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Home My WebLink About16921-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building . .C.O.N.S.T.R.U.C.T..D.E.C.K..A,D,D.t,T,?.~ ....................... Location of Property ... 1.9.5. .O.a.k.w. qqd..D.r.}v.e. ......... 8. qu.t.h.o. 1. d. ,..N.e?..Y.o.r.k. ................ House No. Street Hamlet County Tax Map No. 1000 Section . .7.0. ........ Block 13 ..... Lot 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 7, 1988 pursuant to which Building Permit No. 16921 Z. . dated Apr il 25; 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 AS APPLIED FOR The certificate is issued to STEPHEN & DANIELLE CISEK ..................... ..................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ..... N/A N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 FORM NO. ~ TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, hi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~- 1 6721 Z Date .................................................... , 19 ~' Count,/ Tox Map No. 1000 Section ........... ,~.,,~., ...... Block ......... ,/,,~,~, .... Lot No .............. ~ .... pursuant to application dated ....... .~.../~ ................................... , 19..~....~.~ and approved by the Building Inspector, Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southoid, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter 0 R 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 pz: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 $25.0.0, Accessory ;$I0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50-. 00 3. Cop'/ of certificate of occup~ncy $ 5.00, over 5 years $]0.00 4.Vaoant ,and C.O. 20.00 5.Updated C.O./ $ 50.00 Date ..~.~L..~...~.,.J ...... NewCOnstrucl;ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location ofProperty .../.~.~. ........ (~.~(~.'~. ~ QL/ ~.f~J .L~.'. ~UL~O'~_~) House No. Street Ham/et County Tax Map No. 1000 Section .... .9.0. ....... Block .... !3 ......... Lot .... ~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit ,o..L(~..~..J.~.. Date of Permit ........ Applicant .~.%.J17..~.C.~..~..'..~.../~. !!~.~.~... ? Health Dept Approval Labor Dept Approval ' . ..~.... Underwriters Approval '..-'77 ' Planning Board Approval Request for Temporary Certificate ................... · .Final Certificate . .. ..~..... ......... .. . Fee Submitted $ ............................ Construction on above described bu ilding and permit meets all ~l~7.~_~d~s ~nd regulations' Applicant . .~..~...c~.. A-~ '/.~.~. ~/..~..- ........ Rev. 10-10-78 -! 0 FORM NO. 1 TOWN OF SOUTHOLD l ~ EUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y, 11971 TEL,: 765-1803 Examined ...~.~ .......... 19 .~..~ ........ Disapproved a/c ..................................... (Building~ll~pector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTHt-r*r'' 3 SETS OF PLANS ~f~."-- SOEVE¥ ....~.... CHECK ......... NOTIFY CALL ................ MAIL TO: 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 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, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa~ inspectio,~s. .O-51,.,n . .<-. e ........ (Signature of applicant, or name, if a corporation) ../. ................. .o.. o..~../.. ~ .o. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .<~ec&t.... .. .... ~oO-k'oe_.fo r-"...... Name of owner of premises...~..~./? h(°.~e...('.'~...d~....~..O-..~.l~,_./[ ~.....~./.J~/..~.. ........................... (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 MUST BE SUFFOLK COUNTY LICENSED Builder's License No.. './-~. ,~ ................. Plumber's License No.. ~ ........... Electrician's License No. ~ ............... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ............. .... .......... ................. House Number Street Hamlet County Tax Map No. 1000 Section .... .0..~. ,Q ........ Block /'~ ..... Lot. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' ......... a. Existing use and occupancy .O. 07.. O31. . ;.,.~.(At~. b. Intended use and occupancy d;e.-~d.C. O~(f_~f} .... ..................................... Nature of work (check which applicable): New Building ' Addition . Repair .............. Removal .............. Demolition .......... 4.' Estimated Cost ~ ~ (~. . : 6-40 ! (to be 5. If dwelling, number of dwelling units ............... Number of dwelling uni' If garage number of cars 6. If business, commercial or mixedI occupancy, specify nature and ext4nt of each type of use ..................... 7. Dimensions of existing structureS, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions'of same structure wilh alterations or additions: Front ................. Rear .................. Depth .................... ~. Height ...................... Number of Stories ...................... -' 8 Dimensions of entire new constrUction: Front ' Rear Depth Height ............... Numbe/' of Stories ............. t ............................. 9. Size of lot Front ..... /.~.0.,.9.~ ......... Rear /O 0 . D~nth 10. Date of Purchase ....... q~. i ................. i}lame of Former Owner . . 11. Zone or use district in which premises are situated .... ~.r! .............................................. 12. Does proposed construction viol0te any zoning law, ordinance or regulation: ..0;.O ........................... 13. Will lot be regraded ....... D. ~ ................... Will excess fill be r~nlgged from premises: Yes N~ 14. Name of Owner of premises t~..D~..~14 e,l¢~ ......... Address ..... Phone No ............. - . "' Name of Architect ..~. ....... ~ · · ~ ............. Address ..................... Phq$e bJo ................ Name of Contractor :OObA [~...e~,.nl ...... Address /~'O.'t~ ./'~(' .~f~ ~o. 15. Is this property located ~ithin 300 feet of a tidal wetland? *Yes ..... No .'.~.. · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Gwe street and block number or description according to deed, and show street names and ~ndmate whether interior or corner lot. STATE OF NEW YORK. ¢oumY OF... .K. .............. '.~..~). ~.t*~/. '. 'F'~.'O~'. ~-i~-. ~.'" ~'~ -~" ........... being duly sworn, deposes and 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 dul~ 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 manner~set forth in the application filed therewith. Sworn to before me this ;HELEN IL DE VOE NOTARYiPUI~L C, State o~ New Yed~ No, ~707878, Sufft4k Term Expires i~ml~ · ~. . ~ .......... 19~ .............. County (Signature of applicant) 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST l- ] ROUGH PLBG. [ J FOUNDATION 2ND [ ]/~/SULATION [ ] FRAMING ~ FINAL REMARKS: DATE INSPECTOR DUNDATION ( 2nd ) 0UGH FRAME & .FLUMBING ;SULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 77-5 ........................ p D AINOT[D BY:. 76E-1802 9 AM TO 4 PM FOR 'rile FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POUREO CONCRE'~ 2. ROUGH - FRAMING & PLOMIBING 3. INSULATION 4, FINAL - CONSTRUCTION MUST RE cOMPLETE FOR C O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE NY STATE CONSTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR r)Ee, I~N OR CONSTRUCTION ERRORS APPROVEO BY