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Home My WebLink About17468-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Ot: Occupancy No. Z17.454 Date October 26, 1988 THIS CERTIFIES that the building ....A.q .c.e.s.s.o..r:y .................................. 37130. Main Road Cutchogue Location of Property .............................................................. House No. Street Ham/er County Tax Map No. 1000 Section . . .8..5 ....... Block . .0.3. ........... Lot 0 3 Subdivision ............................... Filed it{ap No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept. 2 I, 1988 pursuant to wh/ch Building Permit No..17468Z dated .8.e.p..t :..2.7.., i .1.9.8.8. ........... was issued, and conforms to an of the requirements of the applicable provisions of the law. The occupancy for wlfich this certificate is issued is ......... Accessory shed. The certificate is issued to RICltARD BRUCe. LEBKUIICItER ..................... io¥,3), ~~ XYX ................. of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO .......... Iq/A PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 0:~7~68 Z Date ...~....~..~.,. ........................................ , ~9 ....... -/ Permission is hereby granted ~:, j ~ . ~ ..~..z..~.~._..~ ........ ~ ........... at premises Iocoted at .,.~.....~.../,.,,'~....~.. ...... ~.,'......~...-.~ ............................................... County Tox Mop No. 1000 Section ......... ~...-~'.....,.. Block ........... ~ ..... Lot No .......~. ............. pursuant to application dated ........ ~..~.....~.~.. ................................ , 19~..~.., 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 ~ ~ 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 pZoperty 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 $25.00, Accessory ~$~0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling ~ ]00.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.wo t o.o. 20.00 5.Updated C.C. $ 50.00 Date ....................... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ' House No. Street Ham/et Owner or Owners of Property .................................................. County Tax Map No. 1000 Section ..... ¢/~..~.. ..... Block ...... ~/ ........ Lot ..... ~.. .......... Subdivision ................................. Filed M~p No ........... Lot No .............. Permit No. /.7/~Z~ ~-Date of Permit ?.~.~-~f~.?.C~.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 permit~meets all applicable code, s and r~gg)tations. /¢ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~AL ________~REMARKS-. ~ DATE TOW? OF SOUTHOLO FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765'1802 Disapproved a/c ..................................... INSTRUCTIONS BOARD OF HEALTH / 3 SETS OF PLANSj.J.~.. SURVEY · ......... CHECK ............. SEPTIC FORM / MAIL TO: a. Tiffs 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 pl~ show~g locanon of lot and of build~s on premises;~hbns~.n t~~ or pubic streets or areas, and ~vm, a detmled descnptmn of layout of property must ~:d~a~;~i~l~(~ ~l~an of t~s app~- c The work co~ered b t~s a 'h~ati~n ma h ......... d. Upon appgoval of this application, the Buildihg Inspector will issfi~,~;~t~'~the appHc~t. Such pe~it sha~ be kept on the premises~'avaflable for ~s~ection throu~out the wo[k.~:~;r '. e. No bulldog shall be o~dqpied ~o~ u~ed in whole or in part for an~-~A~tever until a Ce~ificate of Occup~cy shall have been grant6d by the Butld~ :Iaspector. ~PLICATION IS HEREBY MADE to the Building Dep~ment for the Building Zone Ordnance of the Town of Southold, Suffolk Count :able Laws, Ord~ces or Regulations, for the construction of build~gs, a~ditions or alterations ~t~re~ described. The applicant agrees to comply with all applicable laws, ordinances and to admit authored ~specto~ on premises and ~ bulldog for ' if'a'c'o~porarl~n') ' ' ' · . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. : .................. ':4'"FI;5 ':':'f ................. ' .................. Name of owner of premises ~,A~..~..... ~~ ............................... ~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....°5.~ ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade s Ltcense No ...................... fl ' Location o and on which proposed work will be done. . ........................ 3. 7./z .... ......................... ................... House Number Street County Tax Map No. 1000 Section OC~ ~"-' Block .~. ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of/r)premiscs and intended use and. occupancy of proposed constrt ct on: a. Existing use and occupancy .. ,,~f'~"'/~. ..... ' b. Intended use and occupancy ~ ............... ,3;.: Nature of Xvork (check ~vbich applicable): New Building ' . .... i ' ........... Additioi ..... /dtera ion ... ~ ~ Re air ...... / (tc be paid on filing this application) '~5. If dwelling, number of dwelling units ................ Nnmber of dwellin lunits on each floor ........... : If garage, number of cars ......................................... 6 If business ............................ commercial or mixed occupancy · , cspecffy nature and extent of eact~ type of use · D~mansxons of existing structures if any: Front Rear ..... Height Num[~er of Stories ................... ~ ......... Depth . Dim,'ensions of same structure with alterations or additions: Front ......................... ' Rear Dep,th ...................... Ileight ........................... Dim:ensions of entire new construction: Fro~t' ................... Number of Stories ................ Height Number of Stories Rear I Depth Sizeiof lot- Front ......................... ~ ........................... Rear ' Depth Date of Purchase Name of Former Owner Zon~ or use district in which premises are situated ~ P tic .................... . ............................. Doe reposed construe n violate any zoning law, ordinance or regulation.. ~ .............. Will !ct be regraded ........... · .......... i f P ................. Will excess fill be rem6ved from premises: Yes Add ' PI Name of Owner o remises ................ ress ............ [ ...... rune No ....... i fA hit , Name o rc eot ................ ,~ .... Address ......... ~ .... Phone o ......... N ................ am o ontractor .................. Add ~hi ty ' ' 'i~:hi .... tess ........ Phone No. .. 'IS.Is s proper located w n 300 feet of a tidal' ,wetland? YES .... NO.. ~If lyes, Southold Town Trustees Permit may be required. PLOT DIAGRAM · Locate clearly and distinctly all buildings, Whether existing or proposed, and[indicate all set-back dimens~, property lines. Give street and block number or description according to deed, and show street names and indicate whet interior or corner lot. · 8. 11. 12. 13. 14. OCCUPANCY OR 4. FINAL . rC,,,ONgTRucTioN MUS? USE IS UNLAWFUL ALL CONSTRUCTION ~HALL' WITHOUT CERTIFICATE ..ou,.....,. STATE CONgTRUCTION A OF OCCUPANCY co,,,,. .,-- DESIGN O~ CON~'r~ucIION STATE OF NEW YORK, COUNTY OF ................. S.S (Name of individual signing contract) above named. being duly sworn, de ,oses and says that he is the applicant He is the ............................................................ (Contractor agent corporate officer etc[) ............................ of said owner or owners, and is duly authorized to perform or have performed the isaid work and to make and file this application; that all statements contained in this application are true to the best ofh s knowledge and belief; and that the work will be performed in the m~ner set forth in the application filed therewith. Sworn to before me this ..... / or~!~{)~, ~' ' W ....... N°ta~~'~7~ ...