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Home My WebLink About16864-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Butlding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No zl68~8 Date ...~[~. 26, 1988 THIS CERTIFIES that the bmldmg . A.! t.e.r.a.r.i.o.n. ........................... Location of Property 1960 Mill Lane, Peconzc H3usk 'ato .................. 'S'v~i ................. hi~m/e~ County Tax Map No 1000 Section 0 6 7 . .Block 0 7 .Lot I I Sub&wsion .................. Filed Map No ....... Lot No ............. conforms substantmlly to the Apphcat[on for Bufldxng Permit heretofore filed In this office dated March 25, 1988 pursuant to which Bmldmg Permit No. 16864z dated ~. a .r c.h...2 .9.,.. ! 9 .8.8. ...... was msued, and conforms to att of the requirements of the apphcable provisions of the law The occupancy for winch tins cerhficate m msued ~s ..... Install a sl~dxng door ~n an ex,sting one family dwellzng. The certificate is issued to VERA & HATTHEW CUSUHANO ............... ?&,.e;', aO~i~ .................. of the aforesaid budding Suffolk County Department of Health Approval ~ / ~ UNDERWRITERS CERTIFICATE NO. U/A PLUMBERS CERTIFICATION DATED: Building Inspector Rmv 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 16864 z Permission is hereby granted to: ~,.;.....~?...~.,.~.. ..~..~....~....~~.~ .... .~%~..,;~...t.~.,~.a,,q ......... ,o.~....~..~..~...~...~...~.~~. ~..~...,~-~~..y~....: ............................................................... :, ,,,~= ,~& ~, ..~..~.~.L~.~..g~, .;' 8~L ........................................... County Tox Map No 1000 Section .(~.gZ.-14 ...... Block ...... .~X..-} ....... Lot No ... )! ........ Budding Inspector. Fee $...~.~....'...~ . .... 19.~..~.., and approved by the Building Inspector Rev 6/30/80 FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~FINAL REMARKS: 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST ROUGH PLBG. [_ J FOUNDATION 2ND [. ].~JLATION I* ] FRAMING [/.,~ FINAL REMARKS~: DATE FORM NO 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thru application must be filled in typewmter OR ink, and submitted ~ m,,--.,--., to the Building Inspec- tor w~th the following; for new braidings or new use: 1. Final survey of property w~th accurate location of all buddings, property lines, streets, and unusual natural or topographic featu res. 2.F~nal approval of Health Dept of water supply and sewerage disposal--(S-9 form or equal). 3.Approval of electrical mstallatton from Board of Fire Underwriters. 4. Commercml buddings, Industrml buildings, MulBple Residences and similar buildings and installa- tions, a cert~hcate of Code compliance from the Architect or Engineer responsible for the budding. B.Submit Planning Board approval of completed rote plan reqmrements where applicable. B. For existing buddings (pmor to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topograph lc features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of bu ddings. 3. Date of any houmng code or safety inspection of buddings or premises, or other pertinent Informa- tion reqmred to prepare a certificate. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 l. Cert~f~cateofoccupanc¥ New Dwellzng $25.00, Accessory ,$I0.00 Business $50.00 2. Certificate of occupancy on pre-exist~ng dwelling $ 50.00 3. Copy of certlficate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ......................... New Cons t ruc % z on Old or Pre-ex~stmg Budding Vacant Land Location of ProperW ,..~.~[~ ........................................ House No Street Ham/et Owner or Owners of Property ...~.~.C..~..~..~ .~..~.[Bj~o... ,~...L~..U...h~C...c,M~.' ..................... · o..7 II County/ax Map No. 1000 Section ............. Block ........... Lot .............. Subd~wsion ......................... Fded Map No .......... Lot No ............. Perm,tNo, ................ ~(°(~(~.~ DateofPermlt~12~l(~<~ Applicant ......... ........................ Health Dept Approval ...................... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ................... F~nal Certificate ...................... Fee Submitted $.. -~-.~: ~ ................. Construct,on on above descr,bed building an;ym,t meet~,axp~pl,c_a_bt~ cod~s and regulat,ons Rev 10-10 78 (,6, z/4t/f Approved ~. Disapproved a/c ?~OUTHOLD, N Y. 11971 TEL . 765-1802 ,19~~ BOARD OF HEALTH ...... 3 SETS OF FLANS ....... FORM NO 1 SURVEY .......... /OWN OF SOUTHOLD CHECK -~- ........ BUILDING DEPARTMENT SEPTIC FORM MAIL TO' (Buddzng Inspector) APPLICATION FOR BUILDING PERMIT Date--~~7~2~ °¢~--., 19 .? INSTRUCTIONS a. This application must be completely filled in by typewriter or ~n ink and submitted to the Bmldmg Inspector, vath sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showrng Iocatlon of lot and of braidings on premises, relationship to adjoining premmes or pubhc stree~ or areas, and gxvmg a detmled descnphon of layout of property must be drawn on the diagram whmh ~s part of th~s appl cation. c The work covered by this apphcat~on may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssued a Building Pen-ntt to the apphcant Such perm shall be kept on the premmes available for mspechon throughout the work e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc · shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the isrpuance of a Buildin~ Permit pursuant to th Bmlding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other a, pphcable Laws, Ordinances c Regulations, for the constructmn of bmldmgs, addihons or alterahons, or for removal or demohtmn, as hereto describe, The apphcant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and m bmldmg for~necessary mspectmxns /"x ~ (Signature of apphcant, or name, ff a corporation) (Ma~hng address of apphcant) State whether appbcant ~s owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or builder Name of owner o f premisest~,~q~~ ~ .. (as on the tax roll or latest deed) If apphcant m a corporaBon, signature of duly authorized officer (Name and htle of corporate officer) Builder's L~cense No . . . Plumber's License No Electrician's License No Other Trade's L~cense No Location of land on which proposed work will be done House Number Street County Tax Map No I 000 Section Subdiv~mon ~ Q ~. (Name) Hamlet Block.. r-~ .... Lot.. .... Fried Map No .. Lot State exlsnng use and occupancy of premises and intended use and occupancy of proposed construction Existing use and occupancy ~o ~-2r( .q... . ~v..~¢.'-~ ,,~:-; ,,.~,,.~,~ ~ ....... b Intended use ~d occupancy ,~ .............. t: ~ 3. Nature of work (check which applicable) New BmI&ng Addition .... Alteration Repmr .... Removal ....... Demolition ........ Other Work ........ (Descnp.tmn) 4 Estxmated Cost. .~ .......... Fee ........................ · (to be prod on filing this apphcation) 5. If dwelling, number of dwelling units .... ]'. .... Number of dwelling units on each floor ........... If garage, number of cars ........................................ 6 If business, commercial or maxed occupancy, specify nature and extent of each type of use ............. 7. DxmenslonS, 0I~k~stingstructures, lfany'~ Front .... Rear ........ Depth . . Height .' :. J . . . NumbeFofStones ...................... Dn~ensiofi~s of sa.~t~ure v~th alterations or addltmns Front ..... Rear ............ Depth . . . : ....... Height ........ Number of Stones .... 8. Danensmn~_of_~entjre new constructmn Front ......... Rear ........ Depth .. Height ........ Number of Stones . 9 S~ze of lot Front ........ Rear ........ Depth .......... 10 Date of Purchase ........... Name of Former Owner ................. 1 I. Zone or use d~stnct in which premises are situated .... 12 Does proposed construction violate any zoning law, ordinance or regulation 13 WIll lot be regraded ................. Will excess fill be removed from premmes- Yes No 14 Name of Owner of premises ....... Address ........... Phone No .......... Name of Architect ............. Address .....· .. . Phone No ...... Name of Contractor ~-.%~t:~. ~..(~.-'. ~.~22. Address ~/'c~()¢.c~ ~,~,ql.~a:~. Phone No. 15. Is this property located wzthzn 300 feet of a tidal wetland?' *Yes .~r~... No ..... *If yes, Southold To~n Trustees Permzt may be requzred. PLOW DIAGRAM Locate clearly and d~stlnctly all buildings, whether exlstmg or proposed, and ~n&cate all set-back d~mensmns from property b. nes G~ve street and block number or description according to deed, and show street names and indicate whether Inte"°r °06 ANCY OR USE 15 UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANOY ~ APPROVEO ~S NOT[D NOTI~ BUILD~N¢ · ~r 1802 9 FOL[ OWING INSPFCTION~: STAT~ OF NEW ~ ~ FOR POURED ~.ONCRE ROUGH FRAMING & PLUMBING COU~Y OF..~~ ~ ~ & INSU[~ ~O~t~ ./ ~ ~ ~ ~ being duly sworn, d~o,~ ~t~t~:~'~ ~ant (Name of individual s~gmng contract) BE C0~¢~ ~TE ~[)~ C.O above named ALL CO~ST~OCTIO~ THE REOUI~MEDTS O~ rile He zs thc .. ~~ ..... STATE COiNS~RUC ttO~ & ENERGY (Contractor, ~tGN OR CONS~RUCTION ERRO~ of smd owne~ o: owncm, ~d zs duly authored to perform or h~ve perforated ~e said work and to m~e ~d file t~s apphc=bon, that ail statements continued m ~zs apphcatzon are true to the best ofhzs ~nowledgc and bchcf, and that thc work wffl be peffo~ed ~ thc m~ne~ set fo~ m the agghc=tJon filed the~cwtt~. Sworn to before mc t~zs . ~ .......... .... ~, ~N~Y~ , ~ ...... N* ~ ~ cant e~med m Su~m CounW ~ ~. ~ (S~ature of apph Comm{~mn Exp{res D~ember 8 19~