HomeMy WebLinkAbout17222-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217174 Date AUGUST 12, 1988
THIS CERTIFIES that the building ADDITION
Location of Property 325 HORTONS LANE SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 063 Block OS Lot 17
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 7, 1988 _ pursuant to which
Building Permit No. 172222 dated JULY 18, 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 ROBERT W. & CAROL R. BROWN
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
Building In ector
Rev. 1/81
Foaat xo. s
TQWN OP 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)
N~ 17222 Z Date ......~....I...A 19.
Permission is hereby granted( 4IC,~'"~J'`/x~~~
0 4:%~:r:-:4!~`.~:~°.....s3~..s'~.-.Y.:?r~.....q..a~~4-4M,cit~.. ~'V Q,^'1.....Q.~sErs+....1
at premises located at ...s~..~.,~........1.~ ....:R:?¢:r!A
...........................................................................2....................................................................................
County Tax Map No. 1000 Section O ~.s~r..-.~.. Block ~..r~..~...... Lot No.....l..7
pursuant to application dated 19~~., and approved by the
Building Inspector.
` i
Fee ~
.......l..C Q.V.C7.. a2
.
Building Inspector
Rev. 6/30/80
.e.~,
~l ~ ~ FORM N0. 6 i, , ,
TOWN OF SOUTHOLD , " ~
Building Department iUl
Tawn Hall ~
Southold, N.Y. 11971 TOWN OF'SOU~TF'10
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted to the Building fnspec-
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 Pept. 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 installs-
- 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 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ ] 0.00
4.Vacant Land C.O. $ 20.00 Q JJJJ
5. Updated C.O. $ 50.00 Date
NewConstruction,,,,,,OldorPre-existing Building Vacant Land
Location of Property ...................../"~`iYli3~/?5..L!Q............~O.U?"r~c!~
House No. Street „ Hamlet
Owner or Owners of Property l.E'~~I~t~~ f.7~. t..,ryr~.
S-/ .
CountyTaxMapNo.1000Section Block Lot....
Subdivision Filed Map No. Lot No. - - .
Permit No.~~..~?~ . Date of Permit I~~~Applicant ..F..t ..Cs~~ :ems'-
. . . . . . . . . . . . .
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 m s all app'//a//ble~~codes a gulations.
Applicant L~~!{.,,!~~'~ .
Rev. 10-10-78
g/~y/~~
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7sS-1802
BUILDING DEPT.
INSIPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ~INAL
REMARKS: O~ ~C~ (~D~ ~ .
DATE ~~INSPECTOR Go,,,;D
~L~~ dj"-_
~,w~,
~L,\ .,LLL BOARD OF HEALTH
j . . .
J , v FORM NO.1 SURVEY OF PLANS J.. , , , , ,
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC r•oart
®t-Dw~~G•
pE4'T• TOWN HALL
70WN OF 50t71'FIOLD SOUTHOLD, N.Y. 11971 NOTIFY D~
TEL.: 765-1802 CALL 7~~. ; ,ld~,~~, , , , ,
n ,
Examined . 8 19 MAIL TO : .
Approved ~~f , f. 19~~. Penni[ No.. ~ ,7,112' b' ~
Disapproved a/c 7 `~l~J
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 15 .
INSTRUCTIONS
a. Tlus 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
cr 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, Suffo]k County, New York, and other applicable Laws, Ordinances or
Re;ulations, 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 c4de~,+li'otisin~ code; and gulations, and to
admit authorized inspectors on premises and in building for necessary inspectio
~s%'.r~... . .
(Signpntre oI applicant, or name, ifa corporazron)
.i.t~,(I~p~ltngraddress''o'f appli~ar~~\ .
State whether applicant is owner, lessee, agent, azchitect, engineer, gene c t~~;I~D~li~r or builder.
r~ r- ~j r3~b'~ ~k°iAf~i~~'~5~~
..........................4 Sig.... .6i~?+t#~
yY?Ll3Ji iSEUT31?ilf3~.,~
r--~ -,t~
Name of owner of premises ~ ~ µ t , ,I JOCCJGV,~ : ~N~()(~t?
.a ~ti,(as on the tax rol~c~ lit d
if applicant is a corporation, sign ~ f~, ;h.Qrt~z d'rf(~er. ~ ~
!~4 ~ A[1
Name and title of corporate officer)
Builder's License No. , .J:~~ ~ , , , , , , , , , , , , , .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
I. Location of land on which proposed work tvill be done. , ~-?s~,S , ~'7~J ~ 1
O/J $ /~~i _
1
I{ouse Num bcr ~ Strcet\ " " " " " -
/ ~ Hamlet
County Tax N1ap No. 1000 Section Block S. , , • • , , , , Lot
Subdivision F.ilcd Afap No.
