HomeMy WebLinkAbout14998-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. z14771 Date August 6, 19 86
THIS CERTIFIES that the building deck addition
LocnflnnnfPrnn~rfv 4~0 Haywaters Road Cutchogue, New York
House No. 111 Strefft 3 Hamlet
County Tax Map No. 1000 Section ............ Block ............... Lot .................
S ..... M/o Nassau Pt. Club Prop
uomv~s,on .............................. :Filed Map No. ! .5.6 ..... Lot No..2.7..0..&..2..7.~..
conforms substantially to the Application for Building Permit heretofore fried in this office dated
·.. J. ~.n.e..6, .......... , 198..6. pursuant to which Building Permit No ..... ~..~.9.9.8. z. ..........
dated June 20, 86
........ ~..~ .................. 19..., 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
The certificate is issued to C ar o le S imk in
towner, ~'~ir~.ic'x'
of the aforesaid building.
Suffolk County Depa~ment of Health Approval N / A
UNDERWRITERS CERTIFICATE NO. N/A
Building Inspector
ffORM NO. ·
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
14998 Z
Date .........~ ............................... , .......
Permission is hereby granted to'
· ..~ ~....~.~.Z....~-? ...........
.................................. ; ......... . .................... -..;..
_,,., ...... ! ...........................
at premises located at ....~..~...D.......~....~...~....1~....~ ......... ~~....'~¢~,~,~ .............
County Tax Mop No. 1000 Section ....... I..I..! ........... Block ........ .(~....~...... Lot No ........ ..~'-.....~. .......
pursuant to application dated ..... ~.~ .......................... , 19~....~.., and approved by
the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
BLDG. DEPT
TOWN Of ~? iT~-~C
Instructions
This application must be filled in typewriter OR ink, and submitted m~ 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p=opert¥ 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
5. Updated C.O. $15.00
$15.00
Date ..........................
NewCons truc tion ...... Old or Pre-existing Building ............ Vacant Land .. ~ .....
Location of Property .... ~. .......... ~ .... ~
Hou,~e No. V Street Hamlet
Owner or Owners of Property . .~ ..... .~-~-~ .................................
County Tax Map No. 1000 Section ... ~.// Block ~'~ Lot ~
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No../.~-~.~.~..~.~ Date of Permit..(~/~.~.~=~oplicant
f
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 pe~m~jt meets all _app~L~ble co, de.s and ragu lations.
Rev. 10-10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
January 13, 1987
TEL. 765-1802
Re: Carole Simkin
To Whom This May Concern,
We are unable to complete your Certificate of Occupancy because
of the following reasons.
( )An application for Certificate of Occupancy is not on file.
( )No Underwriters Certificate on file.
( w/)The check is (*__iJ_L_~/not on file.)
( )No Health Department Approval on file.
( )No final inspection has been made.
.Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # ~ ~ ~ ~ ~ Z
)No Plumber Solder Certificate on file.
(all permits involving plumbing being issued after
April 1, 1984)
Mr. Paul Debany
65 Cambridge Ave.
Garden City, N.Y.
11530
TOWN OF SOUTHOLD
OFFICE OF BUILDING IN~PECrOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
August 13, 1986
TEL. 765-1802
Re: Carole Simkin
TO Whom This May Cohcern,
We are unable bo complete your Certificate
of Occupancy because ,of the following reasons.
/_-/
is not on file.
/_--/ No Underwriters Certificate on file.
~_~/ The check is~m~da~d/not on file.)
/-/ No Health Dept. Approval on file.
/--_/ No final inspection has been made.
An application for Certificate of Occupancy
$5.00
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # J_ ~ ~ ~ I Z
Building Dept.
***/Z/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
FOUNDATION (1st}
FOUNDATION (2nd)
ROUGH FRAME &
FLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
~ c.~
ADDITIONAL COMMENTS:
BUILDING DEPT.
INSPECTION
[ ~ FOUNDATION 1ST I' ] ROUGH PLBG.
[ '1 FOUNDATION 2ND [ '1 INSULATION
[ ] FRAMING ... [ ] FINAL
DATE_~INSPECTOR
5URV~Y~U
51TU~TE ,qT
~SS~U POinT
T~V)4 ~F SOUl,OLD, ~,Y.
LO',
Z71
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL,: 765-180:2
Examined..~...,~......~°....,19
Approved. '7 44~q-~-. ~ .... 19~..G. Permit No../.~. ~ ?.g...~:::..
