The URL can be used to link to this page

Home My WebLink About20623-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z~29485 Date: 06/03/03 THIS CERTIFIES that the building ADDITION Location of Property: 865 NEW SUFFOLK ROAD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 109 Block 7 Lot 3 Subdivision Filed Map No. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 30~ 1991 pursuant to which Building Pern~t No. 20623-Z dated ~3kY 14~ 1992 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 REPAIRS TO AN EXISTING DECK ATTACHED TO AN EXISTING ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to JOHN J CHALONER (OWNER) of the aforesaid building. SUFFOLK COUNT"f DEPARTMENT OF H]~ALTH~-PPROV~J~ ELECT~ICAL CERTIFICATE NO. PLUMBERS CERTIFICATION D~rmu N/A N/A N/A Rev. 1/81 rOB,Bf NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-°N.° 20623Z .~_./_~....:.~,~/~::~ ..., .......... ~~.~....:.~ ................................... ................................... County Tox Map No. I000 S~ction ......... ...//..~..?. .... Block ........ .~...'./~....... Lot No ........ .~.....,."~.. ...... pursuant to oppli¢otion dated .......... ~...~../~.....~. ............................. , 19.?../...., Building ,n$.ector. ~ ///"~"//~'f Fee $...~-..~.~-~ and approved by the Rev. 6/30/80 Form No.'6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposai(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 DECK Construction .... .. .. ... Old Or Pre-existing Building .... ..× ........ ... ,ocation of Property ..... BBS. N~.SuffO3k. B~¢ ....................... . ... . qu~q~ogue~ ....~ ...... House No. Street Hamlet ,nwer or Owners of Property tiPS? J' Cha~onep ;ounty Tax Map No 1000~ Section ............ Block .............. Lot ...................... N/A N/A ubdivision ....... ~ ..................... Piled Map ............ Lot ............. 20623Z 5L 14/3~ Oohn O Chaloner ermit No .......... Date Of Permit .... Applicant. · ..... ealth Dept. Approval ...... ~/& ........... Underwriters Approval .... ~6 ......... fanning Board Approval ...... ~ ........... .. .. Updated :quost for: Temporary Certificate ........... ~a~ Certicate...~. ....... 'e Submitted: ~j'~'~4~''''''''''': ~h~ &o .............· --- ' " OCCUPANCY OR USE ~S UN~WFUL WffHOUT CERTIFICATE OF OCCUPANCY 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ] INSULATION FOUNDATION 2ND [ NAL FIREPLACE & CHIMNEY DATE / J ' INSPECTOR ~OUNDATION (1st) ~OUNDATIO~; (2nd) ~OUGH FRAME & .FLUMBING ZNSULATION PER N. STATE ENERGY CODE Ye FI;;AL ADDITIONAL COMMENTS ~)~ FORM NO. 1 TOWN OF SOUTHOLD o - BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... .~. ......... 19 .~. ·Z ""~' '~' ~" '~' ~'/~ Approved .~./4~. ......... 19./~,~ Permit No. Disapproved a/c ..................................... APPL~C^T,ON FOR BU,L~,NG ~'ERM,T BOARD OF HEALTH ......... 3 SETS OF PLA~S SURVEY ................... CIIECK .................... SEPTIC FORH .............. t;OT I FY: CALL ................... HAIL TO: ~0 '~ ,, Date..)/f ............. , 19.c[.~. INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter orin ink and submitted to the Building Inspector, with 3 ,ets of plans, accurate plot plan to scale. Fee according to schedule. b. Pl,ot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub;dc streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. ¢. The work covered by tiffs application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ,hall 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 ,hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County,.N-k'W'~'ork, and othe. g..~aO~licab.l~.,Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterati96s/!or f~r removal45? dem61i, tio,n~.'as herem described. Fl~e applicant agrees to comply with all applicable laws, ordinancel, )~uildin~ ~'ng~,, d~d regulations, and to ~dmit authorized inspectors on premises and in building for necessary~spec~'s( x% ).//~/,~ , , · · '1.~; ......... : ............ . ......... .* ...... -' (S{gnature of appJ. i, cant, or name-if a_corporatmn) ~:z~-~'/-,~ 6J-,x~'VzH,wn'~ pr~g~.~ PC- , .... ~.T.~..~.: .~y?....c-~....~.o~q. ~: .c..,.~..~.~d~a....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... t~7.r..o.e..o.~..~..... ~ g...~.~..~: .