The URL can be used to link to this page

Home My WebLink About17458-zFORM NO. ~t TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17356 Date SEPTEMBER 27, 1988 THIS CERTIFIES that the buildin~ ADDITION Location of Property 625 PRIVATE ROAD #12 House No. Street County Tax Map No. 1000 Section 87 Block 4 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 7 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 22, 1988 pursuant to which Building Permit No. 17458-Z dated SEPTEMBER 23~ 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to HERBERT & CATHERINE LINDTVEIT (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building l~spector Rev. 1/81 FOBM NO. O TO~'N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017q58 Z Permission is hereby granted to:~ .... ~..~....~....~~..~ to ..................................................................... ~. ................ .~.--,~ ........ ~. ................ ,,~ ......... .\ ~t premises located et ........................................................................................... ~ ................. ....................... ~.~..~...~~..~..~.. ....... /.~....;: ............. : ................................... ~ou,,,,, To,, ,,,,ap ,o. ,ooo Sect,or,~...'.Z. ........... ,,o,* ......... ~. ........ Lot No ...... :../... .......... pursuant to application dated ./~ ......... ~,~.........I, ,9..~...~and approved by the Building Inspector. 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 m am~m~a to the Building Inspec- tor with the following; for new buildings or new use: I. 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 · ' 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 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling.$25.~O, Accessory ($10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $/O 0.0 0 3. Copy of certificate of occupancy $ 5,00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date - Newc°nstructi°n ...... Old or Pre-existing Building .. . ......... Vacant Land ............. Location of Property ............... House No. ' ' Street /~amfat Owner or Owners of Property .. ... CountyTa× Map No. ooo Section ...... ...... B,oc < · Lot ...7.. ....... Subdivision ................................. Filed Map No ........... Lot No ............ Permit NoJ']~,5~.~;~/... Date of Permit .c[J~. ~.~...Applicant ................................ Health Dept. Approval ................ Labor Oept Approval Underwriters Approval ...................... Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .................... Fee Submitted $... ~ ~D.~ ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ~ ...................... Rev. 10.10-78 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ZST FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION [ ~;INAL DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL · ' . $OUTHOLD, N.Y. 11971 TOW- ffb~'~)~J'~OLO TEL.: 765-1802, Disapproved a/c ..................................... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY CALL MAIL TO: (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. INSTRUCTIONS '?' ~.. This application must be completely filled in by Wpewfiter or in ink and submitted to the Building Inspector, with 3 ~tof 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 l.~yout of property must be drawn on the diagram which is part of tiffs appli- cation. ¢. The work covered by tiffs 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 pumuant 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, a.d, ditions 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 inspections. ! ' (Signature o~ applicant, or name, if a co~I~or~z~n')' ' ' · . (Mailing address of applicant) - , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ..... ................................................................................ Name of owner of premises ................................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No. ~..~. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1 Location of land which proposed work will be done ' House Number Street Hamlet CounW T~x Map No. lO00 Section .............. Block ................ Lot ................. Subdivision Filed Map No Lot (Name) 2. State existing use and occupancy of premises and intemlcd use and occupancy of proposed construction: · ..... ..... .: ...... · ......................... Repair k. (check which applicab e · Ne~ ' .~- ' ............. Removal .............. Demolition ..... J~2 i!.~,:. Ota~r&V~J... l'~ti ....... 4. Estimate'd Cost ............ ! ................................ 5, If dwelling, number of dwellini / (to units ..... it ......... Number of dwelling uts on each floor .......... If garage, number of cars 6. If business, commercial or mixd4 ...... k~,-' ' .,- · ....... · ·.. , · ~. ~,,-,~-vam, y specny nature and extent of each type of use ....... ' ......... 7. Dimensions of exist n~ sm ctures if an,,' Fr,--~ :~ r~ ~r .......... o , : ......... -.'~ .... ' ....... ear .............. Depth . .$~ ........ if'. N pb orStori / It ............ u! er es ................................ Di i f with alt atio dditi F X~il ' * mens oas o same structure er ns or a oas: rent Rear ' ' ' ''''' ..... Depth . .J-/./-/( .... It,. ,,k. $ D' ' f ntire n~ .... i ....... ~' .......... ~ ........... Number of Stories ...... / · ti F t~ Re ~ D pth ''''''r ....... Hmmnsmns o e w construc on: rent .......... ar ........ e ... (..fi~/.. eight .... .~.~ ......... Number of Stories ....... ]. ~ .................... ' ..... 9. Sizeoflot Front ~.,C~ . ~. ..... . .... ,, ........... t~ear ....... Or/~. ...... Depth., 10. DateofPurchase .~dq~At,~ [.j, [.~.$.~ .... , ~ ................. 11. ' ' ' ....... Zone or use d~stnct in whicli P~'emises are situati(i.. "3Nam'e-'°f FjormerzOwner Ptit.~l. igl~t..~. ~J.~l.n ff. .... .t~. ~ .t ?!.~. F.. 4 ?/. ............... : ........ 12. Does proposed construction vioiate any zoning law, ordinance or regulation .... 13. Will lot be regraded . . hal, , . : ............ ., '' .' ': t f ' ' ' %'*' °l ~' ' ' '~4 ..... WIll excess fill be removel;l from. premises: " 14. ~'~ame of Owner of prem~ses/r/~ ~s Lind ~'r;~t].... Address ~.~t~ .~.-.~..*YflJt .~/.~.~. ~(~l[/one Nor/.~ .~.~-./.: .~.7, .4.q. Name of Architect ......... ' ................ Address .... , ....... Phone No .......... Name of Contractor l?q~.~.e~., .~.'.e.~./ ....... Address.. Obl~.¥~. ......... i Phone Nog'-~6 ,_-~'z. 3 ;-3 ~'~,~ ',~ IS.IS this property loc,ted withlu 300 feet of a tldal wetland? · If yes, Southold towd ~rustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate a/l set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, $.S COUNTY OF .... "'d'Ft/"'.~. ' (Name of individual signiilg contract) OCCUPANCY OR USE IS UNMVVFUL W THOUT CERTIFICATE OF OCCUPANCY being duly sworn, deposes and says that he is the applicant above named. ~ (Contractor, agent, corporate officer, etc.) ...... of said owner or owners, and is dul~ author/zed to perform or have performed the said work and to make and file this application; that all statements contel'ned in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannerlset forth in the application filed therewith. Sworn to before mc this ~ NOTARY PUBLIC, Stale o~ Now Y~r~ . ~, ,~. .................. Term Expires Mmdt-,~t~-I~T I (Signature of applicant)