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HomeMy WebLinkAbout16777-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUP~NCY No Z17442 Date OCTOBER 20~ 1988 THIS CERTIFIES that the building. ADDITION Location of Property 7895 SKUNK LANE CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 104 Block 04 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEB. 23~ 1988 pursuant to which Building Permit No. 16777Z dated MARCH 9, 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 ADDITION TO AN EXISTING ONE FAMILY DWELLINg, The certificate is issued to DOLORES H. & ROGER V. KALLER (owner, ~) of the aforesaid building. SU~OLK COUNTY DEP~/{TMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N038251 OCT. 6, 1988 PLUMBERS CERTIFICATION DATED N/A BuildingUInspector Rev. 1/81 FOBM NO. 0 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°_16777 Z Permission is hereby granted to: .~..~.~.~;......~.r...& ....... ~.~......~.~ ...r~td;~..~_....~.:~........u..~..~.~ ..... ~.~.~.....~.....~¢~....,~ .............. ~ ............................. : ................................. ,t premises Iocate~J at .,."'~.,.~...~..~. ....... S~./~.....C~....~,.....~~.~ ............... pursuant to opplicotion doted ..~..~~I[¢~..q~.~ ............... , 19.~.~..., ~nd c~pproved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southotd, 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 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 $25.00, Accessoryi$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ,,.j 0~¢'/ 5.Updated C.O. $ 50.00 Date .,..~.'~.~yT...~..~..,./.?..~.... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...... "~. . ~. . ~.,~'""'. . . . . . . . . . . .,.,~./.~. .[~. .~. ~. . ,~.4.'~/.,~. . .~. .~. .~. .¢-'¥.~. ..~. ?~. . .-~-y /f¢~,¢'~ House No. ~)dk0/~ E-~ ~ Street Hamlet ....'?."..':: ?.'... ? .... :--.?-.. :/.. ......... 2 ............ Owner or Owners of Property .,?~., -~ ..... ~..~ ~ d'.,-,,__~ ~ /¢'/~-A/,~z;E' ....... ... County Tax Map No. 1000 Section ... ~..~.~. ...... Block .... .~-J.~. ....... Lot.. ~.~.. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~.7.?.7.. Date of Permit .~..Z.~.~.~.'.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 m~ets all applicable codes a~J re~gu/lations. Applicant. t;. ?~.~. ~--~ ..~....~ .~/.~/..~.~ ......... Rev, 10-10-78 ' / // FOUNDATION (1st) FOUNDATION (2nd) 2. 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 REMARKS: FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND []INSULATION ~F~MING []FINAL /c~777 ~ × BUILDING DEPT. / INSPECTION [ ]/~)UNDATION 1ST { ] ROUGH PLBG. / [~,/] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ . . £)C'~'O}~I";R 06,1~93~IS JOHN STREET NEW YORK. ~/~38 N 0~5~ " ~t~ ~ppl~tion No. on file THIS CE~IFIES THAT ~y t~ ~t~ ~u~ment ~ ~c~ ~ ~ t~t~ by t~ ~t ~M ~ t~ ~ ~t~ ~.m~r ~ ~ ~ of ~ examifl~ on ~dyound to ~ in ~m~ian~ with the r~uirements oy th~ ~. gXTUlm FIXTURES RANGES OVENS IXHAUST FANS DRYERS I~IINACE MOTORS FUTURa W FIBliS TiM CROCKS WJLTI4UTIJT WIS SYSTIMS NO. O4~ NIT SIRVK:I IXSCONNICT S E R V I C OTHH AFPARATUS: P.O.BOX 305 hAWREh, NY, 1194g Per This certificate must not be altered in any manner; return te the office of the Board if incorrect. Inspectors may be identified by their credenflels. COPY FOR BUILDMG DEPARTMEHT. THIS COPY OF CERTIFICATE MUST HOT lIE ALTERED It4 A~Mj~ER. 3 SETS OF PL,ANS . .~...1~.... BUILDINBDEPARTMENT ~PTIfi ~0~M ........ : TOWN HALL NOTZFY SOUTHOLD, N.Y. 11971 CALL TEL.: 765-1802 Examined..~~...~ .... 19 ?3 Approved 19 . Permit No. Disapproved a/c ..................................... (Building Inspector) MAIL APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This 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 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 shail 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 building, additions 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 necessarYriospections. ................ (Signature of applicant, 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 (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S MUSTg~ ~.7Og .C~.~UNT¥ LICENSED Builder's License No .................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done~ ................................................. . . .U. .......... ..... . ....... House Number Street Halnlet County Tax Map No. 1000 Section.../..~). ?]f.. ........ Block ....~. ............ Lot...4,~.¢ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended ose and occupancy of proposed construction: a. Existing use and occupancy . ~ .d//-d~. ·~ b. Intended use and occupancy .......... ~ ....... ~ ................... 3. Nature of work (check which applicable): New Building .. ' Addition . j Alteration Repair......,....... Removal .. .... ........ Demolition .............. O[Jit~lX~rk~ .,. ............ o ~ · ~ (~Descriplion) 4. Estimated Cost ....... ~l .......................... ~ ~.O, .~..~. Fee ...................................... i ' (to be paid on filing this application) 5. If dwelling, number of dwelling u'nits ..... jry/.~.... Number of dwelling units on each floor ................ If garage, number of cars ...... i .................................................................. 6. If business, comnercialormixedioccupancy, specify nature and extent of each type of use ...A.f,,~i .............. 7. Dimensions of existing structures: if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... i ' Height ...... '-' ' ' t ........... Number of Stories ............. t.~. r/ ..... 8. Dimensions of entire new construction Front . ~.~.O ' . Rear . . Denth .~1 . ~. Height . ~.[ . Number of Stones ....... ,'~,//~ ............................... 10. Date of Purchase ..... ,~' '?~-' 'i ................. Name of Former Owner . .f~-.~..~..77~...~. ?..Ar. ].~h ..... 11. Zone or use district in which premises are situated .............................................. ... .... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... : ................ Address ................... Phone No ................ Name of Architect . Address Phone No. Nmne of Contractor .......... 1 ................ Address .... : .............. Plione No ................ 15. Is this property located w£1:h±n 300 £eet of a t±dal wetland? ~Yes ..... No ..... ~'rt~ yes, Southold Town TruStees Perm±t maybe requ±red. , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S ..... ~.V.© ¼o. V~ .~.~..~ .~,~. ~. ................... being duly sworn, deposes ~ind says that he is the applicant (Name of individual signiog contract) above named. He is the ...................... ! .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said Work and to make and file this application; that all statements contained 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 me this NOTA~ PtlBLIC, b'lat00f New Yor~ (Signature of applicant) No. 4707878, SuffOlk County~'~- Term Expires Merch 30, 19~L~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [/~INAL REMARKS: ~ .'-fY"" .". ~., ~ /1,-,~ ~/] ,--ff"- . , DATE