~g ................................... : ........................ \'amc of owner of premises . .~..Q .L~.. ~.? ..... .Q:.~..~.L..~.~. ~. ............................................. (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..LA-..N. ~.N.O...~../~. ........... Plumber's License No..LI,..~. t:'&..~'.O. ?..4. .......... Electrician's License No... ,~..~..~.., '. ............ Other Trade's License No...J~,:.~..' ............. Location of land on which proposed work will be done ......................................... ' ......... · ~ ............... .r9..~....4..~...~-. ?....g.o. ra~ ........ .c.o,~..~..,~ .,~ ..... .~.~.V.. ........ lIouse Number Street Hamlet Coun,y V~.~ Map ~o. ,000 Sec!ion ...t..0.~ .......... U,oc~ ...C?...~. ........... ~ot...0.3 ............. Subdivision .......... ](V:..~..~ .................... leiled Map NO...~. :.~..' ....... Lot...~..'.-~-: ...... (Name) State existing use and occupancy of premises and intended use and occupancy &proposed construction: a. Existing use and occupancy ......... ~ .~.~.~.. 0.~..~..~..~..L- ......................................... b. In,ended use and occupancy ........... ~..O. ?..~..q.c. ....................................... _% Nature of wo[k (check which applicable): New Building .......... Addition .......... Alteration ......... _._ges~r .,..~'. .. Removal ......... · .... Demolition ............. Other Work ...... ~. ........ ....... ~ (Description) ~/ . Fee ............. .' ............................. (to be paid on filing this applicatw ) 4. Estimated Cost ~ ppg ~ ........ ,, - tdwe in- units~ ~B¢9 C'~ffmber of dwelling units on each floor. ~ ........ 5. If dweuing, number o u.~ ............... , ............... ~... ........ If arage, number of c~ CN ~ ............ .;' · ': ..... [ '-':-~Uc'~c~'t;~ of use ~D~' ~ ... g mercial or mixed occupancy, specuy nature ano extun~ 6.' If business, cpm ~ ..~a ~R~ ~r 5~ '~ ~ . Depth . .- ............. 7. Dimensions of existing structures, if any: eront ¢~,r ........... ~ ........... ...... ~ 0 ~,~ Number of Stones .~ ............. ~'2~'d ' ' ne gat .............. . . , , ....... Rear ~ ............. D~cnsions of same st~cture with alterations or additions, Front ,~ ........ . ...... ~ Heioht ~ ....... Number of Stones ·..~ ............... Depth.~o'"~ ............... ~X "' ;er ~)~'(~.. Rear .... ~ ......... Depth ,'.; ......... 8. Dimensions of entire new construction: Pront . i, · ,*.0 ' ' u~ioht ~-.. . . Number of StoneS ....... %'~' ~[)~'~k~' nonth %~g. ~ ~-~ ....... 9. Date of Purchase . .[d~//~ S~ .................... ~'~ ............... r ................... ........... Will excess fill be removed fro~ ~rem~ses: 13. Will lot b, regraded .. ~. ~;~.~.~ ~bC~,~a ~ddress%Cq N~ 7¢F~g'~q~°ne No ................ N~e of Owner of premises ........ --.' ....... ' ' ' ' 14. ,, Phone No ................ N~e of Architect . ~ ~.'. ................... Address ................. .. Phone No ................ . ~. . . Address ...... N~e of Contractor .... ~ ............... [5. Is this property within 300 ieer pi a tida1 wetland? ~Yes .............. ~If yes, Sourhold Town Trustees Per.it may be required- PLOT D[AG~ Locate clearly ~d distinctly ~1 bulldogs, whether existing pt proposed, ~d indicate El set-back d~ensions from propertY lines. Give street ~d block number or description accord~g to deed, and show street n~eS and indicate whether interior or comer lot. NOYtr/ 8U..D~G ~E~,~T~T AT l, FOHND~T)O~ ~VO REOUJRED FO~ POLIRED CONCRET~ 2, ROUGH -FRAMtNG & PLUMBING 3, INSULATIO~ 4. FiNAl. CONSTRUCTION MUST BE COMPLETE FOR ALL CONSTRUCTION SHALL ME~ THE REQUIREMEN~ OF THE N.Z STATE CONSTRU~ON & ENERGY CODES. N~ RESPONSIB~ FOR DESIGN OR CONS~UCTION ERRORS rUNTY OF .~.gP~A~- ....... ~ ~ _ ~~nt ~L C: ...... ~ ........... bei,g duly sworn, aepose ~ >a~,, 'e~ ...................... (G~ru ~o~t~ ___~____~ .~..~:4 ..... ~. a~d ts .=~c a~ file this _ , ~d is duly authorized to ~ or h,vc v ........................ . . tree to the best of his ~owledgc and bebef, ication; that all statements contained ~ this application are ill ~o before me this ...... ..... ...... ' Public,'.~ ~fi~r~'~x" .~ ..... z'' R ...'... VmGIN~ ~GINN ~,,~ S~ ~ ~i~ ~¢gL C ~%~(Signature of applicant) Oua/ifl~ in Suff~l ~W ~missi~ E~ires M~ch 23, 1~ ~