Lot...............
(Name) 't
State existing use and occupancy of premises and in [ended use and occupancy of proposed construction:
a. Existing use and occupancy .......~5.), ~ MC..~..... ,
b. Intended ~ )~~?sV~~ ' ~ • '
use and occupancy
i
3• Retair of work (check a•hichmpplicable): New Building , , , , , Addition , Alteration
p Rc ~ oval
Demolition ............'Ot`li`c~1~Ur>~G(C,,
4. Estimated Cost ~~(~Q ~Q, ; U~ , , , , , • . • . • • • • (Description) •
Fee
5. If dtvclhn~, number of dwellin I (to be paid on filing this application)
~ units , , , , , , , , , , , , , , , Number of'~lwelling units on each floor...............
If garage, number of cars .
6. Tf business, commercial or mix' d occupancy, specify nature and exterjt of each type of use . . . . • , , • , ,
7. ~`mf>Ysions of existing stru NU~es, if any: Front , , , , , , , , , , , , , • . Depth .
R~ar
~nberafStorics.
Dimensions of same structure with alterations or additions: Front . , ~ . • • • • ~ • • ' ' • • ' ' '
Depth . Flcight . Rear .
8. Dimensions of envirc new const • • i ~ Number of Stories , , .
niction: Front . • • • • •Re~r /.7, .Depth . /`i, . .
Height JQ , Nu{rtber of Stories . !~!~!}!6 ' • • • • • ' '
9. :iize of lot: Front .....~~.r, Rear . . 7~ ~ .
J Depth
ate o Purchase
p ....Name of Fo er Owner • •
8
1 I. lone or use distract in which rlatesan a zoning law, ordinance or re ul • • • • • • • • ~ • • ' • • '
!2. Does ro osed construction vio
p p y g tion: R/d
13. Hill lot be regraded C.? Will excess f
lil be removed from premises• Yes ~N
14. Name of Owner of premises :
(eu,fi~/~' GV,, ~ jui%e~„y~~dress 4~.
, O,(/3 1f1.
Name of Architect • • • • Phone No:~ 76S-~OF~ L'"
Name of ................Address Phone No........... .
Contractor
15~I's this property loci •••••"'•••.Address. i......•„•,,.PhoneNo........
~ted with in $00 feet of a jtidal wetland? *YES... N ,
Xf es Southold Tow.
Y . P Trustees Permit may be required. ~ -
PLOT DIAGRAM
Locate clearly and distinctly alj buildings, whether existing or propolsed, and, indicate all set-back dimensions from
property lines. Give street and blockinumber or description according to de~d, and show street names and indicate whether
interior or corner lot.
•
~~,,;~1~•,~n,~S~OTfq
~~i'E~ ~ /8 8b' 9,P,U .Z..0.-Z'L ~
Fc. _~S~D• '-._..~ktt'
NC)TIFY t3U1L01NG OEPARTMENT~gT
785. 1842 9 u\M TO 4 RM FOR THE .
FOLLOWING INSPEeTtbryS.
I• FOUNDATION TWb REpU1RED •
R~MLIRERCONCRE'1•E i .
8 1N8ULAA 1 pWMeMFp
i. iINAL - CQNllTgllt'}'MONMDST
~ M ACCUPr~i
~ ~ ~ ~ I1SE IS il~;
~tAWil"U~
~ ~ W~ q~ UT CFRTIFICIl~'~
STATE OF NE~V YORK, ~
COUNTY OF 'S 'i
,nit • • • • • • • • • • • • • • • • being duly st', orn, deposes and says that he is the applicant
(Name of individual sip ~~~g contract)
above named.
He is tJtc ~ j
of said ownc
~ (Contractor, agent, corporate of icer, etc.) • • • • ' '
r or owners, and is duly',authorized to perform or have perfor~ ed the said work and to make and file this
application; that aft statements contained in this application are true to the ~itest of iris knowledge and belief; and that the
work will be performed in the manner set forth in the application filed thcrct ith.
Swom to before me this I
......:.........7~ ~y of.'i.. , ~~~8~.
1`otary Fublic, y~
i L!~, County ~
HELEN K DE VOE 1 ...Fw• ; .
~N~4~TBj~g,jhCeu~
~ (Signature of applicant)
Term Expires Mereh 30, I>~ -
I