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received ........... ,19;..
Date ...6/.6 ............. , 19.86.
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 wtfich 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 necessary inspecti~,/¢,~.. ~.
(Signature of applicant, or name, if a
. .. ........ .
.
(mailing addre~'~ of app.l~c,ant) ,
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumoer or ouiloer.
OWNER CAROL F. SIM~IN
Name of owner of premises CAROL F. SlIqKIN
(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 r~.(~
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..... ~A. 8. 8. A.U..?.QI.$T . .I-~..'~..A. TSR. $ .R.O..AI~.. TO!gI~. QI~. SQUTH. QI~D.
:
............. /~0. .................. .~4~.4I.~.t~ .I~Q .~. ................. I~4s.s. Aq .~qlIq'l: ................
House Number Street Hamlet
County Tax Map No. 1000 Section .... '~':~'~:"~..\\I .... Block ...... .~. .......... Lo~..~ ........
Subdivision ~t~O~'IU ~.±.. ~[t)~ ?.t'p(Q .~'~.~.~.. Filed Map No .... 156 ........ Lot .27.!. .27.0 .......
............. ' '
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:OUT DOOR
DECK IN FRONT OF HOUSE
a. Existing use and occupancy $]~.C.OlqD. I~LOI~E ....... .C~.~...~.(~.t..~,..~. ~l~J~. ¢~ ..........
.....
b. Intended use and occupancy ... DII.TI)DDR..ElqJD~.T. ~J~.~...~.~>...'1~. ~.(~..h4 ...................
3. i~ applicable): New Building .......... Addition . .&I'.P.I.C.Ab.L.E Alteration ..........
Repair ~'~' h~m°val~. .............. Demolition .............. Other Work ............... (Description)
, ' .............................. .... . ...... . .... '. ...............
I ~aC~,~,'..:j;~ :.i \ · -, ~ tto be prod on filing th~s application)
5. It'd v , n n her o[dwening units ............... Number of dwelling units on each floor .....
If garage, number of cars ........................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front .. ~pp3Xcab2~ .. Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front . .3.2..f.e.e.t ....... Rear . .3.7.~.e.e.t ........Depth . .2.7..f.e.e.t .......
Height 3...5. . .f.e.e.t ...... Number of Stories ........................................................
9. Size of lot: Front ...................... Rear ...................... Depth ..................... :
10. Date of Purchase .1084 ......................... Name of Former Owner ..... lq~... ~x~Ir_.4~ ............
l 1. Zone or use district in which premises are situated...TOIg~ g~. S~IJXI~I~OLD ..................................
12. Does proposed construction violate any zoning law, ordinance or regulation: . RO .............................
13. Will lot be regraded .. ~ ........................ Will excess fill be removed from premises: Yes 1~
14. Name of Owner of premises . .C.g&O~ .F... $.EgKIR... Address .6.6.0...t~k.Y34..A.T.E.R.S. gO. AD.. Phone No..7.3.4..5.9.7.4 .......
Name of Architect ........................... Address ................... Phone No ................
Name of Contractor ??~.~..t).~.B..~r/ ............... Address .6.5..C..~I.B?.~.I).~.E. ?.V?... Phone No. 3.5.6..5.6~.7 ........
15. ts this property located w±thin 1.00 feet of a ti_da1 wetland? * Yes ..... ~qo PP...
~ tf yes, Southold To~ ~rustees Perra±t may be requ±red.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or comer lot.
COUNTySTATE OF NEW~ yOKrK~ ~i ~~ *~ ~ ~''
..... 'g~"' ~' '~<z: ·~ -~13ei~§ duly sworn, deposes ~d says that he is the applicant
(Name of individual si~g contrac~
above named.
He is the ....... ~ .... ~~
(Con.actor, agent, co.orate ~e~. ~tc ) x '
of said owner or owne~, ~d is duly authored to perfom or have peffomed the said work and to m~e ~d ~e ~s
application; that fll statements conta~ed ~ this application are true to the best of his ~owledge and belief; ~d that the
work w~l be perfomed in the m~ner set for~ ~ the application filed therewith.
Sworn to before me this
.............. .... ....... ,
Nota~ Public,~ A ~;~.. ~ q[~ 3. ~ ......... County
~--~' ~7~. ~ CounW o~ (Signature of ~t)
~ommi$si~n E~ir~$, Jul~ 31,