involving plumbing being issued after April 1,1984 ) FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & ~PLUMBING e INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDIT!ON~L COMMENTS: 19e . Permit No..l. 7. Disapproved a/c ..................................... ~ ., ~ BOAI~D OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. I SURVEY TOWN OF S~OUTHOLD CHECK ::: BUILDING DEPARTMENT SEFTIC FORM ............. TOWN HALL $OUTHOLD, N,Y, 11971 TEL.: 765-1803 CALL .......... MAIL TO: A~. 4/,'2. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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, builg!ing code, llousing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i~e~tio~q. .... ~Signature df ~pplicaP0'f, or name, if a corporation) .................. .......... / (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~..z~../. ,~,~' .,. : (as on the tax roll or latest deed) If applicant is a cdrpgration, signatur~ of dt~ly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S HUST BE SUJFFQLK COUNTY LICENSED Builder's License No... ~..'~7..9~'./t/~. ......... ' Plumber's License No ................ ' ......... Electrician's License Nol ; ......... ' ............ Other Traders Ljcense,,b/o'.f :..., )~.~;:. ~ ~..:'; ....... 1. Location ol~land o~,w,l~h, ptolSos~ ~or~ will ~e done ............................. House Number Street Hamlet County Tax Map No. 1000 Section .~.~ ........... Block * Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .../J.X~.~.( ...................................................... / · b. Intended use and occupancy .......................................... 3. Nature of work (check which applicable) New BLlilding ..... ' ..... Addition Alteration . .~.I~ .... Repair .............. Removal .............. ~"'"'~' Demohhon' ' .............. Otheiq0~b~k~ .~' ........... ~" (Desc 4. Estimated Cost ...................... Fee .................. , .... i ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars .... ! .................................................................... 6. If business, commercial or maxqd occupancy, specify nature and extent of each type of use ...... ' ..... . .......... 7 Dim nsions f i ti gstructures ifa y F ~' R ' Depth · e o exs n , n : runt..:., ...... . ..... ear .... , ......................... Height .... ~ ' Number of Stones ~ ' , Dimensions'of same structure With alterations or additions: Front Rear Depth ! Height Number of Stories -'-8. Dimensions of entire new construction: Front .......... . ..... Rear ............... Depth ............... Height ............... Nuraber of Stories ........................................................ 9 Size of lot: Front .......... =. , Rear .... ... ~ Depth 10. Date of Purchase .............................. Name of Former Owner ............................. 11. Zone or use d~strlct an which premases are satuated ..................................................... 12. Does proposed constructmn vmlate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ 1 .................... Will excess fill be removed from premises: Yes No 14 N fp ' Add Ph · amc of Owner o remises..: .................. ress ................... one No ................ Name of Architect ......... i~ .................. Address ................... Phone No ................ Name of Contractor ........ i .................. Address .... : .............. Phone No ................. 15. Is this property located'within 300 feet of a tidal wetland? *Yes ..... No .~.. *If yes, Southold Town TrUstees Permit may be required. ~ PLOT DIAGRAM ' Locate clearly and distinctly all buildings whether existing or proposed, and. indicate all set-back dimensions from property lanes. Gave street and block number or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE FO~ [OWmNG ~NSPOO~i~'S 1. FOUNDATION FWO R~OUIRED FOR POURED CONCRETE [w( UPAN Ys 2, ROUGH - FRAMING & I~LUMBiNG STATE O 3. INSUL,~,TION COUNTY~OF ................. ...... F~..~.~.' ~ .¢~ ~f...,. 4. FINAL - CONS*RUCTION MUST ._ .................... being dffi~ ~g~ ~.says that he is me applicant (Nmne of individual signing contract) A~ ~NSTRUC~ON SHALL MEET above named, m THE REQUIR~E~8 ~ THE N,Z He is the ........ ~ ...................... ~eS,. N~. ~8~. '~R' ' (Contractor, agent, cor~~~ ~0~ of said owner or owners, ~d is d~ly authorized to perform or have performed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfumed in the m~nrr set forth in the application filed therewith. Swum to before me this ........... .......... oJf .... ........... .FY Nota~ Public, ... ~..~.]~¢.~ ........ County ~ ~ / / ........... ........ NOTARY PUBLIC ~te o( ~w Y0~