The URL can be used to link to this page

Home My WebLink About2668-zFORM NO. 4 Town OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDA'£~ CERTIFICATE OF OCCUPANCY No Z-23441 Date JANUARY 4,1994 THIS CERTIFIES that the building Location of Propert~ 155 PINEWOOD ROAD House No. County Tax Map No. 1000 Section 110 Subdivision NEW DWELLING CUTCEOGUE, N. Y. Street Hamlet Block 3 Lot 2 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 13~ 1965 pursuant to which Building Permit No. Z2668 dated MARCH 13, 1965 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 ONE FAMILY DWELLING WITH ATTAcH~D GARAGE & ROOF OVER BRICK & CONCRETE TERRACE IN FRONT * The certificate is issued to of the aforesaid building. (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL SEPT. 13, 1965-R. VIT3.% UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *NOTE: THIS UPDATES CO Z-2231 ISSUED ON SEPT. 15, 1965 - / B~in~ fn~c~or Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the build,ng located at .... ..~./~..~.n...e..~...o..o..5.....R...o..a..d.. ........................ Street Map No ..... .~;Y~ .......... Block No ......... ~ ...... Lot No..~¢X.X .......¢.~c~o~l.e.~ ..... ~.,.~., .............. conforms substanhally to the Applicahon for Budding Permit heretofore filed in th~s office dated .................................... ~.~.C.h.....l~ ..... , 19.6~... pursuant to which Building Perm,t No. 7~..~.~.~.~.. dated .............................. M~.~.ch.....]..~ ..... , 19..6.~'.., was issued, end conforms to all of the requ,rements of the applicable provisions of the law. The occupancy for whmh thru certificate is issued ~s ........ ,P...r. $~ ~.t..e....Q~e... ~'.~ .~.$..z.z...cb~ .e..~L.~,iU ~ .............................................................................................. The certificate is issued to ..~.9.l~.~Z'.d...F~.i.a~alo. .................. 0I¢~1.~z'. .............................................. (owner, lessee or tenant) of the aforesaid building. Sept. 13~ 196~ H.D.Approval bt R. Villa Building Inspectc~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2668 z Permission is hereby granted to: .................. ~~...~.'....~.~ ............... ................ ~'~,~..J~.t~...Jin~.e..~. .................... to ...~tI~..tmw.. ~me.. ~ ~...awell&~ .................................................................................. at premises located at ...~eJL...~..Jl[OO~ .~01~1[ .......................................................................... ........................................... ~e~.. ~e.e~ .......... ~,'~I~1[~ ......................................................... pursuant to application dated ................................ J~II~J~:L ...~ ....... 19.~'.., and approved by the Building Inspector Fee $.-.10.00 ........ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 Bo APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/t0 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate'of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date I' ~-~ New Construction ........... Old Or Pre-existing Building../ Location of Property. House No. Street Hamlet Onwer or Owners of Property.. ~o~ ~v~ County Tax Map No 1000, Section. ~ Block.. ~ .Lot ~ Subdivision .................................... Filed Map ............ Lot ...................... Permit No..~.~.~.....Date Of Permit ................ Applicant. W~'~' ~o~-- Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: Sf~ .......................... ~~...~ ...................... KRAUSE LAND SURVEYORS HEINZB.~RAUSE ARTHUR HERMANN MAPOF ~0~ N.Y.S, LIC, 377Zl " / / ~ e~ ~o~o&~ P. O, BOX IIZ. 7B~ OLD COUNTRY ROAO SITUATED AT - ~s~.]~.o~ ' ~ / · ' FOR~ NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, " Approved ............... .................. , 19 ........ Permit N ............................. Application mo ............................. DisapF roved a/c .............................................................................................. (Building InspeCtor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 propertymust be drawn on the diagram which is part of this application." 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 issue a Building Permit to the applicant. Such~1 permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port i~or 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 o Building Permit pursuant to the. 'Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances er Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described'. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. ....s..~p..~.o..~...cl...~.,...~.~,.em~z~ .................................. ~ ............ (Signature of applicant, or name, if a corporation) ...... ~'i~]'e'" ~q'~ *'"QD'Q ~'e'"D'aT'"" S'o~thc~l~ ....................... (Address of applicant) ..~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... awn~....-...Bm%ld~r ................................................................................................... i?~ ................... Name of owner of premises ....San£~d...~..~m~nz~ .......................................................................................................... If applicant is a corporate, signature of duly authorized officer. me and title of corporate officer) Location of land on which proposed work will be done. Map No: ................ X,~7~ .................. Lot No~ ........ 7h~r~ ..... Street and Number .~.S.....gzLr~..l~.oc~...~oa~t...~.].e~t~..~T~ck~..Cuzl~c~-~o~e ....................... i ...................... Municipality State existing use and occupancy of premises and intended use and o~cupancy of i~oposed construction: ~ a. Existing use and occupancy ..... .Y~f~.a:D.~...]~.t3~. ................................................................................................... ' b. Intended use and occupancy .QD.e..~.~.'~...~.W~.]..~r~. ..........................................' ........................................ ' 3. Nature of work (check which applicable): New Building ..g.¥~ ......... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...011.e. ................. Number of dwelling units on each floor ............................ If garage, number of cars ....... ~l~.O....~tZ'.1~ ................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~ ............................... 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 .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of enti~re new construction: Front ...... ~?.Q ................. Rear ....... ~1~ ............... Depth ~,.c2/...~.7 ............. Height ............................ Number of Stories .DJ~f~ .................... 9. Size of lot: Front ........ ~.QO. ............. Rear ....... .],QO. .............. Depth ....]-.2.~...~./..~. .......... 10. Date of Purchase ......... ~e.p:~..~9.~2. ......................... Name of Former Owner ......... ~J.e~.~..1~..~.t~. .................. 11. Zone .or use district in which premises ore s~tuated ........ ~......c1..~..~.~. ....................................................................... 12. Does'proposed construction violate any zoning law, ordinance or regulation? ........... .3.~ ..................................... Name of Contractor ....... 1~1~ ................................. Address ............................................ I)hooe No ..................... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, } COUNTY OF r.'~'~f°Olk ............. { S.S. .................. ~.~J~.Q~.....~'.i~:~. ...................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) ! above named. He is the ..........Ch~z~e=...,...b=~.3~le~. ............................................................................................................ (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 manner set forth in the application filed therewith. Sworn to before me this // ]'3 day of ,r,,..~ ~.Z'.C~ ........ , 19..65' .... z / ,~ Z~ ~ · ...................... · l.: . ........................................ I, ' '¢.~. ~. ~liO.~ ~ , S~e~ ~" (Signature of app 'cant) Notary Pub 'c, ,;'~/f; ~ ...... '...~.: ... ik.l~,, ~1,~,, a, '