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Home My WebLink About16863-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z-16791 Date April 12, 1988 THIS CERTIFIES that the budding DECK ADDITION Locatlon of Property 1195 Crittens Lane Southold, New York House/Vo Street /~am/et County Tax Map No. 1000 Section 070 .... Block I I . .Lot 02 Subd~vimon ....................... Filed Map No ...... Lot No ............ conforms substantmlly to the Apphcation for Budding Permit heretofore filed In tlus office dated March 14, 1988 pursuant to wtuch Bmldmg Permit No 16863 z dated . .M.a.r..ch. 25. ,. 1.9.8..8 ..... was ~ssued, and conforms to all of the reqmrements of the apphcable prowmons of the law. The occupancy for wtuch flus certfficate is issued m ...... DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR JOAN BLANCUF IELD The cerhficate is issued to .............. /o.~nbb,.f~F~X~f ............. of the aforesaid building Suffolk County Department of Health Approval N /A UNDERWRITERS CERTIFICATE NO.. N / A N/A PLUMBERS CERTIFICATION DATED: Rev. 1/81 TOWN OF 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°-16863 Z Perm,ss,on is hereby gran~ted,,t~' ./Z~. .~..~ ..................... ............................................................. ~, ~,~, ,=,.~ ~, ..~z/~~~-_/~ ........................................... ........................................... ~~~/ ......................................................... co~.~ ~ M~ No ~000 Se~,o~ ~ ~P ~k ......... /~... ~o~ No ........ .~.~ pu~uant to application dat~ ..... ~ ...................... , 19.~ and Budding Inspector. approved by the Rev 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Bu ~lding Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATIO~ FOR CI=~TIFICATE OF OCCUPANCY A This application must be filled in typewriter OR ink, and submitted m ImiimmI to the Buildmg 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 dmposal--(S-9 form or equal) 3.Approval of electmcal ~nstallation from Board of Fire Underwmters. 4. Commercial buddings, Industmal buddings, Multiple Remdences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the budding. 5.Submit Planning Board approval of completed site plan requirements where apphcable. B. For existing buddings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses. 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condibon of buddings. 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. Certlficate of occupancy New Dwelling $25.(10, Accessory '$10.00 Business $50 O0 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certlflcate of occupancy $ 5.00, over 5 years $10,00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewConstruction .... Old or Pre-exmtmg Building .......... Vacant Land ............ Locat,on of Property . .1. i.? 5..C.r ~..t ?.e, ns.. L.a.r.~ .e ............................ House No. Street Owner or Owners of Property ,]OG;~..~ ]~ ~,D.c.[.~ .~.l.e.~.d. ........................ County Tax Map No 1000Section .,.QT.Q ...... Block..............il Lot Hamlet 0Z Subdwm~on .................... Fried Map No ........ Lot No .............. Permit No. [~.8.~,3... Date of Permit . .3/.~.5./, 88.Apphcant Jp.a,z~,. D,~.a, rt~b~,%~J,~J .............. Health Dept. Approval ................... Labor Dept. Approval ....................... Underwmters Approval ....................... Planning Board Approval ...................... Request for Temporary Cert~ficete ................. Final Certffteate ...................... Fee Submitted $ .... 2.5. :.0.0 .................... Construction on above described building and permit meets all apphcable codes and regulations. Applicant..~..~:t.~~'~.~.. ....... Rev 10-10-78 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N Y. 11971 , ~ TEL.: 765-1802 Examined~,,3/'~0. s"l.~. ~. ..... 19 Disapprove8 a/c ............ BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL MAIL TO. APPLICATION FOR BUILDING PERMIT .., 19: INSTRUCTIONS a. T?us application must be completely filled m by typewriter or ~n ~nk and submitted to the Bmldmg Inspector, w~. sets of plans, accurate plot plan to.scale Fee according to schedule ' b. Plot plan showing location of lot and of binldmgs on premises, relationship to adjmnmg premises or pubhc str or areas, and Dvmg a detatlell ilescnptmn of layout of property must be drawn on the d~agmm whmh is part of flus a! cabon ~ ~ '. f~,[,",~'l'~,TM c The work covered by t~'us appl~at~on may not be commenced before ~ssuance of Budding Permit. d Upon appJco~I ofgtu$ apphcatton, the~Bmldmg Inspector wdI issued a Bmldmg Permit to the applicant Such pet shall be kept on the premises avafl[tb.le_ for ,m~lpect~on throughout the work e. No buildihg sqi~I1 l~e' ~c'~up~ed'or (zsed ~n whole or in part for any purpose whatever until a Certificate of Occupa shall have b, ee~ granted rb~ the"'Bmld[~ ~spector APPLICA~'ION iS HEREBY MADE to the Budding Department for the issuance of a Bmldlng Permtt pursuant to Bmld~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulatmns, for the constructmn of buddings, addlhons or alteratmns, or for removal or demohtion, as herein descnl The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulatinns, an, admit authorized inspectors on premises and m bmldm~ for p?ceqsa mqrmCtlr~s ' ~ture of, apphcanl, or name, if a corporanon) (Mailing address of applicant) State whether applicant ~s owner, lessee, agent, architect engineer, general contractor, electncmn, plumber or buff, Name of owner of premises~ ~-~.~-~-~?'L/~ '~-~. ~'e-~~ .... (/ z-- (as on th~'fix roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer (Name and title of corporate officer) ALL CONTRACTOR*S MUST BE SUFFOLK COUiSI~Y LIUEI'ISIED Builder's License No Plumber's License No Electrician's License No Other Trade's License No Location of land on which propos, ed work will be done Itouse Number Street County Tax Map No i000 Section Block Hamlet It . .. Lot Subdiv~sion Fried Map No ..... Lot ... (Name) State existing use and occupancy of premises and Intended use and occupancy of proposed construction a Existing use and occupancy / ............. b. Intended use and occupancy - (, Nature of work (check which apphcable) New Bufl&ng Repmr . Removal .... Demolition Estnnated Cost If dwelling, number of dwelling units .. If garage, number of cars ..... Addition S'~.. . Alteration .. ·. Other Work ...... (Description) · . . .. Fee..... .. ..... . .. ..... ... ' (to be paid on filing this application) / .. Number of dwelling units on each floor ......... If business, commercial or mixed occupancy, specify nature and extent of each type of use . Dimensions of existing structures, if any Front Height Number of Stories .... Dunenmons of same structure wlth alterations or additions Front Depth Height .... Dimensions of entire new construction Front Height . . . Number of Stones Size of lot Front Date of Purchase ~Z ~ 7. · ~D.. Rear ...... Depth .. Rear .... Number of Stones .......... ·. Rear .... Depth Rear ........ .. Depth ....... Name of Former Owne~:~;~4..~t-J4~. '/':/'~a~,~-e ~.'.~ Zone or use district m which premises are situated .................. Does proposed construction violate any zoning law, ordinance or regulation ,~ ............... Will lot be regraded ............. Will excess fill be removed from premises Yes No Name of Owner of premises ....... Address ......... Phone No .......... Name of Architect ..... Address ..... Phone No ..... Name of Contractor ........... Address .... Phone No ......... Is thzs property located wzthin 300 feet of a tzdal wetland? *Yes ..... No ;¢If yes, Southold Town Trustees Perm~.t mavhe required. PLOT DIAGRAM t.ocate clearly and distinctly ~dl buildings, whether existing or proposed, and ~ndlcate ail set-back dnmenslons from ~erty lines G~ve street and block number or descnptlon accordmg~o deed, and show street names and indicate whether uor or corner lot ~.3 OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY , ~APPRQV£D AS NOTED NOTIFY ~ff_IILDING DEPAR~E~T AT 765-1802 9 AM TO 4 P~ FOR ~E FOLLOWING IN~ECTIONS- ~. FOUNDATION - ~O REQUIRED FOR POURED CONCR~E ROUGH - F~MING & PLUMBING 3. INSU~TtON 4. FINAL - CONSTqUCTION MUST BE C~M9L~E FOR C O ALL CONSTRUCTION SHALL MEET THE REQLJIREME~S OF THE N Y ~ATE CONSTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRO~ TE OF NE'~}' YORK, [NTY OF ~ S S .... x..?c0 ~9 ,cf.. ~'.. ~ ~.~A~C# ~"/~-L-~., being duly sworn, deposes and says that he ~s the ~pplicant (Name of md~vldual mgmng contract) , ,e nmed .the ........ ~ .......................... ~--~. '-e}~ .... (Contractor, agent, corporate ofhcer, etc ) ~,d owner o~ ownem, ~d ~s duly authomea to perform or have perfo~ed the sa,d work and ~cat,on, that an statements contmed m th~s apphcat,on are true to the ~est of h~s ~owledg%a~ b~~at the ~ wall be perfomed m the m~ner set forth m the apphcatmn filed therewith. rn to before me thru .C~t4 ....... dayof . ~gnature of al~l}llCan't3 ,?